60yr female with shortness of breath

A 60yr female who was farmer by occupation came with the complaints of Shortness of breath since 1o clock in the night ..

HOPI: pt was apparently asymptomatic since 1  o clock in the night ..then started developing sudden onset breathlessness in the night which was grade 4 , progressive .pt was taken to the local RMP ,found to have high BP levels and took some medication and came to KIMS for further evaluation.

Past history: K/C/O DM and HTN  since 10 years .

Persoal history: PICKLE : negative.
 
General examination : Pt conscious but irritable .
Vitals : BP : 180/90 mmHg
            PR: 140bpm
            CVS: S1S2 + 
            RS: BAE + , Coarse crepts in all areas.
            P/A: Soft.
           GRBS: 256mg/dl
Investigations:

Diagnosis: INFERIOR WALL NSTEMI with CARDIAC ASTHMA

COURSE IN HOSPITAL :

1)Inj.LASIX 40MG IV / STAT FOLLOWED BY LASIX 40MG IV AFTER 2MIN 
2) INJ.NITROGLYCERINE ( 1AMP= 4ml =20mg) ..1ml has 5mg and 1ml diluted with 4ml NS ..5ml has 5mg ( each ml has 1mg)
Inj .NTG 1ml followed by 2ml flush...BP checked after 2min ...Repeated the another dose ...BP checked after 2min and repeated the another dose.
3) T.ASPIRIN 325MG/PO/STAT
4) T.CLOPDOGREL300MG /PO/ STAT
5) T.ARORVAS 80MG/PO/STAT
6) INJ.HYDROCORTISONE 100MG/IV / STAT
7) NEB.BUDECORT STAT
8) O2 INHALATION.
 
PT WAS SUBJECTIVELY FEELING BETTER AFTER THE MEDICAL MANAGEMENT AND WAS REFERRED TO HIGHER CENTRES IN VIEW OF PTCA.?

TREATING TEAM: Dr. Laxma Reddy
                                Dr. Manasa
                                Dr.Ajith
                               Dr. Durga Krishna
                               Dr. Mohitha 
                               Dr. Sanjay.

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