ACUTE CARDIOGENIC PULMONARY EDEMA 2° TO NSTEMI
38M owner of JCB proclainer, father of 3 months old baby brought to casualty in an unresponsive state with c/o left arm pain and involuntary movements 11 days back
ABG @4:45 AM
HISTORY OF PRESENTING ILLNESS:
Patient was apparently asymptomatic 5 years back then started alcohol and gutka as peer pleasure and then he brought JCB proclainer by taking loans. After first wave of COVID-19 due to decreased demand for JCB, he had a hard time in repaying the loans. Due to this agony, patient started to drink excess alcohol initially 90ml of whiskey everyday which gradually increased to 90ml of whiskey 4 to 5 times a day since 3 months. 11 days back patient had left armpain for which he was taken to local hospital and advised for de-addiction. Package of 1lakh/month was negotiated and downpayment of 45,000 was paid. Next day after patient admission, patient wife got a call from hospital and was told that her husband became serious and was shifted to ICU and put on oxygen. Initially the patient recovered but after 4 days again became unresponsive. The wife was told that he had liver, heart and brain problems because of alcohol. Then due to financial burden, the wife shifted the patient to KIMS-NKP.
PAST HISTORY:
Not a K/C/O DM, HTN, Asthma, Epilepsy, COPD
PERSONAL HISTORY:
Diet - Mixed
Appetite - Normal
Bowel and Bladder - Regular
Addictions:
Alcohol - Regular
Tobacco - Chewable (Gutkha)
FAMILY HISTORY:
Not Significant
GENERAL EXAMINATION:
Patient is unconcscious
No Pallor, Icterus, Cyanosis, Clubbing, Lymphadenopathy, Edema
VITALS:
BP - 110/70mmHg
PR - 140bpm
RR - 50/min
SpO2 - 80% @RA
Temperature - 103°F
SYSTEMIC EXAMINATION:
CVS : S1,S2 heard, No Murmurs
RS:
Dyspnoea present
NVBS heard
Trachea central in position
Crepts present
P/A: Soft, Non-tender, Abdomen obese, Bowel sounds present
CNS:
GCS:
Level Of Consciousness: Stuporous
TONE:
UPPER LIMBS: Decreased
LOWER LIMBS : Decreased
POWER:
UPPER LIMBS:
Both upper limbs against gravity
LOWER LIMBS:
Both lower limbs - 2/5
INVESTIGATIONS:
HEMOGRAM:
CUE:
ABG @ 10:32PM
ABG @4:45 AM
ABG @ 8:29 AM
LFT & RFT
TREATMENT:
1) IV fluids DNS @30ml/hr
2) Inj. Lasix 40mg IV/BD
3) Inj. Thiamine 200mg in 100ml NS IV/OD
4) Inj. Piptaz 4.5mg IV/STAT----> Inj. Piptaz 4.5mg IV/TID
5) Inj. Atracurium 0.005 to 0.01mg/kg/min to maintain adequate paralysis
6) Inj. Midazolam 30mg/kg/hr
7) Inj. Heparin 5000IU IV/TID
8) Inj. Neomol 1gm IV/QID
9) Propped up position
10) RT feeds 100ml milk + free water
