80 years old with COPD + Dengue

 80 year old male with fever 

November 21, 2022

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A 80 year old male who was patient agricultural labourer by occupation was bought to the casualty with the chief complaints of 

fever since 8 days

And an episode of Shortness of breath sunday at 03:45pm

HOPI.

Patient was apparently asymptomatic 8 days and developed fever which was high grade, intermittent in nature  associated with chills and relieved on medication.patient went to local hospital and diagnosed with dengue (NS1+ve) and got admitted for 5 days also had a history of cough since 5 days wet cough, whitish sputum, non blood tingled , Breathlessness since 2 day , insidious in onset gradually progressive from grade 2 to grade 4 not associated with excessive sweating/ nausea 

No history of chest pain, swelling of ankles, heartburn ,pain abdomen, co change in stool colour, no burning micturition

PAST HISTORY

No similar complaints in the past.

Know case of Hypertension 1year ( Tab. Atenolol 50mg )

Not a known case of diabetes, tuberculosis, epilepsy  and asthma 

TREATMENT HISTORY : For Hypertension from 1 year Tab. Atenolol 50mg

 

FAMILY HISTORY: His brothers had similar history and passed away 

PERSONAL HISTORY

DIET: mixed.

APPETITE: NORMAL

SLEEP: adequate

BOWEL AND BLADDER MOVEMENTS: regular

Addictions : he is addicted to smoking. He smokes 1 pack of bidi per day daily  .

                    Alcohol occasionally 

ON GENERAL EXAMINATION

patient is conscious, coherent , co operative. moderately built and moderately nourished

Physical Examination: 

       Pallor:absent 

       Icterus: absent

cyanosis: absent

clubbing : absent

lymphadenopathy:absent

pedal edema: absent 

 

AFEBRILE

Bp:110/80 mm hg

PR:89bpm

RR;24cpm

GRBS M :117

SYSTEMIC EXAMINATION:  

RESPIRATORY SYSTEM

INSPECTION: 

Upper respiratory tract:

Oral hygiene maintained

No oral thrush

Post nasal drip not seen

Tonsils seen

Dental caries absent

Deviated Nasal septum absent

No nasal polyps

Lower respiratory tract:

 

Barrel shaped chest 

Tracheal position is central

Symmetrical chest 

Apical impulse: not seen

Movements of chest : 

                                    Respiratory rate: 22 cpm

                                    Type :Abdominothorax type

                                    Symmetry : Bilateral equal 

                                    Accessory muscles used

                                    Skin over chest : no engorged veins , subcutaneous nodules , intercostal              

                                                                scars, intercostal swelling is seen

 Trails sign : trachea is central placed 

Remaining areas are normal

PALPATION:

All inspectory findings are confirmed by palpation 

No local rise in temperature 

No tenderness is seen 

Trachea is central

Chest is symmetrical and expanded 

Symmetrical expansion of chest .

Dimensions 

Circumference:        Rt /        Lt

1. Transverse :
2. Anterioposterior :
3. Hemi thorax :   

 

Tactile vocal fremitus: decreased 

PERCUSSION:

Hyper Resonant on chest percussion. 

AUSCULTATION :

 Wheeze heard during expiration 

Normal breath sounds decreased 

PER ABDOMEN

Shape : scaphoid

Tenderness : no

No palpable mass

Hernial orifices : Normal

No free fluid

No bruits

Bowel sounds : present

CNS 

Conscious

Speech : Normal

No signs of meningeal irritation

Cranial nerves : intact

Motor system : Normal

Sensory system : Normal

Reflexes : Normal. 

INVESTIGATIONS

 

 

  

 

  

Treatment