\) safer oiracier giiglicdisirat BeMal, STEIGZ Lay ALL INDIA INSTITUTE OF F MEDICAL SCIENCES,, icant > Asha Kom 8h yrs ues De Avis J50H 7 203, 087 [002 FF Foxted coheter fre mol GQ USG aflux bermt ure pore ie bladeler but me rrge G7 vce feos I Cahefertredé of Rlnwk Ane andr ate arefr [Mecanhanis (4 faz Aieey ES wR Claw Waris | Oe 2 Crhmue 706 Tran Laas OG ang oD i tar 3. Vlad ni bw bey of: Agha” 04 ween fr refers theta Jaw Frat: Com ony Menday ) Sb She CY Pog l ertored : Basnl industrial Area, Phasel, Jodhpurs4200S ara g-urctacr een, Sa, Wregl-342008O«é & GP ! Gr Cif Me onay os Lredte y beg 2 GQ "Ds isfy Gin dpm € G0 apire fs aie aoe, T Figo Foti taps «bs YO ebay? anrinn Lory 7 Set RL [po _ nd XO sift “ova ° by Late bi9s pepy/ Bi) M4 ie ce Let p28}1 wid Asam «ma bs ig 5/224 705/0029 AGE. 84 Year GENDER: Male - ADDRESS: . CENTRAL JAN JODHPUR, , Jodhpur, on; 16/66/2084 Sidcr zarody2nes ye san ott rei larger sont wth rin eteitan with otros wisest wth Rypoiyaim I HOcEDURE: catheterization and! Conservative Management ‘ ‘u/ Be Gautam Ram Choudhary Cansitant inchaeger Dr, Niki Kathari/ Wr. A.S Sandhu De CiiiEE COMPLAINTS: Fever low ewlcy in breathing for ane da ‘ ane IG HISTORY; Patient Asharam alas Astuaal 4 ys Mai, wat rough 10 AIMS Emeroncy by 1A eer yymptomati il previous evening, He had complaints of spiravry distress with ove ena of lx ee rmaring, On adneson New beeatess with respsatiry rte at A6/ein, ik sataraon was kha of Hg PR-T31/minite: feop: HAF On Pxantanaban ho fas crncions, orianted, pale 6 hhad agraidal vesiar sound Tatar lly © ws dw-cne episode panasts, clubbing, edema ne honpisacenopatiy, sl His che veka clintally. a view nf past Kistory oF COMP. {ane month 3, Flowing prow diag shifted ta 1, ager sail Ht aw org 4 ‘ Syst EUG» (21-D6-RO2ANRpht Kiley 4.Rem, MUG prewsinence Of PCS mated. ( M0 well calcul not. vt Fidney 9.2xScm, nl dlstanion acon pes, loves Gaby andl apne tee note eatin wath thickened wall Prostate snnsatey 2h + unary bladder shows Faloy catheter i site and antl tnvesnganions |.” 606202; "20062021 4-06 2081 etn wncyocr { .8)10:57/20(N- | 9.AAR/28 YN BO ievrp le Ps i | samy : seinen, asisnny , weve) © wip oosal amg 8 Inj Hyéracortsone 50 mg Gl in LMWH 40 mg .C.00 Tals Aspurin 75 mpc Tab Thyroxine 100 mics OD Yah amsuosin rm The Noradrenaline infusion targeting, mean PEGS malig 6 1806-202), he was taken of inottupes Cedoceinology, er dalugyeeloronce wos taken srsblowed Grookuly ‘condition improved. His urine culture rede Cob and Rlebsiella and wert? sensitive (0 Fosfomyein aul ret to nultiple other drugs, After cenyult ation with the patient and Ins Lean of peevonal doctors, fostanrye in was stvued He respdndal weil ahe testes dl wept uring eu rafter 7? hours This culture Was reported to ls steno. Gradual hi Ft sated nealing ~ Current: the patient is alehule, accepting aval, on rou cand waihng ve eathate, discharge in stable conditions CONDITION AT DISCHARGE: Gc FAIR, VITALS STAAL, PUC inst ADVICE ON DISCHARGE: Tab. Levofloxacin 500 mg OO x 2weeks — ” - Fosforiijtiit Sachet 3 gm with 190 mt water orally every 3” day for total of 2 doses (3 doses ii Cumment Neomycin local applcaron around cinarynnsatys TOS & 7 days Tal Pantoprazote 40mg OD fr 4 Days Tab Pacacatime S00 my SOS Ine fever dh SYRP Lactulese 20 cr HSO0 le % days then SOS Tab Uhyexine 100 nis OD Tal Tamsulosin 0.4 mg HS to continue Review in endocrinology OP Raviow in cardiology OPD Rent TFT er six waeks (Asada by enaccineons fhoiew m Urology OPO Callotar care as explains eal PSA ler 1 months ‘Momtor catheter output daily and note down val iin ava Far -UR MRT ar gh A) ames el cane a ET RRT 4 16 twin lamnod foe sen a) AN e i ding emergency GR , eee tm Ya ant ge glaees a geste Maret « alee Feral unde aRRore sr eR a TSN Nera AH BIR ifs ee erst seh ce? a site PUC init PLANER 1 in urvlony QPP tor cathecer rqmoval trial FOLLOW UP FOR REVIEW IN UROLOGY OPD ON 30-06-2021, ! : ‘%, PA . Ga’ SIGNNTFREOF RESIDES) SIGN.ATURIEOF CONST 4 BW fefr| jnfectinn ; retention Prdealcitonin, HscRe 2% Lipid Proflefti- | Cholostaroiead 06-2021) | madi HDD 25 vowel unk 85 get 6s Ferritin (17-06-1167 Angin us FR TREE pint - ~ ~—s - opamp LJ i = TREATMENT GIVEN IV ANTINIONIES, ANALCIPGICS neh Inj Piperaillin Tazobiactuns 2 Jr Rati TOS. : to Lovnfloxacin S00 mg ww. OD every alternate day In Fosfosycan 4g Ww TDS fo} Minneyetive 200 mp ivoasling dose Fallowwd ly 10° ay Iv BD fn Partapraxots 40 rg BO Inj tIyleacartisone 50 mg we O40 Inj UM 40 mg 5:6, OD Tab Aspiria 75 mg OD Tab Thyroxine 100 mics OD . Tab Tamsulosin 0.4mp HS Fag Roradrenaline infusion tay ‘COURSE IN HOSPITAL STAY: 16-06-2021 lin ICU, Mule chaeyge was ven 0.04 mics/kg/minute, la ve fuser! any fur ting ane BEBE mum oun any immprovedient in BP, hewew, Injertion Noradeenaine tetra i possibility of pulworsary embolism CI pulmonary angio way wlanned, te pater svn. Inj LMWH a ag he cod. Tlo|GRE Opinion wae si ene FT it. ECG sv ECHO ween normal making the pussibility of pulmonary wnrbalran lowe, f= savestigations showed Hh 8.8eav. TLC 10570emm wath 93% polyrndirphs, CHM 28,18 nyglelh Seren. cenations 2.4 g%, serum sodium 131 nv vonitared soul motassinen 40 neq? LET aas normal. He 0 actin! in Uhe-awering, he complamed af lower 3 whirl was suspected due tosearngy eatention velo eit vas. given The pation was examined by Prat Dr A. Sanviu andl Or .R, Chauary. The patent wey a tye ws unwiling iniinly. Later fue was catheterized! afte aintation of prequcrs ‘initial catheter qutput was about one lnre of turbid urine, which was sent for routine examination and culture thy bi ‘ount revealed neutrophilic fouroxylasis with inerensed proraiatonin, hone, a provisional ‘wotic shack was entertained and following treatment x started: hm Piperac dle Tazabactinn A. In Pantoprarale 40 my BD 1 tyracortison 50 rnp 6 CD In LMWH 40 mg 5. OD in} foreign on ba Tab Aspirin 75 mq OD Tab Thyroxine 100 mis OD 17-06-2021 He was started on w,ambiotis, hee ddvcreased 0 0°02 microgp/ngminute over 24 howe ‘His nvostiatinns reports shoved: Nb 4.7 Ren Hel 29. 116 A0.e:6oiicéa! wath palymerphs ss Plate ths LO/imeroL HS 18.8 ef ont of car, Poca; GO.04 rym, Fern 162.7 male, agg 20 sear TSH? Ph mii, F135 nna, e408 po, Bl res AG ny S-Cavatinme 1.70 aye e GitesinO 4, SGOT 224. Nu/L, SGPL 54 Hi/l, Total protensb. yoval, § Mbunsin 2.8% fd, Alkaline PhospAPlove 7 Yorsd Cholesterat 80 mg/d, HDL, 25 ny, LL 93 wap, Vaplycerides 97 m/l, Usine routine report sowed pats? 1MMPY with bacterial colonies witure Ten shaved Diluse area of eetxuloe pact’ sith shy round lags opacity aw rey aera ny. prea as wal es act mn prominent in baat Tower se! mi ces, kel reresot chao oF old CM-I interior We camiecw Aw ciiflding nf aorta and aortic kaye ble caeication General condition conscious, anented, no peripheral wedema, chest ick ‘98/mimute, BP 110/68 monk on Injection Naradsenatne infusion 0.0? mics aceepring oral diet Fevatment ny Prneraain Tanobactury 2 2 ym iy UD, denial die zonort. Exarnation reyaled distensaas wtb ul cathousization at ¢ skin neler all ase. conditite thw g rowan 1965 mol sade to initial veatihent, his noradnealui> examen 1 saturation 96% en 3 lyre oxygen How, le minute, rine gutpet 80-266 ensbe srgotless ava SED MG, «a oo Ba ~Unie CULTURE PTfINR/D-Dimar sa. TAST (Seon Gi Wat AT ISGP! 20 lua 1 Serunt tonal | Bitiratna | 14 mth Biever iran E a iooweat f Inclieoct* lieu 0.28 ope Serum Fral Brot 6.00 g/dl i Serum Albumin | 2st anifal Globulins 5.42 py) Alkaline basahatns: | {ALM TIAL 4 i+ i ° 4 * | en = | TRS/LAL) +20 cngont E97 Pgfinl (24 06-202 7ilposibly we cated dae be