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Case 1
50 year old lady presented with acute onset of
shortness of breath this morning. This was preceded by one episode of chest pain and vomiting. She has had diabetes mellitus for the past 10 years.
What other history would you ask for? What are your differential diagnosis?
bpm, HR 120 bpm, BP of 98/60, SPO2 89%. Her peripheries were cool to touch and her pulse was thready. JVP was raised at 10 cm. Fine crepitations were heard up to the mid zone in both lungs. Examination of the heart revealed a gallop rhythm.
ECG is as follows :
How would you manage her? What do you do for her poor oxygenation? What if her blood gas is as follows :
pH 7.31 pO2 9 kPa pCO2 7 kPa HCO3 28 kPa Interpret the blood gas. What would you do?
congestion?
Case 2
65 year old male, with known CRF.
Last seen in nephrology unit in June 2011. Counseled
for dialysis but refused. He presented with increasing shortness of breath and bilateral pedal oedema of 2 weeks duration. He also had epigastric pain. He has been taking some medications for his knee pains for the past 3 weeks and some traditional chinese medicines to improve his kidney function.
Renal profile done in casualty are as follows : Na 130 K 6.4 Urea 42 mmol/L Creat 465 mmol/L Minimal hemolysis noted.
What other history would you ask for? What painkillers might he have taken? Can you explain the epigastric pain? Give some examples of nephrotoxic drugs.
following :
BP 220/120 mm Hg HR130 SpO2 88% T afebrile Pallor
Describe the fundus. What are the changes of hypertensive retinopathy? How is this useful in determining your management?
ABG as follows : pH 7.30 pCO2 3.9kPa pO2 10.0 kPa HCO3 16.0 mmol/L
How do you interpret the blood gases?
ECG
The end.