Sepsis morning presentation updated form

Case presentation on sepsis updated managment

1. Morning session Dr.Betrearon

2. Icu 55yrs old pt P1-Advanced HIV disease P2-PTB+?TB meningitis +R/O ICSOL P3-Moderate anemia of CD P4-Esophagial Candidiasis 55 yrs old ptwith newly dx RVI present with chief complain of decrease in mentation of 2 day duration.associated with this he had also globalized dull aching headache of 2 wk duration.for the past 1 wk he had no voluntary control of urination and defication. For the past 3 month he had productive Cough with non bloody sputum., night sweet, low grade intermitent fever,significant unquantified wt loss. He is field worker , drinks alchol usually sometimes to level of intoxication. He had no previous similar sx, contact with chronically coughing person.

3. Pe ASL in pain Bp 120/80 Pr 71 temp 38.8 oxy 98 on atm air Rbs 120mg /dl HEENT-Nis PC,no nasal or ear discharge seen. LGS no lap Chest clear CVS -NM NG Abd full moves with respiration No organomegally MSK-no deformity CNS-Confused 14/15 Pupil bilateral small szed..lefr larger than rt with reactive to light.rt non reactive. Neck rigidity +

4. Lab Cbc wbc 9k N 60% Hg 9.8 Plt 225 Rft,LFT,elt, normal CRP 126, ESR 90mm/hr Cxr, Brain MRI pending

5. Mx Ceftriaxon Vancomycin Ampcilline Dexametason Clotrimazole Pcm Omeprazole UFH Urinary chateter Anti TB-planned

6. Surgical ward 58/M TURP was done for BOO 2ry to BPH
42/F excision was done for Lt Shambllin II/III Carotid body tumor
78/M TURP was done for BPH
44/M Fistulotomy for low anal fistula and silk seton insertion for communicating sinus tract (Complex fistula in ano ) 45/M Mesh herniorrhaphy for Rt. Inguinoscrotal hernia
52/M thoracotomy + diverticulectomy and repair was done for Esophageal diverticula (rt middle 3 rd )
33/M Left Posteriolateral Thoracotomy + Wedge resection+ foreign body removal was done for foreign body with cavity

7. Pediatrics This is  a 10 days old male neonate presented with yellowish discoloration of skin to the level of foot . Maternal BG/RH is A+.Admitted with dx of Term+NBW+AGA+NHB
Objectively
V/s   PR  152 RR  42 T   36.7 SPo2  99%on ATM O2
HEENT  Pcis flat AF
Chest good air entry billateraly
Cvs  no murmur no gallop
Abd  flat moves with resp
Gus NMEG
igs/mss Jaundice to the level of foot
CNS  alert NR are appropriate for the age
Bind score is 0

8. Investigation
CBC,CRP, normal
PCT , peripheral morphology and reticulocyte count are pending
Baby’s BG/RH, A+
Abdominal and cranial ultrasound are normal Management
Intensive phototherapy
Full feeding

9. This is a 10 months old male infant who presented with fever fast breathing and grunting of 1 day duration.in association to this he has urinary retention of similar duration for which he was taken to private clinic where he was catheterized and he passed urine then was referred to Us.
GA  stable
PR  126 RR  30 T 37.4 Spo2  94%on ATM O2
HEENT pc/nis
Chest  clear
Cvs  no murmur  no gallop
Abd flat
Gus NEMG
Igs  no pallor no rash no edema
Cns  stable

10. Investigation
WBC 12k
Neu 59%
PLt 222k
CRP12
Blood culture preliminary no growth
Urine culture pending
U/A ,RFT ,electrolyte are normal
ABD u/s cystitis

11. Management
Cateterized
Ceftriaxone
Gentamicin
Paracetamol
MF

12. This is a22 days old Twin B female neonate referred from MCH center after she aspirated milk while the family were taking her to the clinic as she developed cough and fast breathing of 2 days duration. She vomited right after feeding and aspirated .she was then immediately referred to our hospital after stabilization. Admitted with dx of aspiration pneumonia
V/s   PR  159 RR 66 T   37.7 SPo2  99%on 7 cm CPAP HEENT pc/nis flat AF
Chest sever ic/sc retraction, audible grunting , creps bilaterally
Cvs  no murmur no gallop
Abd  flat moves with
Gus NMEG
igs/mss No pallor no rash no edema
CNS  alert NR are appropriate for the age

13. Investigation
CBC, WBC. 9 k. Hgb 6. Hct. 20. Plt. 333
CRP, 5.5
PCT ,15
CSF analysis ,RFT, electrolyte are-normal
CXR. Pneumonia
Abdominal u/s. Normal


Management
NGT feeding
CPAP
Meropenum
Vancomycin
Nebulization

14. This is a 4 years old male child presented with watery non bloody diarrhea and vomiting of ingested mater of about 5 episodes per day of3 days duration. Also has LGiF eagerness to drink water and sunken eye ball.
GA ASL
PR  120 RR  30 T 37.4 Spo2  94%on ATM O2
HEENT pc/nis , sunken eye ball dry tounge and buccal mucosa
Chest  clear
Cvs  no murmur  no gallop
Abd flat moves with resp
Gus NEMG
Igs  no pallor no rash no edema
Cns irritable

15. Investigation
WBC 12k
Neu 75%
PLt 466k
CRP 80

,RFT ,electrolyte are normal
ABD u/s normal
Stool examination pending

Management
Rehydration
Ceftriaxone
Metronidazole
Paracetamol

16. Gyn/obs 40 F TAH+ BSO +omentectomy for advanced ovarian tumor 33 F perineoplasty for grade 3 and 4 perinial tear 31F LUTS done for indication of 2 previous CS scar to effect 3.5kg alive female neonate with apgar score of 8 and 9. 32 F LUTCS done for 2 previous CS scar to effect alive male 3.6kg neonate with apgar score of 8 and 9 38 F LUSTCS +myomectomy. Out come was 3.3 kg alive male neonate with apgar score of 8 and 9.