A 55yr old male with Anterior wall MI.

A 55 yr old male pt. came to the casualty with c/o chest pain , sob ( grade 3),nausea,loss of appetite and b/l pedal edema since 3 days.Reduced urine output since 1 day.
Pt was apparently asymptomatic 3 days ago then he developed sob (grade 3) ,not associated with cough ,no h/o fever, no h/o orthopnea and no h/o PND , h/o B/L pitting edema ,
K/c/o pulmonary kochs (used ATT for 9 months 4 yrs back)
K/c/o DM2  since 1 yr and is on GLIMY M1/ PO 
O/E 
Pt is c/c
CVS - s1 s2 +
R/S - BAE + , inspiratory crepts + in Rt MA IMA IAA , Rt. Sided wheeze +
P/A soft and non tender
CNS - E4V5M6
Vitals-
Pr- 107bpm 
Bp- 80/60 
Spo2 - 93 % at RA.

DIAGNOSIS - Anterior wall MI with pneumonia (REACTIVATION OF PULMONARY KOCH'S )

TREATMENT -
INJ. Lasix 40 mg iv stat
Inj. Noradrenaline 2ml in 45ml ns @ 8ml/hr
Inj.Dobutamine 1amp in 45 ml ns @ 2.5 ml /hr
Inj.Heparin  5ml in 45 ml nd @ 1.6 ml/hr
Neb with budecort and impravent @ 8th hrly
Tab.Ecosprin 325mg po stat
Tab.Clopidogrel 300mg po stat
Tab.Atorvas 80mg po stat
Fluid restrictions( <1.5 L/day).



Soap notes
 Day 1 No fresh complaints

O/E 
Pt is c/c
CVS - s1 s2 +
R/S - BAE + , inspiratory crepts + in Rt MA IMA IAA , Rt. Sided wheeze +
P/A soft and non tender
CNS - E4V5M6
Vitals-
Pr- 107bpm 
Bp- 80/60 
Spo2 - 93 % at RA.

Treatment
INJ. Lasix 40 mg iv stat
Inj. Noradrenaline 2ml in 45ml ns @ 8ml/hr
Inj.Dobutamine 1amp in 45 ml ns @ 2.5 ml /hr
Inj.Heparin  5ml in 45 ml nd @ 1.6 ml/hr
Neb with budecort and impravent @ 8th hrly
Tab.Ecosprin 325mg po stat
Tab.Clopidogrel 300mg po stat
Tab.Atorvas 80mg po stat














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