CASE PRESENTATION.pptx pleural effusion in emergency medicine

Pleural effusion

1. CASE PRESENTATION Presenter - Dr Rahul (JR3) Moderator - Dr Pranay Gupta (SR) Guide - Professor Dr Haider Abbas (HOD) - Dr Mukesh Kumar ( Assistant professor)

2. PARTICULAR OF PATIENT Name: Ram Singh Age: 70 yr Gender: Male Marital status: Married Occupation: plumber Adress: lakhimpur Date of Presentation: [ 10/05/2025 ]

3. CHIEF COMPLAINTS SHORTNESS OF BREATH X2 MONTHS CHEST PAIN (on and off ) x 2 MONTHS LOSS OF APPETITE X 1 MONTHS

4. Initial Emergency Room Approach Primary Survey 1. Airway: Patient is alert, conscious, speaking in full sentences. : Airway is patent 2. Breathing: Increased work of breathing : RR: 24/min, decreased chest movement on the right side : Decreased air entry over the right lower chest : SpO₂: 89% on room air : Breathing compromised – supplemental oxygen started with Nasal prongs - start nebulization with bronchodilators

5. 3. Circulation: HR: 97 bpm, BP: 122/70 mmHg : No peripheral edema, no JVP elevation : Capillary refill < 2 seconds : Circulation adequate 4. Disability: GCS: 15/15 : No focal neurological deficits : Pupils equal and reactive 5. Exposure/Environment: Afebrile at presentation, no skin lesions or edema : Chest wall intact, no signs of trauma

6. ADJUNCTS TO PRIMARY SURVEY ABG : mild respiratory alkalosis with normal bicarbonate : likely due to hypoxia-induced hyperventilation : Lactate: 2.0 mmol/L (↑) → Mild lactic acidosis, may indicate tissue hypoxia

7. ECG

8. Secondary Survey 1 Allergies : None 2 Medications : -INJ. MONOCEF 1 GM IV BD - INJ. PAN 40 IV OD - INJ. EMSET 4MG BD - INJ. HYDROCART 100MG BD - INJ. LASIX 20 MG BD - NEBULIZATION WITH BRONCHODILATORS 3 Past Medical History: NONE 4 Last Meal: 6 hr before

9. History of Presenting Illness (HOPI): A 70-year-old male presented to the Emergency Department with complaints of Shortness of breath for the past 2 months .The breathlessness was initially on exertion and has progressively worsened to occur even at rest and associated with dry cough. There is no orthopnea or paroxysmal nocturnal dyspnea. Chest pain (on and off) for 2 months The pain is dull, non-radiating, and localized to the right side of the chest. It is not related to exertion, position, or meals. Loss of appetite for the past 1 month ,Gradual decline in appetite, with associated fatigue and mild weight loss (unquantified). No nausea, vomiting, or early satiety. No history of fever, night sweats, hemoptysis and lower limb swelling. The patient received treatment at the local district hospital for the above complaint, but there was no clinical improvement. Therefore, the patient was referred to KGMU, Lucknow, and admitted to the Emergency Medicine Department for further management.

10. HISTORY OF PAST ILLNESS No history of tuberculosis, COPD, asthma, Diabetes , hypertension heart disease, or malignancy No past surgeries

11. FAMILY HISTORY Patient have contact history of tuberculosis (doughter had history of tuberculosis )

12. PERSONAL HISTORY HE IS ALCOHOLIC AND CHRONIC SMOKER NON-VEGETARIAN IN DIET SLEEP IS IRREGULAR