55 yr old with fever and SOB

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55 year old female came with chief complaints of 

• Fever since 4 days

• SOB since 4 days

HOPI:  The patient was apparently asymptomatic 4 days back , then developed  she had a H/o RTA ( Fracture of left lowerlimb) S/p wound debridement with external fixator under spinal anaesthesia)

H/o pus discharge from external fixator site.

Grade 4 SOB progressive in nature ( At rest) a/w lower back ache and generalised body pains.

 , progressive in nature

, high grade , relieved on medication.

PAST HISTORY:  k/c/o Diabetes mellitus 2

Not a K/c/o HTN, TB,CVA ,CAD ,Epilepsy ,Asthma

PERSONAL HISTORY:

Diet: Mixed

Appetite: Normal

B&B: Regular 

Addictions: No addictions.

O/E

General examination 

Temp: 98.9 F

PR: 100 bpm

BP: 130/90 mm hg

RR:  22 cpm

SpO2: 98% @ RA

GRBS: 387 mg / dl

Systemic examination 

CVS: S1S2 + , No murmurs

RS: BAE + , NVBS

P/A: Soft , NT

CNS:  No FND

INVESTIGATIONS

TREATMENT:

IVF NS & RL continuous infusion @ 180 ml/hr

Inj. HAI 8 units/IV/STAT

Inj. HAI 10 ml in 39 ml NS IV @ 6ml/hr

Inj. MEROPENEM 1gm IV/BD

Inj. VANCOMYCIN 1 gm in 100 ml NS IV/BD

Inj. PAN 40mg IV/OD

GRBS Monitoring hourly 

IVF 25% Dextrose if GRBS is more than 150 mg/dl.