ICU Portfolio:

STATUS EPILEPSY
PATIENT NAME A. HAMEED
AGE 23 YEARS
GENDRE MALE
WARD M-5
D.O.A 01-01-23

MEDICAL DIAGNOSIS : STATUS EPILEPSY

PHYSIOTHERAPY DIAGNOSIS : DISTURBANCE OF NEURAL ACTIVITY
THAT CAUSES ABNORMAL MUSCLE CONTRACTIONS.

SOCIAL AND MEDICAL OUTLINE : According to pati ent att endant he was
alright 3 days back then he developed fi ts which was tonic-clonic in nature (4
episodes per day) + drooling from mouth + up rolling of eyeballs + urinary
inconti nence with no history of Fever. Pati ent’s att endants give history of Altered
loss of Consciousness for 2 days, which was occur aft er fi ts. Initi ally pati ent was
drowsy but able to talk and oriented to ti me, place, and person aft er that he
become unconscious. On 1 s t January he got fever in then pati ents family rushed to
ER. Now he was on venti latory support (SIMV MODE) with GCS 10/10.
PAST MEDICAL AND SURGICAL HISTORY : No history of hospital stays but
multi ple ti mes visit clinics for fi ts and appendectomy procedure was done in
childhood and he has past medical history of seizures past 8 years.

MEDICATIONS:

Inj. Dormicum (IV) 5mg/5ml

Inj. Provas (IV)
Inj. Risek 40mg
Inj. Meropenem (IV) 1g
Inj. Lerace 500mg/5ml
Inj. Epivel 500mg (IV)
Inj.Neurobion 100mg (IV)
Tab. Folic acid
Tab. Dalsan
NG Feed = Ensure (4 scope in 150ml water x6)
Syrup HepaMerz

INVESTIGATION:

OBJECTIVE ASSESSMENT:

VITALS:

Blood pressure: 108/61 mmHg

Heart rate: 140 beat per mint

Respiratory rate: 20 breaths per mint

Temperature: A/F

Saturation: 98%

SUBVITALS:

Anemia: Negative

Edema: Positive

Clubbing: Negative

Cyanosis: Negative

Jaundice: Negative
Jugular venous pressure: Negative

Lymph nodes: Negative

GLASGOW COMA SCALE : 3/15 at the ti me when he came to ER

SYSTEMIC REVIEW:

RESPIRATORY SYSTEM:

I: On Inspection, patient was conscious. His extremities were warm with no sign of clubbing. No
chest deformity was found.

Patient’s respiratory rate was 26 breaths per mint. Abdomin-thoracic breathing pattern was
found. Oxygen saturation (SpO2) level was 98%.

P: On Palpation, patient’s chest expansion was normal. There was no tracheal shift, tactile vocal
fremitus was resonant. Capillary refill was normal: less than 3 sec

P: On Percussion, he had dull percussion in lower lobes of right and left lungs.

A: on auscultation inspiratory crackles were heard on both sides of lungs.

INTEGUMENTARY SYSTEM: Patient had warm, mild pale skin, with no clubbing and no pressure
sores was found.

CARDIOVASCULAR SYSTEM: He is tachycardiac, his skin was warm, and edema

was present on his extremiti es

NEUROLOGICAL SYSTEM : the pati ent was unconscious because he was sedate.
He frequently disoriented but he follows my command when he wake up.

PAIN:

BIOCHEMISTRY AND HEMATOLOGY:

HEMOGLOBIN 11.5 (g/dL)

TOTAL LEUCOCYTES COUNT 11.7 x 109/L

PLATELETES TEST 11.1s
POTASSIUM 4.0 (mmol/L)
SODIUM 143
CHLORINE 104
BLOOD UREA NITROGEN 11
 CREATININE BLOOD TEST 0.5

PROBLEM LIST:

FUNCTIONAL LIMITATIONS:

Shortness of breath. 

Decrease lung compliance. 

Unable to breath without mask or ventilation.

Difficulty in expectoration.

Decrease muscle strength in upper and lower limbs.

SHORT TERM GOALS:

To clear chest sputum.

To stabilize patient hemodynamically.

To regain muscle power and strength from grade 2 to 3

LONG TERM GOALS:

To increase lung compliance.

To learn patient about Active cycle of breathing technique (ACBT).

To mobilize patient from bed to chair and chair to walk.

TREATMENT:

SESSION 1:
S: 23 years old male patient, named Abdul Hameed was admitted in Medical intensive care
unit (MICU) Civil Hospital Karachi. Due to known case of epilepsy with complaint of ALOC., fits,
fever, dizziness. This condition is because of stop to taking his antiepileptic medicine, now he
was on the Ventilator (SIMV MODE).

O: Patient was unconscious. Skin was warm with no sign of clubbing.

VITALS:

Blood pressure: 127/86mmHg

Heart rate: 106 beat per mint

Respiratory rate: 21 breaths per mint

Temperature: A/F

Saturation: 98%

CHEST X-RAY: consolidation present on lower sides of both lungs

SPUTUM: yes, white in color with thick consistency.

SPO2: 98 %

LAB FINDINS:

Hb: 11.5 (g/dL)

Leukocytes: 11.7x 109/L
Platelets: 130,000

Rx:

 Percussion, manual suctioning technique to mobilize and dislodge the secretions and to
aid in expectorations.
 Positioning to decrease the work of breathing.
 Postural drainage to drain the sputum from the bronchial airways and to improve the
airway clearance.
 Bed Mobility to prevent the bed sores.
 Stockings to prevent from the Edema.
 Passive range of motion exercises to maintain blood flow and muscle strength in upper
and lower limbs.

SESSION 2:

Rx:

 Percussion, manual suctioning technique to mobilize and dislodge the secretions and to
aid in expectorations.
 Positioning to decrease the work of breathing.
 Postural drainage to drain the sputum from the bronchial airways and to improve the
airway clearance.
 Bed Mobility to prevent the bed sores.
  Stockings to prevent the Edema.
 Passive range of motion exercises to maintain blood flow and muscle strength in upper
and lower limbs.
 PROM exercises of upper and lower limbs bilaterally.

SESSION 3:

Rx:

 Percussion, manual suctioning technique to mobilize and dislodge the secretions and to
aid in expectorations.
 Positioning to decrease the work of breathing.
 Postural drainage to drain the sputum from the bronchial airways and to improve the
airway clearance.
 Bed Mobility to prevent the bed sores.
 Stockings to prevent the Edema.
 Passive range of motion exercises to maintain blood flow and muscle strength in upper
and lower limbs.
 PROM exercises of upper and lower limbs bilaterally.

A:

 On 3rd session treatment for status epilepsy.

 Reduced shortness of breath.
 Oxygen saturations 98% on air, respiratory rate 21

OUTCOME : As our pati ent was on a venti lator, aft er his chest physical therapy,
which we performed to prevent sputum retenti on and to facilitate sputum
expectorati on, the pati ent's breath sounds improved because of the chest physical
therapy's improvement in airway clearance and the reducti on of his work of
breathing.

REFLECTION: As it was our first experience of doing chest physiotherapy in I.C.U patients who
was on ventilator with critical care so in the starting off rotation we were afraid in doing chest
physiotherapy of such patients but our supervisor gave us the confidence so day by day our
chest physiotherapy techniques improved so we gave our best and we tried our best to
accomplish our goals with sincerity.