bed 3
60yr/M
A 60 yr old male  daily wage labourer by occupation b came to the casualty with chief complaints of fever with chills since 10 days
c/o dry cough since 10 days
c/o burning micturition  since 10 days
patient was apparently alright 10 days ago and then developed high fever which was intermittent , associated with chills ,relieved with medication/o dry cough not associated with sputum since 10 days,SOB since 10 days which was intermittent
C/o burning micturition since 10 days
 
no c/o of vomitings, loose stools  
history of pulmonary kochs 3 yrs ago used ATT for 6 months , (coughassociated with sputum and low gade fever)
past history 
not a known case oc HTN,DM,CAD ,CVA
appetite- normal
bowel movements- regular
micturition- normal
no addictions
no significant family history
general examination
no pallor,icterus, cyanosis, lymphadenopathy and edema
pulse rate: 104bpm
BP: 110/80 mmHg
respiration: 29/min
spo2 : 98%at RA

CVS
s1,s2 heard
RS :
BAE + ,NVBS,right inframammary and infra axillary crepts +
Abdomen:
soft,non tender
CNS: 
NAD
provisional diagnosis
PULMONARY KOCHS
Treatment
1) IVF 
  2 pint NS 
  2 pint RL
  1 pint DNS @100 mp/hr
2) Tab.Dolo 650 mg po/Qid
3)Neb.Duolin 12th hrly
             Budecort 12 th hrly
4)inj.neomol 1 gm IV /sos ( if temp > 101F)
6)inj.pantop 40 mg IV/OD
7) vitals monitoring 4th hrly
8) plenty of fluids (4 lit /day)
9) syp.Grillinctus 10 ml /po/BD
  
RICU
60yr/M


S- High grade with chills yesterday evening

O-
Pt is c/c/c
temp-101F
PR-72 bpm
BP-90/60 mmHg
CVS- S1, S2 heard
R.S - BAE+ ,IMA,IAA crepts +
P/A- soft,non tender, 
CNS-Hmf intact ,no FN


A- PULMONARY KOCHS
p-
1)IVF @ 100ml/ht
Treatment
1) IVF 
  2 pint NS 
  2 pint RL
  1 pint DNS @100 mp/hr
2) Tab.Dolo 650 mg po/Qid
3)Neb.Duolin 12th hrly
             Budecort 12 th hrly
4)inj.neomol 1 gm IV /sos ( if temp > 101F)
6)inj.pantop 40 mg IV/OD
7) vitals monitoring 4th hrly
8) syp.grillinctus 10 ml/po/BD
9)inj.monocef 1 gm 
IV/BD
10)plenty of oral fluids
11)ATT drugs*3times

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