Case C (13) Pulmonary Embolism without hemodynamic instability

Patient name Paul Wilson

BMI 28,1 (overweight)
Weight 83 kg, height : 172 cm
Chronic conditions Type 2 Diabetes, Rhinitis
Age 41 years old

After having a discussion with his mother, Paul suddenly felt worsening of the chest pain he had
been feeling. He immediately called the emergency unit and was brought to the hospital. Forty one
year old man. Suffers from shortness of breath and complains about chest pain. He started
complaining about it three days ago and, since then, his condition has been worsening.

Dialogues with patients

1. How are you feeling right now? I feel intense pain in my chest and I can’t breathe
properly
2. Are you feeling pain? I felt pain
3. Does chest pain increase during inhalation? Yes
4. Tell us about any health conditions? I have diabetes, suffer from rhinitis, and broke my
foot one week ago
5. Is the condition relapsing? No
6. When did your symptoms start? I suddenly started feeling chest pain three days ago and
breathless all day since a couple of days ago. I have been feeling worse day by day.
7. Do you have any allergies? No
8. Are you taking any medication? Metformin 850 mg twice a day and oscasionally taking
paracetamol for my foot pain, but I didn’t feel much better
9. Do you habe any allergies? No
10. Medication side effects? No
11. Do you have high blood pressure? I don’t know
12. Do you have high cholesterol? I don’t think so
13. Do you smoke ? Yes, half pack a day
14. How much do you walk each day? A few minutes to and from work

Vital sign: patient diagnoses and Laboratory Test:

TD: 131/72 mmHg, conditions: pH = 7.35; pO2 = 65 mmHg;
HR 127 x/min - Deep vein thrombosis paCO2 = 27 mmHg; O₂ Sat =
RR 25 x/min - Pulmonary embolism in 92%; HCO₃⁻:
Saturatio O2: 92%, left leg without 26.1 mEq/L; Na⁺: 142
T: 36 hemodynamic instability mEq/L; K⁺: 4.1 mEq/L; Cl⁻:
GDS 144 mg/dL - Moderate pain 102 mEq/L; Lactate: 30
Urinary output : 49, 8ml/h mg/dL / 3.3 mmol/L
GCS : E4-V5-M6 (4-5-6)
Hemoglobin : 14,9 - Tachycardia\reduced coagulation test: increases
oxygenation D-dimer 6,3 µg/ml

Stroke scale (NIHSS) :-

ECG 12-lead: sinus tachycardia
Wells criteria : 9 (high risk)
Revised Geneva Score : 11 (high
Risk)
 Case Infectious and Respiratory (case 15) PASIEN PPOK EKSASERBASI EC. PNEUMONIA

Patient name FERDINAND DELANEY

BMI 31,2 (obesity)
Weight 86 kg
Chronic conditions Cronic Obstructive Pulmonary Disease
Age 47 years old

Ferdinand felt increasingly fatigued. His ability to brathe progressively deterioting. He was the
transport to the Emergency department. He suffers for shorthness of breath and coughing wint
increased mucus production for 5 days. Yesterday he started complaining about nausea and bilateral
chest pain

General condition: identify to pneumonia, feel intense pain in his chest and can’t breathe properly.
History of illness : COPD more than 10 years
History of medication: salmeterol twice a day, ibuprofen for the pain
Smoke: Normally smoke one pack a day (since 15 years ago)
Alcohol: Normally drink a glass of wine with meals

Vital sign: Laboratory Test Initial conditions:

TD: 118/59 mmHg Arterial blood gas: - COPD exacerbation
HR : 115 x/min pH= 7,36 - Fever
RR : 27 x/min pO2 = 58 mmHg - Hypokalemia
Saturatio O2: 89% paCO2 = 80 mmHg - Hypotension
T: 38,1 0 C HCO2- = 43,7 mEq/L - COPD exacerbation leads
BG : 141 mg/dL Na = 137 mEq/L to moderate pain
Hemoglobin 14,1 g/dL K = 3,2 mEq/L
Urine output: 0,6 ml/kg/h Cl = 100 mEq/L
FEV 1 = 58% Lactate = 26,1 mg/dL
CAT = 8 Biochemistry:
BUN = 47 mg/dL
Cr = 1,5 mg/dL
Creat Cl = 69 ml/min
Leukocyte = 17,5 x 10 3/L
 Case A Neurology (5) Felt Poorly at a wedding Party
Patient name George Mathews
BMI 33,7
Weight 95 kg
Chronic Chronic left ventricular hyperthrophy
conditions
Age 65 y.o

George Mathews, Patient Male, 65 years old. Complain about numbness the right half of his body.
Presents shortness of breath, hypertension and tachycardia.
General conditions: half of body feels numbs at least He can see again, no pain.
Time since symptom onset: almost two hours ago.
History of medication: He taking some pills for his hypertension
History Illness: Hypertension, usually Blood Pressure is high, Cholesterol (+)
Dialogues with patients
1. How are you feeling right now? Half of my body feels numb. At least I can see again
2. Are you feeling pain? No just feeling of numbness
3. How long since you started feeling like this? Almost 2 hours ago
4. Do you have any allergies? No
5. Are you taking any medication?I’m taking some pills for my high blood pressure
6. Are taking any supplements? No
7. Do you have high blood pressure? Yes
8. Do you have high cholesterol? Yes, I’m afraid so
Vital sign: patient diagnoses and initial Laboratory Test:
BP: 200/103mmHg conditions: Blood Ph: 7,36 -BG :
HR: 130x/min - Transient ischemic attact 120 mg/dL
RR: 32 leads to trombotic stroke PaO2: 53mmHg -urine
T: 370 C and hypoxia output : 0.6 ml/kg/jam
O2 saturation: 87% - Severe hypertension
PaCO2:49mmHg
- Tachycardia
General Conditions: - Tachypnea HCO3: 26.7mEq/L
GCS: 4-5-6 O2Sat 87%
Stroke Scale (NIHSS) total: Imaging: Na: 141 mEq/L
21 - Echocardiogram : left K+: 3.6 mEq/L
aPTT: 35 ventricular hypertrophy Cl-: 102 mEq/L
protrombin time: 12 Stroke scale: 7 (moderate) Lactate: 10.8 mg/dl
INR: 1
Head CT scan report : no evidence
of focal lessions in the brain
parenchyma.
 Case Cardiology (222) Felt Persisten Chest Discomfort

Patient name Stuart Grayson

BMI 25,2 (over weight)
Weight 96 kg
Chronic conditions Type 2 Diabetes, hypertension, hypercholesterolemia, kiedney disease
Age 68 years old

Stuart Grayson, 68 years old, 96 kg was having breakfast with his family. Following a brief argument with his
wife he started to feel persistent chest discomfort. He was immediately transported to the emergency service.
Stuart has a diabetic with hing blood pressure and high cholesterol. Complains about chest discomfort, nausea,
and sweating. Accoding to th family, this event has no precedents.

General condition: chest hurts badly, nausea, sweating

Pain onset : about 2 hours ago
Concomitant health condition: diabetes, high blood pressure, high cholesterol
Doctor diagnosis : Acute coronary syndrom with Heart failure
History recent weight changes: -
History of illness: kidney disease, diabetic,hypertension, dislipidemia
History of medication: someting for diabetes and for blood pressure, but patient can’t remember the names
Compliance: NA
Recently under stress: he and his wife have been many arguments lately
Consume alcohol: yes, wine
Tobacco consumption : stop smoking 23 years ago
History to take supplements: -

Vital sign: patient diagnoses and conditions: Imaging:

BP: 167/93 mmHg - Myocardial infarction wih ECG  ST elevation in V1, V2,
HR: 131 x/min ST elevation leads to severe V3, and V4
RR: 26 x/ min pain Coronary angiogram  Total
T: 36,10 C - Tachypnea occlusion of the middle left
O2 saturation: 95% - Heart failure anterior descending artery. No
FBG : 183 mg/dL - Hypertension significant
Hb : 14,3 - Tachycardia stenosis in the other coronary
Biochemistry: - Hypoxia arteries.
Cardiac markers