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    Opd Case

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    Raven Cièl
    - Continue monitoring vitals signs enroute to hospital - Start IV access and fluid resuscitation before transfer - Consider blood transfusion if Hb is low and platelet count critical - Inform receiving hospital of condition and ETA for prompt management Early recognition of deterioration and timely referral/transfer is important to save lives in such critical cases. Close monitoring during transfer and immediate stabilization measures could have optimized patient's chance.

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    Opd Case

    Uploaded by

    Raven Cièl
    119 views13 pages
    - Continue monitoring vitals signs enroute to hospital - Start IV access and fluid resuscitation before transfer - Consider blood transfusion if Hb is low and platelet count critical - Inform receiving hospital of condition and ETA for prompt management Early recognition of deterioration and timely referral/transfer is important to save lives in such critical cases. Close monitoring during transfer and immediate stabilization measures could have optimized patient's chance.

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    Opd case

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    - Continue monitoring vitals signs enroute to hospital - Start IV access and fluid resuscitation before transfer - Consider blood transfusion if Hb is low and platelet count critical - Inform receiving hospital of condition and ETA for prompt management Early recognition of deterioration and timely referral/transfer is important to save lives in such critical cases. Close monitoring during transfer and immediate stabilization measures could have optimized patient's chance.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    119 views13 pages

    Opd Case

    Uploaded by

    Raven Cièl
    - Continue monitoring vitals signs enroute to hospital - Start IV access and fluid resuscitation before transfer - Consider blood transfusion if Hb is low and platelet count critical - Inform receiving hospital of condition and ETA for prompt management Early recognition of deterioration and timely referral/transfer is important to save lives in such critical cases. Close monitoring during transfer and immediate stabilization measures could have optimized patient's chance.

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    of 13

    OPD Case 1

    Dr Amilia Hazreena Hamidon


    KK Greentown
    26/6/12 Klinik Kesihatan
    FEMALE 60 year old
    C/O: Fever for 3 days
    Dizzy and lethargy
    Joint pain and myalgia

    Nausea but no vomiting

    PMH: DM and HPT. Not on treatment


    O/E:
    T=38 C
    BP=120/70
    Fever ? Cause
    Treatment:
    Paracetamol

    Cefaclor 375mg bd

    Q1: What is your comment on the case


    management?
    Answer Q1: Page 17

    A Stepwise approach on outpatient


    management of dengue infection is important

    Step 1: Overall assessment Not to forget


    1. History assessment of
    2. Physical examination- not done co-morbidities,eg
    capillary sugar etc
    3. Investigations - ?UFEME / FBC

    Step 2 : Diagnosis, disease staging and severity


    assessment

    Step 3 : Plan of management


    27/6/12 (Day 4 of fever) at Klinik
    Kesihatan
    Patient came back the next day, still complaining of
    fever with lethargy, diarrhea, vomiting and epigastric
    pain.
    T=38.5⁰C, BP 110/65, PR 100/min, hydration fair,
    Abd: soft, mild epigastric tenderness
    Diagnosis: Acute Gastroenteritis with gastritis

    Differential Diagnosis Dengue Fever

    Hb 10.3, HCT 41.5% Platelet count 120

    To review the next day with repeat FBC

    Q2: a) What are the warning signs?


    b) Would you have admitted this patient?
    Answer Q2(a):
    Page 18
    Answer Q2(b):
    CRITERIA FOR HOSPITAL REFERRAL /
    ADMISSION
    Page 19
    The decision for referral and admission should depend on
    the Total Assessment:
    1. Symptoms :
    • Warning signs
    • Bleeding manifestations
    • Inability to tolerate oral fluids
    • Reduced urine output
    • Seizure
    2. Signs :
    • Dehydration
    • Shock
    • Bleeding
    • Any organ failure
    3. Special Situations :
    • Patients with co-morbidity e.g. DM, IHD,
    coagulopathies, morbid obesity, renal failure,
    chronic liver disease
    • Elderly (>65 years old)
    • Pregnancy
    • Social factors that limit follow-up e.g. living far
    from health facility, no transport etc

    4. Laboratory Criteria:
    • Rising HCT accompanied by reducing platelet
    count
    28/6/12 (Day 5 of fever)
    Brought to KK at 12:05pm by ambulance call
    Seen by MO
    Fever 5 days

    still had diarrhea and vomiting

    Headache and joint pain

    Epigastric pain for 2 days

    Dark sticky stool 2 days

    BP unrecordable. Alert conscious


    Pulse: fast and small volume
    DIAGNOSIS :
    UPPER GIT BLEED WITH SHOCK SECONDARY TO DHF
    OR PEPTIC ULCER

    Ix: RBS=21.4mmol/L
    Treatment: IVD- Hartman’s 3pint via 2 IV lines
    Wrote a referral letter to the hospital
    Referred to hospital and accompanied by
    JM

    Q3. What could have been done by the doctor at K


    Kesihatan ?
    Answer Q3:
    Page 19

    The BP, Pulse monitoring must be continued while in


    the ambulance and patient must be accompanied by MO/MA

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