Interesting Cases & Achievements

Case of month of March 2019


A CSR patient with chronic pain abdomen attended to the hospital at medical      OPD for the treatment in march 2019. He attended TO medical OPD where he was recommended for USG Abdomen .  He underwent USG abdomen  where he was suspected to be a case of ILEOCAECAL TUBERCULOSIS and advice by sonologist  to rule out neoplasm  . For this he was sent to higher centre for imaging of  the abdomen.His MRI abdomen suggestive of Ileocaecal TB with Potts Spine at L3-4 level and abscess in right lower back and Gluteal region. There were a big collection of puss in his back. The surgeon has aspirated around 750 ml of collected puss. After this he  has been started AntiTB drugs on DOTS .He is doing fairly well and getting followed up. This is a rare form of TUBERCULOSIS where intestinal T.B. making a track leading to psoas abscess OR possibly this may be two independent foci of T.B.

   

 Case of month of May 2019

INTERESTING CASE OF BRUGADAS SYNDROME WITH PULSELESS VENTRICULAR TACHYCADIA REVERTED TO NORMAL SINUS RYTHM

ON 6TH MAY 19 ONE PATIENT  CAME FROM NEARBY PLACE OF VK BORL HOSPITAL WITH C/O REPEATED VOMTTING FOLLOWED BY GIDDINESS. HE WAS  ATTENDED BY US, WHERE HE WAS IN SHOCK HIS BP AND PULSE WAS NOT RECORDABLE, ECG WAS RECORDED HIGH S/O VENTRICULAR TACHYCARDIA. HE WAS SHIFTED TO ICU . IMMEDIATE CARDIOVERSION WAS DONE WITH XYLOCARD AND AMIODARONE I.V AND I V FLUID, HE RESPONED AND HIS ECG BECOME NORMAL SINUS RYTHM.

ON VIEWING THE ECG IT WAS FOUND TO BE A CASE OF BRUGADAS SYNDROME,THAT IS PARTIAL RBBB WITH J POINT ELEVATION. HIS ECHO CARDIOGRAPHY HAD SHOWN  NO STRUCTURAL ABNORMALITY, HIS LVEF WAS 55 %. PATIENT IS DOING WELL, FURTHER HE IS ADVISED IN FUTURE FOR IMPLANTABLE CARDIAC DIFIBRALLATOR AT HIGHER CENTER.

                                         

ECG ON ADMISSION

ECG AFTER CARDIOVERSION

     OTHER INTERESTING CASES TREATED AT VK BORL HOSPITAL 

  

 1 A CSR PATIENT ADMITTED IN EMERGENCY DEPARTMENT WITH A H/O SCORPION STING POISON. SHE WAS IN SHOCK STATE WITH RESPIRATORY DISTRESS. BP WAS ONLY 70 MM HG. HER ECG S/O SINUS TACHCARDIA  WITH ST DEPRESSION IN ANTERIOR LEADS.. X RAY CHEST WAS DONE WHICH INDICATED BILATERAL PULMONARY OEDEMA WITH NORMAL C T RATIO.

HER LAB REPORTS S/O LUCOCYTOSIS AND NORMAL BLOOD SUGAR,LFT AND KFT AND ELECTROLITE. SHE WAS KEPT ON ICU MONITORING. VASOPRESSOR  DOBUTAMIN DRIP STARTED ALONG WITH REPEATED DOSE OF   PASOPRESS WHICH IS AN ALPHA RECPTOR BLOCKER . FOR BILATERAL PULMONARY OEDEMA INJ FRUSEMIDE WITH CONTINUOUS OXYGEN SUPPORT GIVEN. EMERGNCY 2 ECHO WAS  PERFORMED WHICH INDICATED A VERY POOR LVEF 30 %. SHE RESPODED WELL TO TREATMENT.,FOLLOWUP 2 D ECHO DONE WHERE HER LVEF IMPROVED TO 65%. SHE WAS DISCHARGED IN STABLE STATE.

     OTHER INTERESTING CASE IN MONTH OF FEB 2019

  "A SWINE FLU CASE PRESENTED WITH  AVNRT IN BORL TOWNSHIP    CANTEEN"

ONE OUTSOURCED EMPOYEE OF BORL CANTEEN DEVELOPED  COUGH AND COLD IN FEB 2019. HE LANDED IN CASUALTY IN MILD RESPIRATRY DISTRESS AND   IN  SEVERE HYPOXAEMIA, SPO2 WAS RECORDED WHICH  WAS SHOWING 84% SATURATION ,HIS PULSE WAS VERY FEEBLE AND BP WAS 70 MM HG.  HIS  ECG WAS RECORDED WHICH WAS SHOWING NARROW COMPLEX TACHYCARDIA  THAT IS AVRNT. IMMEDIATELY I V DILZEM 5 MG TWO AMPULES IN THE GAP OF 5 MINUTES PUSHED.PATIENT RESPONDED HIS B.P CAME TO 120/80 AND PUSE 96/MINUTE. DESPITE THIS HIS OXYGEN SATURATION WAS PERSISTENTLY LOW. OXYGEN SUPPORT GIVEN AT THE RATE OF 4 TO 6 LITRE/M.MEANWHILE  X RAY CHEST WAS PERFORMED SHOWING BILATERAL PNEUMONITIS WITH NORMAL C.T. RATIO. EMPEICAL ANTIBIOTIC STARTED AND PATIENT WAS REFERRED TO HIGHER  WITH THE SUSPICION OF SWINE FLU.  IN THAT CENTRE HIS SAMPLE WAS SENT FOR EXCLUSION OF SWINE FLU TO VIRLOGY LAB THAT LATER ON CONFIRMED TO BE A CASE OF SWINE FLU. AFTER FEW DAYS HE WAS DISCHARGED IN STABLE VITAL.