70 year male with unresponsiveness





PRESENTING COMPLAINTS:
A 70-year male was brought to the casualty on 28/09/2022 with complaints of :
• An episode of vomiting at 4 pm.
• Breathlessness 
• Unresponsiveness since 7 pm.

HOPI: 
A 70-year male was brought to casualty with a complaints history of binge alcohol intake in the morning; followed by an episode of vomiting at 4 pm followed by complaints of breathlessness which was sudden in onset, and gradually progressive; not associated with chest pain/ palpitation/ orthopnea/ PND. No history of fever/ cough/ cold/ seizure/ burning micturition/ decreased urinary output and head injury. The patient was unresponsive for which he was brought for consultation and admitted for further treatment and evaluation.

PAST ILLNESS:
The patient had complaints of multiple episodes of breathlessness after exposure to dust for which he sought consultation and was diagnosed to be having  ASTHMA 3 years ago, and started on inhalers.
He was diagnosed with Hypertension 2 years ago upon regular checkup.

PERSONAL HISTORY:
Moderately built and nourished.
Appetite normal.
Sleep disturbance when the patient doesn't consume alcohol.
Regular bowel and bladder movements.
Allergic to dust.
The patient was a Chronic alcoholic: who started at the age of 24 years of age (amount unknown); he gradually decreased the quantity of alcohol due to gastric issues and frequently consumes 90-180ml of whisky/day.
Chronic smoker: The had history of tobacco consumption in the form of chutta for 24 years of age, he changed to cigarettes 10 years ago and gradually stopped smoking after being diagnosed with Asthma 3 years ago.

GENERAL PHYSICAL EXAMINATION:
The patient was drowsy but arousable. 
GCS E2V2M3 ( 7/15)
No Pallor/ Icterus/ cyanosis/ clubbing/ lymphadenopathy and pedal oedema.
Afebrile Temp: 98.7°F
PR: 72bpm; RR: 36cpm; SpO2: 99%@ RA; BP: 160/100 mmHg; GRBS: 155 mg/dl.
CVS: S1,S2+; R/S: BAE+, clear; P/A: Soft, non tender, BS+; CNS: NFND.

COURSE IN THE HOSPITAL:
A 70 year male clinically presented with the above mentioned complaints. Upon admission initial assessment was done and necessary investigations were sent. He was using his accessory muscles for respiration and tachypnic. His GCS was E2V2M3, he was started on INJ. THIAMINE. He regained consciousness and was irritable. He was sedated with INJ. LORAZEPAM 2cc. He was shifted to AMC for further monitoring. At 6 AM he regained consciousness and was cooperative, oriented to time,place and person. His BP was 110/70mmHg.





CLINICAL IMAGES:

 



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