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41 | [{'role': 'user', 'content': '\nIP Number: 41\n\nPatient Number: 2756\n\nPatient Name: KOCHU THRESIA MICHAEL\n\nGender: F\n\nDate of Birth: 07-07-1932\n\nAddress: 27/78, V.P MARAIKAR ROAD, EDAPALLY NORTH\n\nPincode: 682024.0\n\nPhNo: 0484 - 2543217\n\nAdmission Date: 31-08-2011\n\nDischarge Date: 22-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by Dr.A.K.Bhat\r\nResolving ?Necrotising fasciitis Lt leg.\r\nAdvice:IV Fortum,Tbact oint. local application tds,Candid cream between toes bd,Inj.Clexane,Rest&leg elevation.\nVitals stable. pre- lunch- 159, still has redness in the Lt leg, an area of ? pus collection near the ankle. will show it to Dr Bhatt\nvitals stable, more alert now, clinically the Lt leg looks better, oedema subsided. redness still present.\r\nBlood sugar well controlled\r\nInput- 850\r\nOutput- 700, Na- 123\nFeeling sleepy. was able to get an I.V access. Will check NA+\r\nOedema subsiding\r\nHb- 8.6, TIBC- 163\nSeen by DR.A.K.Bhat\r\nEdema&redness decreased.Small focal scab lateral ankle needs observation.\r\nAdviced:vaseline application&Tbact\r\n\r\nVitals stable. had good sleep yesterday. more alert sittting up and eating food.\nvitals stable, blood sugar controlled. alert, slept well. oedema subsided. erythema better.\nGeneral condition stable. Cellulitis better. Since the IV line is out we have decided to go with oral cephalosporins.\nSeen by Dr.A.K.Bhat\r\nThe redness is less &ulcers of the left leg are healed.\r\nAdviced:Emollients.\npt feels better, more alert , oedema and redness subsided.\r\nswitched to oral antibiotics.\r\nTab Flunil put on hold.\r\nwill discuss with DR bhatt and family the plan for discharge\nPR 76/min , B.p-140/70mmof hg, CVS-S1S2 Normal , RS-Clear, Restricted Rt Shoulder movement, Cellulitis subsiding\r\n\nfebril, vital stable, Continue the same\r\nTPR Chart, Intake /output\nVitals stable, No fever. ,AC- 150, Blood RE- 12,050.\r\noedema subsiding, redness getting better.\r\n11:00am Disscused with Dr. Bhat, adviced to add Tab. Ciprofloxacin watch for 2days, continue the other medication , Tab.Chymoral forte 1-0-1\nvital stable, no fever, changed the cannula, continue the same orders\nCellulitis better. Onychomycosis+\r\n6:00pm Vital stable , Afebrile, continue the order\nDoing well, vital stable, swelling status co, FBS 169,increse the dose of metformin\r\ncontinue the same orders\nBetter,vital stable, continue the same\nVital stable, Leg sweelling decresed, Systemic examination -NAD\r\nBlood routine , platelet count\nAfebrile, Limb status co, Systemic examination NAD\r\nDiscussed with son , insisted to start on Linzolid, started on Linazolid\nCellulitis/ Necrotizing fascitis - status quo. Over all general condition is good.\nCellulitis better. General condition good. Mobilized her a bit.\r\nSeen by Dr.A.K.Bhat\r\nRedness &swelling decreased.Adviced:Crepe bandage.\r\nStop fortum.\nDoing well, redness subsided , FBS 164, Vital stable , Systemic Examination -NAD\r\nplan to change to Oral medication\nVitals stable. GRBS- 203, No fever\nDoing well, Odema subsided, redness subsided , D/C Cannula, Continue the same order, swith over to Tab.linazolide\nPR-86, B.p 190/100mmof hg , RS-Rhonchi +, \r\nStop Revolol, Change to Tab. Nebivolol, Tab. Amlodipine 2.5mg stat\r\n8:15pm C/o Chest pain transient, PR-70/min, B.p-150/70mm0f hg ECG-RBBB, No ST-TChange\r\nRpt ECG in the morning\nPR-80/min , B.P 140/70mmHg,RS-Rhonchi+, Crepitation +\r\nPA-NAD, Mild pedal odema\r\ncontinue the same\nPR-80/min , B.P 160/70mmof Hg, RS -Crepitation +/Rhonchi\r\nLeg better\r\nDoing well, Plan to add small dose of Diuretics\r\nBLOOD ROUTINE, PLATELET COUNT, UREA , CREATINE, Na+, Ka+ TOMORROW\nPt ambulating. Cough better. Blood work done.\r\nPlan is to discharge to a rehab facility\nseen by Dr.A.K.Bhat.\r\nAdviced emollients.Stop linezolid.\r\n6:30pm Better, RS-Rhonchi +,Stop Cetaphil\nS/b Dr.Ramesh Nair\r\nCellutitis, Acute Bronchitis\r\nIV Deriphylline 2cc i.v slowly bd\r\nCombimist Neb Q6h\r\nBudocort Neb Q8h\r\nTab.Mucinac 600 1-0-1\r\nSteam Inhalition\nc/o feeling Nauseous, B.P better control. \r\nChest - B/l wheeze and Rhonchi\nDoing well. General condition status quo. Chest better- occasional rochi\nfine, B.P 170/80mmof Hg continue the same\nRhonchi, GRBS-223mg/dl, Stop Odyphylline, Started on Abphylline 100mg BD\nVital stable, B.P 130/70mmog hg, CVS-S1S2 Normal, RS-B/l Rhonchi +, Leg Odema Better\r\nStop Tab.Linozolid\nDR.Rmesh Nair visited the Pt\r\n\r\nGC- Better\r\nVital stable. GRBS- 136, plan to discharge on thursday\nPR 76/min , B.P-140/70mmof Hg, RS-Rhonchi+, Mentation stable.Stop Linazolide, stat Levofloxacin , Mucomix Nebulization , continue the same\r\n\r\n\r\nDr .Ramesh Nair visited the pt on 17/09/11\nVitals stable. GRBS- 120, \r\nRS- B/L rhonchi, seen by pulmonary yesterday, continue the same medicines\r\nIntend to D/C tomorrow.\r\nChesyt Physiotherapy\r\nRpt Na tomorrow\nbetter, vital stable, Rs-Rhonchi +\nVitals stble. Intend to D/C today'}, {'role': 'model', 'content': '\nIP Number: 41\n\nPatient Number: 2756\n\nAdmission Date: 31-08-2011\n\nDischarge Date: 22-09-2011\n\nDiagnosis: Cellulitis/? Necrotising fascitis\r\nSIADH\r\nOsteoarthritis\r\nEssential HTN\n\nClinical Exam(With BP): admitted with swelling, redness and pain in the Lt leg x 10-14 days\r\n.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Elderly female, not in any distress.\r\nRS- B/l Rhonchi\r\nLOcal - oedema, redness, INcreased warmth with chronic dermatitis changes\n\nDiscussion: 79 yr old with H/o DM, Osteoarthritis admitted with redness, pain and swelling of the Lt leg, ( cellulitis/? necrotising fasciitis ) started in I.V antibiotics, seen by surgeon. Venous doppler was done which showe No thrombus, but valve incompetanance. Hyponatremia was corrected with hypertonic saline. Glycemic control was achieved with tab Metformin and bed time dose of lantus. Pt was also seen by Cardiology for evaluation of hypertension. Echo was done which was normal. Antihypertensive meds were adjusted. During the hopsital stay, devloped chest congestion, started on Combimist Nebs and Budesonide Nebs and also seen By pulmonary who recommended the same.\r\nPt was initiated on to physical therapy.\r\n\n\nDiet: NUTRITION Dept:\r\n1600 kcal, low fat,less spicy, diabetic diet with small, frequent feeds adviced\r\nExtra salt added\r\nDiet sheet given\r\n\n\nRemarks: nan'}] |
53 | [{'role': 'user', 'content': '\nIP Number: 53\n\nPatient Number: 2822\n\nPatient Name: SOPHY JOSEPH\n\nGender: F\n\nDate of Birth: 10-09-1951\n\nAddress: PAVANA HOUSE, KP VALLON ROAD\n\nPincode: 682020.0\n\nPhNo: nan\n\nAdmission Date: 10-09-2011\n\nDischarge Date: 26-09-2011\n\nDiagnosis determined by the doctor when the patient was admitted: PRIMARY HYPOTHYROIDISM\nTYPE 2 DIABETES MELLITUS\nEssential (primary) hypertension\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\froman\\fprq2\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 Ms Sans Serif;}{\\f2\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \\fs28 \\ul VENOUS DOPPLER\r\n\\par \\plain\\fs24 \r\n\\par \r\n\\par \\f1\\fs18 \\fs24 \r\n\\par \r\n\\par Right Limb : Absant flow Rt Femoral and Poplital Vein\r\n\\par \\fs18 \r\n\\par \r\n\\par \r\n\\par \r\n\\par \\fs24 Left Limb : Evidence of absant flow in Lt Femoral vein\r\n\\par Poplital vein shows Normal flow \r\n\\par \r\n\\par \r\n\\par \r\n\\par \\f2 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Ms Sans Serif;}{\\f1\\froman\\fcharset0 Times New Roman;}{\\f2\\fnil\\fcharset0 MS Sans Serif;}}\r\n{\\colortbl ;\\red0\\green0\\blue0;}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 \r\n\\par THROMBOSIS/THROMBOPHLEBITIS OF Rt FEMORAL & POPLITAL VEINS \r\n\\par THROMBOSIS OF Lt FEMORAL VEIN \\cf1\\f1 \r\n\\par \\pard\\li1440 \r\n\\par \\fs28 Dr.Joe Antony \r\n\\par \\pard Consultant Radiologois \\cf0\\f2\\fs20 \r\n\\par }\r\n\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Vital stable, mild Hypoglycemic episode at 6:30pm , adviced to give dinner\r\nC/o Pain in the Leg\r\nInj.Emeset 4mg I.V stat\r\nAdviced Inj .Tramadol 50mg I.V st ATD\r\nNovorapid 10units just after dinner\r\nLantus 16units at bed time\r\nTab.Lasix 40mg st\r\n10:40pm C/o Brethlessness, B.P 130/80\r\nRS-Basal Crepitation +\r\nInj. Lasix 40 mg i.V stat\r\nECG Left axis deviation, No ST strain\r\nSPO2-95%\r\n\nSleep disturbed , pain prsentPR 76/min , B.p110/70mmof hg, RS-Clear\r\nIntake/output-300/350\r\nSerum Creat levels are going up (2.4 mg/dl)\r\nReduced the Microtaz 4.5g BD\r\nStop Tab. Telmisartan, Tab. Platloc A\r\nS/b Dr.A.K.B \r\nB/l Lower limb lymphangitis/Cellulitis\r\nNo Evidence of focal abcess.Blisters dorsum of left foot-deroofed.\r\nPlanned to add Linozolid.\r\nXray left foot including toes AP&Oblique\r\nCBC, Urea, creatinine,sodium, potassium\nPR-76/min , B.p 110/70mmof Hg, RR-26, RS-Air entry equal \r\nAfebrile, Pain subside,\r\nTachypenic , Rs-Clear, CVS-S1S2 Normal , PA-Fluid shift +\r\nPlanned Shift to ICU\r\nS/B Dr.Sasikumar\r\nTachycardic , Tachypenic, Cardiac status with in normal limit\r\nBreathlessnesss because of Volume overload, ? Acute on Chronic Renal failure\r\n\r\n11:15am S/B Dr.Elizabath, Dermatologist\r\nImpresion Bacterial Skin infection , Cetaphin lotion , Rt axilla mild Fungal infection , apply candid cream, \r\nApply T-bact Ointment for Local infection. Antibiotic according to blood c/s\r\n12:00 am Shift to ICU\r\nUrinary Cath\r\nI/O Chart\r\n\nPulse- 107, B.P-110/70, output- 800ml\r\nNo fever, \r\nChest - clear\r\nHb, TC, Na+, K+, Urea, Creatinine- Morning\nBetter, Afebril,vital stable, continue the same\r\n7:30pm Febrile, cannula out , adviced Tab.Welset, Inj.Clindamycin i.m , incrase oral intake\nSeen by Dr.A.K.Bhat:Pain&redness right leg has decreased.\r\nThere are multiple blisters over dorsum of left foot.The blisters were deroofed&serous fluid drained.Dressing done.Adviced:Inj.Clindamycin.\r\n9:00am S/b Dr.Tom , Clinicaly better, Vital stable , continue the Hydration , Spo2 99% , PR-108/min , B.p 110/80mmof Hg, CVS-S1S2 Normal ,RS-NVBS,No added sound\r\nStop Linazolide, continue the other, Blood transfusion (Whole Blood)\nSeen by Dr.A.K.Bhat.\r\nThe blisters of left foot dorsum were deroofed to reveal a sinus exposing deeper subcut.fat /slough, suggestive of localised necrotising fasciitis.Repeat wound swab fr C/S taken.A part of the subcut.fat was excised and sent fr tissue C/S.\r\nC&D DONE.\r\nCounts coming down, S.creatinine coming down, \r\nDiuretic phase\r\nH/o L-stools\r\nadd Cap.Yogut 1-0-1\r\n8:30PM B.P 190/80MMOF HG\r\ntAB.REVOLOL50MG 1-0-1\r\nTAB.OLVANCE 40MG STAT\nNo loose stools since last night. Sleep disturbed. c/o dry cough. Secured a good line for IV access.\r\no/e: chest clear, skin lesion with cellulitis better.\r\nTransferred from the ICU, Renal function getting better.\r\nCreatinine-1.4, blood urea- 54, will stop I.V fluids\r\nSpoke with surgeon, might need debridement of the underlying tissue, discussed with the family\nSeen by Dr.A.K.Bhat.\r\nDressings changed.The blisters of left foot dorsum completely deroofed.However the edema&redness of foot&leg has decreased.There is e/o subcut.necrosis fr about 7x7 cm over dorsum.This may need skin&soft tissue slough excision under LA.\nC/o Breathlessness at night, sleep disturbed, vital stable\r\nBlood sugar good, Xray Chest -PA, ECG\nSitting, PR-108/min , B.P-140/80mmof Hg , CVS-s1s2 N0rmal, RS diffuse crepitation ,spo2 90%, adviced\r\nBudocort Nebulization 1-1-1\r\nInj.Tramadol 50mg sos\r\nwithhold platloc As\r\nHb,DC,S.Cr, Na+,K+-morning\nBetter, Vital stable, Spo2-94%, PR-80/min , RS-few rhonchi\r\nContinue the Nebulization\nVitals stable. dyspnoea slightly better..pulse oximetry- 94% RA. Planned to do debridement today under local.\r\nafebrile, renal function improving. WBC slightly decreased.\r\nChest- b/l rhonchi and wheeze\nHas not slept last night. Swelling over both feet much better.\r\n\r\nTo send CBC, Na, K, Se Creat tomorrow\nfine, Tab.Trika 0.5mg stat\nFine vital stable, Rs-Clear, CVS-S1S2 Normal, Vasolin Body lotion for local application , Cetaphil lotion -stop.\r\nSeen by Dr.AK.Bhat.\r\nDressing changed.Raw area left foot dorsum is clean.\r\nS/b Dr.KMR\r\n? Allergic Bronchitis\r\nAdviced add Tab.Claribid 250 mg BD x 5days\r\nOdphylline 400mg 1/2 -0-1\r\nTab.Allegra 180mg OD\r\nSyp. Alex (sugar free) 2tsp 1-1-1\r\n\nVital stable , comfortable, Inj. MicrotaZ 4.5g, Tab.Dalacin 600mg, Tab.Linazolide 600mg\\\r\nContinue the same\nVital stable, RS-Clear, stop Microtaz , reduced the nebulization, Clindamycin changed to tab, added Linazolide\r\nClaripid for atypical coverage\nVitals stable. GRBS- 99, \r\nRS- B/l creps\nSeen by DR.A.K.Bhat.\r\nDressings changed.The raw area over left foot dorsum is clean.No residual pus or slough.Right heel superficial ulcer is healing well.Adviced:Cap.Clindamycin 300 mg tds.\r\nfine, continue tha same\nsitting up, not in any distress. blood sugar controlled. \r\nc/o itching in the armpits and in between the buttocks.\nVitals stable. No fever. Dressing change done yesterday by DR bhatt. Lt foot- healing, granulation tissue present.\r\nChest - B/L creps\nseen by dr.a.k.bhat.\r\nafebrile.\r\nGetting chest physiotherapy. No fever, stopped linezolid\nSeen by Dr.A.K.Bhat.\r\nDressing changed.Raw area left foot dorsum is clean.Rt. leg blisters healing well.\r\nContinue trt.\r\n6:00pm Cough, vomited once \r\nRS-Crepitation +, Rhonchi +\r\nIncrese the nebulization Combimist Q6h, Derinide 1-1-1\r\nRestarted Tab. Mucinak 600mg -1-0-1\nVitals stable. sittting up. GRBS morning controlled, afternoon sugar slightly high.\r\n\n142mg/dl -8units Novorapid ,\n6:00pm PR-90/min , B.P 140/60mmof Hg, CVS-S1S2 Normal, RS Few crepitation , Rhonchi\r\nBlood tranfusion \r\nPremedication\r\nVital stable\r\n\nDoing well. Blood sugars are well controlled.\r\nSeen by Dr.A.K.Bhat.\r\nDressing changed.Left foot raw area clean.\r\nRt. heel healing well.'}, {'role': 'model', 'content': '\nIP Number: 53\n\nPatient Number: 2822\n\nAdmission Date: 10-09-2011\n\nDischarge Date: 26-09-2011\n\nDiagnosis: DIABETIC FOOT-Necrotising Facitis\r\nFILARIASIS-RT\r\nGLUCOMA\r\nImpetigenous Lesion all over both lower limbs\r\nUrosepsis\r\nAcute Renal failure\n\nClinical Exam(With BP): H/o Sweling over the Both foot-1week\r\nUncontrolled Diabetes\r\nH/o multiple Furcuncle over the leg. Duration of Diabetes - 10 years\r\nCurrent Medication\r\nNovorapid 18-20-0\r\nNovomix 25 at bed time\r\nDecresed urine out put\r\nH/o fever\r\nPolyuria, Polyphagia, Polydipsia - No\r\nWeight Loss- No\r\nBlurring of vision-No\r\nDiabetic eye examination- Yes\r\nGlucoma, No DPR\r\nBurning Sensation of feet -Yes\r\nNumbness of feet-Yes\r\nNon healing Diabetic Foot Ulcer-Recurren\r\nSwelling of feet -Yes, increses during Fever\r\nRt Filariasis\r\nCornary heart Desease-No\r\nDyslipidemia-No\r\nHypertension-yes\r\nRecurrent infections- Yes\r\nAutonomic dysfunction (orthostatic hypotension, early satiety, constipation)- Yes \r\nHypoglycemia - No\r\nDry skin. Had Abscess-Rt foot, Iand D done 11/2yrs back\r\nH/o Blood transfusion in past for anemia\r\n. Dyspenic\r\nRS-B/l Airentery Equal\r\nCVS-S1S2 normal\r\nPA- Soft, No Tenderness, No Organomegaley\r\nShifting dullness prsent\r\nCNS-Consious /Oriented\r\nMotor/sensory -Normal\r\nReflex -+\r\nPeripheral circulation -+\r\n.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: Elderly Lady K/C/O Type 2 Diabetes Mellitus , Hypertension , Diabetic Neuropathy .Admitted with the history of Swelling and pain over the both leg more on the Lt ,Lab investigation Leucocytosis, Elevated Urea , Creatinine, Urine routine -Bacteruria, Multiple Pus cell. Treated with Broad specturm antibiotic covering Gram Positive,Negative,Anaerobic, Pus/Blood Culture were negative . On 3rd day of admission Renal parameter are settling down,\r\nInfection localized to Rt foot, Incsion and Excised the Necrotic tissue, Blood count are improving, Had Broncho constriction , sought pulmonoilogist consultation , started on Bronchodilators, inhaled steriods and Mucolytic and Chest Physio, Chest is better, on Prophylactic DVT regimen. Slowly ambulated. Her HB was low tranfused 1units of Whole Blood\n\nDiet: NUTRITION Dept:\r\n1500 kcal, low fat, low salt, low potassium, diabetic diet with small, frequent feeds adviced\r\nDiet sheet and diet booklet given\n\nRemarks: nan'}] |
99 | [{'role': 'user', 'content': '\nIP Number: 99\n\nPatient Number: 3092\n\nPatient Name: K.M NOORJAHAN\n\nGender: F\n\nDate of Birth: 06-10-1956\n\nAddress: THACHAVALLATH HOUSE, MUPPATHADAM P.O\n\nPincode: 683010.0\n\nPhNo: 0484 - 3222955\n\nAdmission Date: 06-10-2011\n\nDischarge Date: 20-10-2011\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Feels better. GRBS- 198\nPatient was weak.GRBS 395mg/dl.\nDental Consaltation.Opthalmic Consultation.Check TSH,T4.Check Versa lab,Vibrometer.\nFeels better. Sugar still not controlled.Opthalmology and podaitry evaluation done.\nCheck Orsthostatic hypotension.\r\nECG done.\r\nODST to be done.\nC/o Burning sensation in the foot\r\nAdded Tab.Amitone\nVital stable, \r\nMoon face, buffole Hump,Straie\r\n\r\nDexona 1mg at 11:00pm , S.Cortisol at tomorrow 8:00am\r\n(send 1sample outside)\r\nContinue the orders\nPatient was weak.T.welset sos to be given.\nbetter,vital stable, dexomethasone suppresion test\r\n\nPatient feels much better.Low dose supressive test to be done (13/10/2011).\nfine,vital stable, continue the Dexona as adviced\nC/o burning sensation in both the legs,GRBS- 424\nVitals stable.Pelvic traction today.Tomorrow blood withdrawal at 8am.\nGC fine.S.cortisol taken.FBS-193mg/dl.\nComplaints of weakness.AC 231mg/dl.Cortisol reports awaited.\nPut Cannula, heparine 0.5ml dilute in 1ml ,push 0.5ml (Heap block) Draw serum cortisol at mid night(12am)\r\n\nBeter,on MVI\r\nSyp.Duphalac 15ml HS \r\ncontinue other\nMidnight cortisol report awaited.Complaints of generalised weakness.Slept for a few hours.FBS-172mg/dl.\nfine, vital stable\r\nAC-154\r\nDiffculty in walking, \r\nS.cortisol awaited\r\nContinue the same\nAC-138mg/dl.Planning for 24 hrs urine free cortisol level.\r\ncontinue the same\r\n\nC/o pain.GRBS-196mg/dl\nC/o genaralised weakness.Fbs still high.Slept well.Passed stools.24 hr Ufc ongoing.\nfeeling tired,GRBS-301mg/dl\r\nVital stable\r\nWithhold Amitone\r\nContinue the others\nGeneral condition slighlty better. AC- 111 mg/dl. MRI done in 1996 was discussed with radiologist who opined that she had severe spondylosis back then.\nVitals stable, sugar better controlled today.\nC/O GC weakness and head ache.'}, {'role': 'model', 'content': "\nIP Number: 99\n\nPatient Number: 3092\n\nAdmission Date: 06-10-2011\n\nDischarge Date: 20-10-2011\n\nDiagnosis: nan\n\nClinical Exam(With BP): nan\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: 55 yr old with H/o DM admitted with weakness and uncontrollable blood sugar.Insulin dosage was titrated up according to the GRBS.She was also evaluated for cushing's during the stay. ODST was performed, cortisolAM level was high, so evaluated for high dose Suppression test. 24 hr urine free cortisol level was done, results awaiting.\r\nH/o lumbar radiculopathy Lt side, phsical therapy was done, with better relief of the pain. Pt also being evalauted ny a neurologist for the worsening radicular pain .\n\nDiet: NUTRITION Dept:\r\nLow calorie, low fat, diabetic diet in small, frequent feeds adviced\r\nDiet booklet given\r\nGlucerna SR- 2 scoop/ day with skimmed milk- 1 cup (Bed time)\r\n\r\n\n\nRemarks: nan"}] |
182 | [{'role': 'user', 'content': '\nIP Number: 182\n\nPatient Number: 4062\n\nPatient Name: KOCHUMUHAMMED\n\nGender: M\n\nDate of Birth: 12-12-1931\n\nAddress: KUZHUPPILLIYIL HOUSE\n\nPincode: 686671.0\n\nPhNo: 0485 -2548263\n\nAdmission Date: 12-12-2011\n\nDischarge Date: 28-12-2011\n\nDiagnosis determined by the doctor when the patient was admitted: Essential (primary) hypertension\nTYPE 2 DIABETES MELLITUS\nDIABETIC NEUROPATHY\nPRIMARY HYPOTHYROIDISM\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: FLP\r\nTSH\r\nUrine Microalbunuria\r\nXray Chest-PA\r\nXray Ankel Lt -AP/LT\r\nVeralab. Verometer\r\n\n0950:Pain less. DP & PT pulses felt, no fever, BP 150/90\r\nTendoachilles exposed. Xray: OM calcaneum. \r\nSeen by Dr. Bhatt.Ulcer leg exposing necrotic tendoachilles at insertion.C/S taken.Needs debribement under spinal anesthesia on 14-12-2011.\r\nPreop:Medical fitness.Nil oral as per anesthetist advice.IV Antibiotics.C&D.\nVitals stable. Scheduled for Wound debridement tomorrow.\r\nNO SOB\r\nECG- Normal\r\nCXR- Normal\r\nMildly anaemic, Pt medically fit for surgery\nCase posted today\r\nNPO after 12:00pm\r\nInj.Pantodac 40mg i.v sta\r\nInj.Emeset 4mg st\r\nTab.Welset 500mg st\r\nI.V NS 500ml 75ml/hr\r\nCombimist + Budocort st\nfine\r\nvital stable\r\ncatherised\r\ncontinue the same\r\nInsugen R4units st, Insugen N per orders\n4:15AM\r\nRestless\r\nVital stable\r\nC/o Itching and pain over the operated foot\r\nAdviced Tab.Deslar, Trika 0.5mg st.\r\n1130:Seen by DrA.K.Bhat.\r\nContinue trt.\r\n\n6.30\r\npt c/o mild paain.\r\nno fresh complaints\nEye check up\r\nRemove Catheter.\nSeen by Dr.A.K.BHAT\r\nDressing changed.\r\nUlcer heel clean.\r\nContinue trt.\r\nC/o constipation \r\nNot passed Urine\r\nTab.veltam 0.4mg st\r\nTab.dulcolax 2tab\nBlood sugar control fair.. Dressing today.\r\nSeen by Dr.A.K.Bhat.\r\nAfebrile.Pain decreased.\nHypoglycemia in morning\r\nVital stable \r\nContinue the same .\r\n\r\nSeen by Dr.A.K.BHAT.\r\nDressings LEFT LEG changed.\r\nWound clean.\r\nContinue treatment.Suggested oral antibiotic.\r\n\nChange I.V ANTIBIOTIC, CHANGED TO Clindamycin ACC C/S\r\n\nSeen by Dr.A.K.Bhat.\r\nNo dressing soakage.Continue trt.\nSeen by Dr.AK.Bhat.\r\nC&D done.The ulcer is clean&so is the upper suture line.\r\nSuggested oral antibiotic.\r\nCase seen by Dr Faisal\r\nnil special. wound dressing done in the evening, clean dry dressing.\r\nGRBS- 315mg/dl. Advised 16 units insugen R before dinner and 10 units Insugen N @ bed time s/c.\nc/o fissuring over the angles of the mouth (stomatitis). Bed side and chest physio\nBlood sugars are a little high on the current dose of insulin.\r\nChest- crepiations \r\nChest physio\nSeen by Dr.A.K.Bhat.\r\nContinue trt.\r\n6.00PM\r\nseen by doctor on call-dr sneha\r\nno pain.\r\nvitals stable.cough+,sneezing+\r\ncreps+\r\nadviced steam inhalation\n6.40am.\r\npt seen by dr sneha\r\nno fresh complaints\r\npt appears better,cough subsided,grbs-117,give R-14U\r\n0925: VS stable, Chest-better, minimal ronchi. Glossitis better.\r\nPlan:Ambulate slowly with walker.\r\nSeen by Dr.A.K.BHAT.\r\nDressings changed.\r\nWound clean.\r\nContinue treatment.\nVital stable\r\nRS-Rhonchi\r\nadd combimist\r\nContinue the rest\nC/S by Dr Faisal\r\nGC fine. \r\nGRBS 217mg/dl - Inj. Insugen R 16U s/c\r\ncont. same orders\nSeen by Dr.A.K.Bhat.\r\nContinue trt.\r\n\r\nMorning round: GC fine.\nc/s by Dr Faisal\r\nnil spl\r\ncont. same\nfeels well. physiotherapy to be done today. suture removal today.\r\n\r\nSeen by Dr.A.K.BHAT.\r\nDressings LEFT LEG changed.\r\nSutures removed.Residual ulcer clean.\r\nContinue treatment.\r\n\nVital stable\r\nContinue the same\r\nChest Much better\r\nReduced the frequency of Nebu\nDoing well. Blood sugars are well controlled. Dressing to be done today.\nSeen by Dr.A.K.BHAT.\r\nDressings RIGHT LEG changed.\r\nWound clean.\r\nContinue treatment.\r\n6.50pm\r\nseen by dr sneha\r\nno complaints,cough better\r\ngrbs-261,given insugen r-16,n-14\n6.40am\r\npt better,no complaints.\r\ngrbs-68.\r\n9:48am\r\nReduce the bed time insuline\r\nContinue the same\r\nPT\nSeen by Dr.A.K.BHAT\r\nNo dressing soakage.\r\nContinue treatment.\r\n\r\n8:00 pm\r\nvitals stable.\r\nnil spl. continue same.\r\n\nSeen by Dr.A.K.BHAT.\r\nDressings RIGHT LEG changed.\r\nWound clean.\r\nAdviced dressing with BiofillAB once in 2 days.\r\n'}, {'role': 'model', 'content': '\nIP Number: 182\n\nPatient Number: 4062\n\nAdmission Date: 12-12-2011\n\nDischarge Date: 28-12-2011\n\nDiagnosis: Non Healing ulcer over the Lt Foot\r\nosteomyelitis Lt calcaneum\n\nClinical Exam(With BP): nan\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: General Examination :Corneal opacity\r\nRS-B/L Crepitation\r\nNVBS\r\nCVS-JVP Normal\r\nS1S2 Normal\r\nPA-NAD\r\nCNS-Blind\r\nObey the Orders\r\nConsious/ Oriented\r\nAbsent Ankel reflex\r\nImpaired sensation\r\nDP-Feable Both side\r\nPT-Not felt\n\nDiscussion: A 80yr old man ,admitted with the history of non healing ulcer over the Lt Achillis, under antibiotic cover and fair glycemic control taken for wound exploration , found to have necrosis of Achillis tendon and OM calcaneum .\r\nTendon excisied, part of calcaneum curreted, Culture and sensitivity -Staphylococcus ,\n\nDiet: nan\n\nRemarks: FBS, PPBS, TSH'}] |
202 | [{'role': 'user', 'content': '\nIP Number: 202\n\nPatient Number: 4215\n\nPatient Name: IBRAHIM E K\n\nGender: M\n\nDate of Birth: 27-12-1957\n\nAddress: ELANJITHARA HOUSE, VADUTHALA JETTY P.O\n\nPincode: 688535.0\n\nPhNo: nan\n\nAdmission Date: 27-12-2011\n\nDischarge Date: 14-01-2012\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC NEUROPATHY\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: P/S Amputation of the Rt Great toe 3month back, Sustained Injury over the wound\r\nO/E Swollen Foot, Redness Mid Foot, raw wound over the Amputation stump\r\nSmall infected abrasion.\r\nSeen by Dr.A.K.BHAT\r\nOsteomyelitis right foot.Multiple sinuses discharging foul smelling pus.Cellulitis foot&ankle.\r\nxRay confirms osteomyelitis of residual first,2nd and 3rd toes till their bases.\r\nPlan:Guillotine mid foot amputation under SA.High risk consent.Packed cell transfusion.C&D.\r\n 2units blood transfusion \r\nIf Willing can do in the afternoon\r\n8:00pm\r\nSever Hypoglycemia\r\nIv 25% D rpt after 5min \r\nStop evening dose of insulin \r\nBlood transfusion 1unit before surgery\nRecovered from Sever Hypoglycemia\r\nVital stable\r\nNPO \r\nDNS +6units Insugen R 50ml/hr \r\nConsent-High Risk \r\necg -ST DEPRESSION IN V4V5\r\nPOOR \r\nXray Chest -AP-Apparent Cariomegaly\r\nNormal Lung Feild\r\n Xray Foot -OM 1st,2nd,3rd MT\r\nCan be Taken Under high risk\r\nRisk Explained and Consent taken \r\nSurgery at 2:30am\r\nBlood Transfuision started\r\nNo Rxn\r\nContinue the same\nVitla stable\r\nSpo2-99 at room air\r\nRs-Clear\r\nBlood on flow\r\nCath-Insitu\r\nInj.Lasix 20mg st\r\nContinue the antibiotic\r\nI.V.F NS 50ml/hr\r\nStop DNS\r\nInsulin dependent on \r\nInsugen N 4units \r\nCombimist Neb\r\nHB,PCV,NA+,K+,UREA,CRET\nSeen by Dr.A.K.BHAT.\r\nDressings dry.\r\nContinue treatment.\r\n\r\n8:00 pm\r\nseen by Dr Lakshmi.\r\nBP 110/70\r\nchest - clear.\r\nadvised to maintain strict I/O chart and inform sos.\r\ncontinue same.\r\n\nSeen by A.K.Bhat.\r\nFor secondary suturing of right foot stump under LA on 31-12-2011.Get consent.\r\nVitals stable. no fever. \r\nPus culture- enterococcus\r\nSensitive to cefuroxime\r\nCount has increased- 30,000\r\nHb- 13.0\nVitals stable.RBC on flow.S/P Packed RBC given yesterday.BRE,Ca,Na,phosphorous, Creatinine.Transfer out\r\nSeen by Dr.A.K.Bhat.\r\nDressings changed.\r\nThe large raw area of right foot and the leg fasciotomy sites look clean.\r\nContinue trt.\nDoing well. Appetite better, slept well. Has not passed stools since 5 days. Dulcolax suppository. BRE tomorrow\nVitals stable. more alert, talking, will repeat the count tomorrow.\r\nurine RE - normal\r\nNo fever. s/p suturing of the plantar flap\nSeen by Dr.A.K.BHAT\r\nSome dressing soakage-Overpadded.\r\nContinue treatment.\r\n\r\nseen by Dr Biju.\r\nGC - better.\r\nresponsive, vitals stable.\r\nGRBS - 136.\r\nno fresh complaints\r\ncontinue same.\r\n\nVitals stable. No fever, more alert. passed bowel movements.\r\nBlood RE tomorrow\nGeneral condition better. Has started eating better. Slept well.\n7.00am\r\ngrbs-114,\r\nadvised R-4units\r\nNo other complaints\nSeen by Dr.A.K.BHAT.\r\nDressings RIGHT FOOT changed.\r\nThe residual slough which was present esp. on lateral side of ankle was excised.Plantar flap looks viable.\r\nContinue treatment.\r\nMovement of limbs.\r\nc/s/b Dr Lakshmi\r\nbetter\n1020:V/S stable, prefers to lie in bed.Hb stable, leucocytosis less.\r\nRelative want to d/c in v/o finances. \r\nAdv: to stay on for few more days, check Na+.\nSeen by Dr.A.K.BHAT.\r\nDressings RIGHT FOOT changed.\r\nThe amputation stump looks clean.No e/o ascent of infection.\r\nContinue treatment.\r\nc/s/b Dr Lakshmi\r\nGC fine. afebrile.\n10:50am Has redness over lt.trochanteric femoral area.\r\nAdvised bed sore care.\nseen by dr lakshmi and dr sneha\r\nvitals stable\r\nno fresh complaints\r\nadv-inj ampoxin 1-1-1-1\n7.00am\r\ngrbs-140,give insugen-4 units\r\n10:20am Stable.Redness over left trochanter reduced.\n7:15 pm \r\nseen by Dr Lakshmi.\r\nvitals stable\r\nGRBS - 208\r\nContinue same.\nVitals stable. Sugar slightly high.\r\nDressind done everrday\nVitals stable. sugar slightly high. Dressing change done.\r\nSeen by Dr.A.K.BHAT.\r\nDressings RIGHT FOOT changed.\r\nLarge raw area medial&lateral aspects are clean.May be discharged with advice of once in 2 days dressing with metrogyl&cuticell.Frequent change of position.The prolonged time for healing has been explained.\r\nContinue treatment.\nSeen by Dr.A.K.BHAT.\r\nDressings RIGHT FOOT changed.\r\nRaw area clean.?plan for partial wound suturing.\r\nContinue treatment.\nSeen by Dr.AK.Bhat.\r\nFor sec.suturing under LA 11-1-12.\r\nGet consent.C&D.\nWound healing well. Plan to secondary suture soon.\nScheduled for 2* suturing. \r\nV/S stable.\nTolerating oral feeds better. Secondary suture planned for today. Wound looks better.\nDoing much better. Secondary suturing done yesterday.Physiotherapy to see and Dental consult.\nSeen by Dr.A.K.BHAT\r\nNo dressing soakage.\r\nContinue treatment.\r\n1815: bedwetting after removal of Ext.drainage.\r\nV/S stable.\r\n\nSeen by Dr.A.K.Bhat.\r\nDressings changed.The raw area rt.foot and suture line is clean.Plan for suture removal after 10 days.\nStill incontinent. Dressing today & then Monday before discharge.\nV/S stable,Discharge today.\r\nSeen by Dr.A.K.BHAT\r\nNo dressing soakage.\r\nAdviced dresing change once in 2 days.Betadine oint+cuticell.Review OP on 25-1-2012,wednesday.'}, {'role': 'model', 'content': '\nIP Number: 202\n\nPatient Number: 4215\n\nAdmission Date: 27-12-2011\n\nDischarge Date: 14-01-2012\n\nDiagnosis: Stump infection-Rt\n\nClinical Exam(With BP): Pt undergone amputation of the right great toe 3 months back,sustained injury over the wound.On examination found swollen foot,redness mid foot,raw wound over the amputation stump. The woumd was foul smelling.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: 54yr old male admitted with Swollen Foot, Redness Mid Foot, raw wound over the Amputation stump and Small infected abrasion.Seen by Dr.A.K.BHAT,suggestive of Osteomyelitis right foot.Multiple sinuses discharging foul smelling pus.Cellulitis foot&ankle.X-Ray confirms osteomyelitis of residual first,2nd and 3rd toes till their bases.underwent \r\nGuillotine mid foot amputation under SA.Packed cell transfusion and 2units blood transfusion given.wound cleaned and dressing done.Vitals normal.Discharging on stable condition.\r\n\n\nDiet: nan\n\nRemarks: nan'}] |
236 | [{'role': 'user', 'content': '\nIP Number: 236\n\nPatient Number: 4421\n\nPatient Name: K B BADARUDDEEN\n\nGender: M\n\nDate of Birth: 14-01-2029\n\nAddress: KAVAVUMKADA , THOPPIL HOUSE\n\nPincode: 683108.0\n\nPhNo: 2604087\n\nAdmission Date: 14-01-2012\n\nDischarge Date: 28-01-2012\n\nDiagnosis determined by the doctor when the patient was admitted: Essential (primary) hypertension\nDIABETIC NEPHROPATHY\nChronic ischaemic heart disease\nDisorders of lipoprotein metabolism and other lipidaemias\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: Non healing ulcer over the Lt 2 nd toe which started as an abrasion. Known diabetic on Insulin, hypertensive and is under treatment for CAD. Doppler study done outside shows reduced vascularity to the Left foot. He c/o severe pain now over the whole of the Lt lower limb. Complete blindness over both eyes 7 years ago.\n\nXray information: nan\n\nClinical examination: Dry Gangrene of Lt foot 2 nd toe with sorrounding cellulitis over the rest of the foot (? compartmentelised)\n\nPrecautions to be taken while treating the patient: Smoker- stopped 30 years ago\n\nRemarks: 1915:Sugarscontrolled. ?Versalab tomorrow.\nSeen by Dr.AK.Bhat.\r\nGangrene left 2 nd toe with cellulitis dorsum&plantar aspects.Distal pulsations not palpable,suggesting chronic PVD.C/S taken.\r\nPlan- conservative:Daily betadine oint. dressings,Antibiotics.\n7.00am\r\npt c/o severe pain in the foot\r\nadv inj tramadol\r\ngrbs-54,adv biscuits and sugar\nSeen by Dr.A.K.BHAT\r\nNo dressing soakage.Pain is less.\r\nContinue treatment.\r\n\r\nseen by Dr.Tom\r\nt.nitrest 5mg hs\r\ncontinue treatment\r\ngrbs-107mg/dl.hold insulin today\nSeen by Dr.A.K.BHAT.\r\nDressings LEFT FOOT changed.\r\nThere is gangrene of 2nd toe with e/o midplantar abscess.Cellulitis of foot.\r\nPlan I&D under LA.Get consent.\r\nstop platloc.\r\n\r\n7:00 pm.\r\nseen by Dr Biju.\r\ncatheterization done. Temp - 100\r\nurine output - good.\r\nGRBS - 145, \r\nIVF - DNS 75ml/hr.\r\nBP -110/50.\r\ncontinue same.\nStill spiking temprature. c/o pain over Lt limb. Had breakfast. BRE and Na+, K+ tomorrow. Repeated hypos despite holding insulin, chase culture reports.\nGeneral condition status quo. Still c/o pain. Slept well last night. AC- 122 mg/dl. Has not recieved any insulin since 2 days. Urea, Creat reports awiated.\nPlanned for Trans metatarsal amputation \r\nStop Platloc/Asprine, with hold the Dynalix\r\nCase at 3pm tomorrow\r\nIVF NS 50ml/hr\r\nStop DNS\r\ncontinue other\r\nConsent\r\nECG if not taken\r\nCardilogy consultation(fitness)\r\nHigh Risk consent\r\nHIV/Hbsag, PT/BT/CT\nI/O 1450/1550\r\nPR-84/min\r\nB.P-140/70mmof Hg \r\nC/O Pain over the wound which was relieved with Inj Tramadol.\r\nC& S shows Klebsiella species.\r\nSeen by Dr.AK.Bhat.\r\nFor leftmid foot amputation-->?proced BKA.Get high risk consent.\r\n\nshifted to Post Op\r\nvital stable\r\nIVF DNS 500ml + 6Units Insugen R 50ml/hr\r\nfollow the Post Op Orders\r\nstart orally\r\n\r\n09:30pm\r\nseen by RMO(Dr. Raees)\r\nvitals stable\r\nInj Tramadol 50mg IV SOS\r\nstart NS 500ml after DNS\n07:20am\r\nseen by RMO(DR. Raees)\r\nC/O centralised chest pain and sweating\r\nO/E BP-165/90, pulse-98/min,GRBS-111mg/dl, CVS-NAD, RS-NAD, spo2-89%\r\nECG- ST depression in lead 1, avl,v5,v6\r\n\r\nADV: T. sorbitrate 1 stat, T.clopilet 300mg stat, T.telmisartan 20mg, o2 inhalation\r\n\r\n\r\n08:15am\r\nBP-170/90, pulse-104/min\r\nRS-B/L basal mild crepts\r\nADV: inj. lasix 40mg iv stat\r\n\r\n\r\n08:30am\r\nBP-180/92, pulse-105/min\r\nADV: T. metoprolol XL 50mg 1 stat\r\n\r\n\r\n8:30pm \r\nAdded LMWH\r\nFollow the Advice\r\nNA 149, K 4.4\r\nHb-12\r\nTc 13000celll/cmm\r\nESR-102\r\nCkMB-23\r\nTrop I Negative\r\nShift to room\r\nCardiology Opnion\nSeen by Dr.A.K.BHAT\r\nMinimal dressing soakage.\r\nContinue treatment.T.Ultracet 1tds.\r\n\r\n\r\n7.11pm\r\nvitals stable\r\nno fresh complaints\r\ngrbs-149.\r\ncardiology consultation tommorow\n7:00 pm \r\nseen by Dr Deepak.\r\nGC - better, Afebrile\r\nvitals stable.\r\nno fresh complaints.\r\nGRBS - 177.\r\ncontinue same..\r\n\nBetter\r\nSeen Dr.Sasikumar\r\nAdviced \r\nTab.Carvipress 12.5 1-0-1\r\nARB,Statin,Nitrate, Antiplatelet\r\nfollow the orders.\r\nSeen by Dr.A.K.BHAT.\r\nDressings RIGHT FOOT changed.\r\nStump raw area looks viable.\r\nContinue treatment.\r\n\nSeen by Dr.A.K.BHAT\r\nNo dressing soakage.\r\nContinue treatment.\r\n\r\nI/o-850\r\nVital stable\r\ncontinue the same\r\nI.V NS 500ml i.v over 5hrs\r\n\nSeen by DrA.K.Bhat.\r\nDressings left foot changed.Stump raw area clean.Continue trt.\r\n7.00pm\r\ntemp-100f,given tab paracetamol\r\npus sulture sent\r\ncontinue same\nStill complaining of pain add Tab.Pregabalin\r\nRpt Creat,Na,K,Hb,Urea\r\nc/o Diarrhoea since AM.\nHad 1episode of fever\r\nD/C cath\r\nUrine Routine\r\nVital stable\r\nRS-Clear.\r\nSeen by Dr.AK.Bhat.\r\nTemp:99.\nseen by dr.deepak\r\nnot passed urine\r\ncontinue same medications\r\nt.weltam 0.4mg stat\r\nadv plenty of orla fluids\nSeen by DrA.K.Bhat.\r\nC&d Done.Stump raw area is clean.Continue trt.\r\n\r\nseen by Dr Deepak.\r\nchest clear.\r\nvitals stable.\r\nno fresh cmplaints\r\ncontinue same.\nSeen by Dr.A.K.BHAT\r\nNo dressing soakage.\r\nContinue treatment.\r\n\r\nClamping \r\nUsG Abdomen tomorrow\r\nContinue the same\r\nTab.Deslar 5mg 0-0-1\r\nTab.Veltam o.4 0-0-1\r\nHb,TC,DC,Na+,K+, Urea,Creat\r\n\r\n\r\nseen by dr.muneer\r\nnil complaints\r\ngrbs-178\r\ncontinue same medications\nVital stable\r\nAsypmtomatic\r\nHb,TC,DC,Na+,K+, Urea,Creat\r\nUSG Abdomen -Tomorrow\r\n\r\n\nSeen by Dr.A.K.Bhat.\r\nDressing changed.Stump raw area clean.\nvitals stable. no complaints. USG normal postrate. D/C cath. discharge tomorrow.\nDischarge\r\nVital stble \r\nContinue the same\r\nDressing Alternative days'}, {'role': 'model', 'content': '\nIP Number: 236\n\nPatient Number: 4421\n\nAdmission Date: 14-01-2012\n\nDischarge Date: 28-01-2012\n\nDiagnosis: POVD\r\nDry Gangren Lt Foot 2 nd toe\r\nCRF- Diabetic Nephropathy\n\nClinical Exam(With BP): Non healing ulcer over the Lt 2 nd toe which started as an abrasion. Known diabetic on Insulin, hypertensive and is under treatment for CAD. Doppler study done outside shows reduced vascularity to the Left foot. He c/o severe pain now over the whole of the Lt lower limb. Complete blindness over both eyes 7 years ago.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Dry Gangrene of Lt foot 2 nd toe with sorrounding cellulitis over the rest of the foot (? compartmentelised)\n\nDiscussion: Mr. K.B. Badrudeen presented to us with a limb threatening Diabetic foot infection - Dry Gangrene of Lt foot 2 nd toe with sorrounding cellulitis over the rest of the foot (? compartmentalised). Arterial doppler done outside showed compromised blood supply to that foot. He was taken up for a transmetatarsal amputation. The wound is healing well. Alternate day dressing with tight glycemia was maintained in the hospital. While in hospital, cardiology consult was taken and cardiac meds were titrated.\n\nDiet: Low Calorie Low fat Low salt 40gm protein Diabetic Diet advised.\n\nRemarks: RBS, Se Creat, Na+, K+,HB to be done at Silverline'}] |
245 | [{'role': 'user', 'content': '\nIP Number: 245\n\nPatient Number: 465\n\nPatient Name: ROY LOPEZ\n\nGender: M\n\nDate of Birth: 09-09-1968\n\nAddress: THUNDIPARAMBIL HOUSE,S.S.K.S.ROAD\n\nPincode: 682023.0\n\nPhNo: nan\n\nAdmission Date: 19-01-2012\n\nDischarge Date: 03-02-2012\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC NEPHROPATHY WITH CRONIC RENAL FAILURE\nTYPE 2 DIABETES MELLITUS\nEssential (primary) hypertension\nDIABETIC NEUROPATHY\n\nData from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Ms Sans Serif;}{\\f1\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\qc\\ul\\b\\f0\\fs28 UT SCAN- LEG\r\n\\par \\pard\\plain\\b0\\fs24 \r\n\\par \\b Left foot : Small peritendinous fluid collections seen around \r\n\\par dorsum tendons(extensors)\r\n\\par \r\n\\par No evidence of abscess\r\n\\par \r\n\\par \r\n\\par \r\n\\par Impression: Cellulitis with tendinitis of extensor tendons of left foot.\r\n\\par \r\n\\par Dr.Joe Antony\r\n\\par Radiologist.\r\n\\par \\b0 \r\n\\par \\f1\\fs20 \r\n\\par }\r\n\n\nImpression data from scanning: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 MS Sans Serif;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs20 \r\n\\par }\r\n\n\nDiscussion: A 43yrs male ,known case of Type 2 Diabetes Mellitus, Diabetic Nephropathy-Chronic Renal failure, Diabetic foot-Lt, P/s amputation of the Rt Gr toe, admitted with the history of left mid foot infection with oesteomylitis of the Metatarsals, under antibiotic cover, Mid foot amputation done and incision and drainage of compartment of leg done. wound healing not satisfactory, taken for Below knee amputation, blood transufion done to correct anemia, EPO given, stump healthy, Renal function test improving, titre the diuretics, ambulated slowly, Discharge in a Stable state\n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by Dr.AK.Bhat.\r\nAbscess dorsolateral aspect left foot.\r\nFor I&D under LA.Get consent.\nPallor +\r\nContinue the same\r\nPlan to Explore under LA\r\nI/O\r\nEPO weekly\r\nTab.Tramodal sos\r\n\r\n\nSeen by Dr.A.K.BHAT\r\nDressing changed.Deep osteomyelitis needs further debridement under SA.Adviced XRAY left foot AP,LAT,Obl.Shows destruction of lateral tarsal/metatarsal bones due to osteomyelitis.\r\nContinue treatment.\r\n\r\n7.11pm\r\npt to be posted for surgery tommorow at noon\r\nblood to be cross matched and sent\r\narrange for 1 packed cell blood tommorow\r\nobtain high risk consent\r\nto send for serum electrolytes tommorow\nECG\r\nPT,BT,CT\r\nRS-Clear\r\nP-80/min\r\nB.P-130/90 mmof hg\r\nCVS-S1S2 S3Normal\r\nPlan\r\nHigh Risk Consent\r\nPackecd cell transfusion \r\nInj.Lasix 40mg stat\r\nNPO\r\n\nShifted to Post OP\r\nAmputated upto the ankel Under spinal\r\nInfection Tracking Upto the Mid Leg\r\nMay need B/K\r\nPR-64/min \r\nBP-120/98 mmof hg\r\ncvs-s1s2 normal\r\nRS-Clear\r\nSpo2-95%\r\nMontoir I/O\r\nK+,TC,HB\r\nMorning\r\nS.Na+,S K+, Creat, HB, TC\r\n\r\n10:15 pm\r\nc/o severe pain at the surgery site.\r\nvitals stable.\r\nInj neomol 2 amp im stat.\r\n\n3:00 AM\r\npt is sleeping since one.\r\nvitals stable.\r\n\r\n7:00 am.\r\nseen by Dr Biju.\r\npt is awake...slept well.\r\nmild pain at surgery site.\r\nBP - 120/60\r\n \r\n10:00am\r\nPR-58/min\r\nB.P-\r\nSpo2-95 at room air\r\nRS-Lt Basal crepitation +\r\nCVS-s1S2S3\r\nNo pain \r\nI/o-2080/1250\r\nHB-7.3mg%.\r\nSeen by Dr.AK.Bhat.\r\nSoakage overpadded.\r\nContinue trt.\nseen by Dr. Raees\r\nno complaints\r\ncontinue same\nPR-\nSeen by Dr.A.K.BHAT.\r\nDressings LEFT LEG changed.\r\nUnhealthy stump of left foot.\r\nPlan for below knee amputation under SA,under high risk and informed written consent.Continue treatment.\r\n\r\n\n6:00pm\r\nPR-98/min\r\nB.P-120/80\r\nCVS-S1S2Normal\r\nRS-Clear\r\nC/o pain adviced \r\nInj.Tramadol 50mg IV sta\r\nBlood Transfusion \r\nInj.Hydrocortison 100mg I.V\r\nInj.Avil sos\r\nInj.Lasix 40mg st\r\nHB,TC,UREA,CREAT,NA+,K+\nB/K Amputation\r\nPR-58/min\r\nBP-130/80mmof hg\r\nRS-Clear\r\nI/O-1050/2250\r\nHb-7.6\r\nK-3.5\r\nCreat-5.5\r\nCase at 12:00pm\r\nNPO\nPO-1day\r\nPR-68/min\r\nB.P-151/86mmof Hg\r\nCVS-S1S2S3\r\nRS-\r\nPA-Soft,NAD\r\nCNS-Consious/Oriented\r\nI/O-2420/2350\r\nHb-9, TC16000cell/cmm, Urea199, Na-129, K 3.7,s.creat 6.9\r\nBlood transfusion\nSeen by DrA.K.Bhat.\r\nPain +.No soakage.\r\nContinue trt.\r\n\r\nC/o pain in the suprapubic region\r\nAdviced \r\nInj.Tramadol\r\nContinue the rest\r\nWatch for cath obstruction\r\n\r\n\nSeen by DrA.K.Bhat.\r\nDressings changed.Drain removed.Suture line clean.Oedema +.Continue trt.\r\n\r\nseen by dr.muneer\r\nnil complaints\r\ncontinue same treatment\nVitals stable. urine output- 3600. pain present.\r\nDressing change today\nI/O-750/1950\r\nVital stable\r\n1045: No new c/o.\r\nDecrease T.Lasix 2-1-0.\r\nCont.all above.\nSeen by Dr.AK.Bhat.\r\nContinue trt.\r\n\r\n8.45 pm\r\nPatient is comfortable. Not eating adequately. Urine out put is good.\nSeen by Dr.A.K.BHAT.\r\nDressings LEFT LEG changed.\r\nSuture line clean.\r\nContinue treatment.\r\nPhysiotherapy static mobilisation of limbs.\nseen by dr.muneer \r\nnil complaints\r\ncontinue same treatment\n10.30am: stable,V/S stable, I/O 1200/1930ml.\r\nChest-clear.\r\ncont.same\r\n\r\n\r\nSeen by Dr.A.K.BHAT\r\n5th POD.\r\nNo dressing soakage.\r\nContinue treatment.\r\nQuadriceps strenghtening exercises.\nseen by dr.muneer\r\nnil complaints\r\ncontinue same treatment\nSeen by Dr.A.K.BHAT\r\nNo dressing soakage.\r\nContinue treatment.\nVital stable\r\nI/O 1500/2175\r\nTC Come down to Normal\r\nRS-Clear\nDoing fine. AC- 218 mg/dl. Out put satisfactory.\nSeen by Dr.A.K.BHAT.\r\nDressings LEFT LEG changed.\r\nSuture line clean.\r\nContinue treatment.\nSeen by Dr.A.K.BHAT\r\nNo dressing soakage.\r\nContinue treatment.\r\n\r\nseen by dr.lakshmi\r\nvitals stable\r\nnil complaints\r\ncontinue same treatmen\nVitals Stable.\r\nSugars are slightly elevated.\r\nAdjust Insulin Dosage accordingly.\r\n\nSeen by Dr.A.K.BHAT\r\nNo dressing soakage.\r\nContinue treatment.\r\n\r\n1800: No systemic c/o, V/S stable, Urine output 850ml till evening, GRBS high-298mg%, give 16u Insugen R now.\r\nAM labs as scheduled.\nVItal stable\r\nI/O -1500/1700\r\nFBS-High, adjusted the insuline\r\nRS-Clear\r\nCVS-s1s2 Normal\r\nWeekly dose of EPO Tomorrow\r\nPlan Discharge tomorrow\r\nRpt.Na+,K+,Cr,Urea,HB,TC\nPR-62/min\r\nB.P-116/66mm of Hg\r\nRS-Clear\r\nCVS-S1S2 Normal\r\nPA-S0ft\r\nEPO given\r\nS/b Dr.Abdul Rasheed , continue the same\r\nDischarge\nSeen by Dr.A.K.Bhat.\r\nSutures removed.Healed.Adviced protective dressing for 2 weeks-Betadine oint.,pad and crepe bandage.Exercises as per physiotherapist advice.Review 2 weeks in OP Friday-17-2-2012..'}, {'role': 'model', 'content': '\nIP Number: 245\n\nPatient Number: 465\n\nAdmission Date: 19-01-2012\n\nDischarge Date: 03-02-2012\n\nDiagnosis: P/S BK Amputation-Lt\n\nClinical Exam(With BP): nan\n\nSystolic BP: 130.0\n\nDiastolic BP: 68.0\n\nPhysical examination: \r\n\n\nXray findings: nan\n\nDiscussion: 43 yr old with H/o DM, Diabetic Nephropathy with renal failure, Diabetic retinopathy admitted with swelling and pain in the Lt leg. Pt was started on I.V antibioitcs, Insulin for Glycemic control and Regular monitoring of his renal status. Pt was seen By sugeon, a transmetatarsal amputation of the Lt leg was done followed by Below Knee amputation 2 days later. PT infcetion got better, White count decreased from 35,000 on admission to 10,500 on discharge, Renal status also improved , Serum Creatinine from 8.4- 4.1\r\nPt tolerated both the procedures well without any complications.\r\nDischarged on a stable state.\n\nDiet: nan\n\nRemarks: nan'}] |
305 | [{'role': 'user', 'content': '\nIP Number: 305\n\nPatient Number: 4062\n\nPatient Name: KOCHUMUHAMMED\n\nGender: M\n\nDate of Birth: 12-12-1931\n\nAddress: KUZHUPPILLIYIL HOUSE\n\nPincode: 686671.0\n\nPhNo: 0485 -2548263\n\nAdmission Date: 20-02-2012\n\nDischarge Date: 05-03-2012\n\nDiagnosis determined by the doctor when the patient was admitted: PRIMARY HYPOTHYROIDISM\nDIABETIC NEUROPATHY\nEssential (primary) hypertension\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: A 80yr old man ,admitted with the history of non healing ulcer over the Lt Achillis. During previous admission under antibiotic cover and fair glycemic control taken for wound exploration , found to have necrosis of Achillis tendon and OM calcaneum . Tendon was excisied, part of calcaneum curreted. The wound healed well with treatment and was dsicharged in a stable condition. He was asked to clean and dress the wound on alternate days. The wiound was healing well with treatment. He is admitted for SSG\n\nXray information: nan\n\nClinical examination: Wound is granulating well- ready for SSG\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Vital stable, admitted for skin grafting.\r\nChest- B/L rhonchi , creps+\r\nNo fever\nfine\r\nContinue the same\nSeen by Dr.A.K.BHAT.\r\nDressings LEFT LEG changed.\r\nWound clean.\r\nFor SSG under LA 23-2-2012.Adviced :C&D,Consent.Betadine scrub of left thigh HS&CM.\r\n\r\nStoped Levoflox\r\nStarted on Biopiper\r\nadded LMWH\r\n\r\nseen by dr.lakshmi\r\nvitals stable,grbs-256 mg/dl\r\nposted skin grafting tomorrow\r\ncontinue same\nScheduled for SSG under LA today.\r\nOn Biopiper bd & Dynalix od.\r\nCan take light food.\r\nHas mild cough with mucoid sputum.\r\n\r\n\r\n\nshifted back to room after SSG. still has cough.\r\nChest- ronchi less.\r\nSyp. Brosdex bd\nSeen by Dr.A.K.BHAT\r\nNo dressing soakage.\r\nContinue treatment.\r\n\r\nfine\r\nSugar were High \r\nAdjusted the dose of insulin\nVitals stable. post skin graft yesterday. sugar - slightly high.\r\nwill check TC, HB, urea , creatinine. Na , K\r\nstarted on heparin for DVT prophylaxis\n\r\n Seen by Dr.A.K.BHAT\r\n No dressing soakage.\r\n Continue treatment.\r\n\nS/B Dr. Kenny: Had chest Physio today\r\nNo new c/o , V/S stable. No pain rt. foot or thigh.\r\nPlan- cont.same.\nS/B Dr. Kenny: Cough less.\r\nV/S stable, Chest- few low pitched ronchi.\r\nPlan- Dressing tomorrow, Cont. same.\r\n\r\n\r\nSeen by Dr.A.K.BHAT\r\nNo dressing soakage.\r\nContinue treatment.\r\nFor C&D in OT tmrw.\nDressing changed.SSG taken up.\nRS-Rhonchi +\r\nCrepitation\r\nCVS-S1s2 Normal\r\nWound Healthy\r\nContinue the rest\n08:00pm\r\nS/b Dr Biju.\r\ndoing well, chest - clear.\r\nno fresh complaints.\r\ncontinue same.\nDoing fine, graft has taken up well. Plan is dress thrice more before discharge. Cough better. Chest is also relatively better.\nDoing fine. Cough better. AC- 126 mg/dl.\nSeen by Dr.A.K.BHAT\r\nNo dressing soakage.\r\nContinue treatment.\r\nPlan for discharge on Monday.\r\n\r\nSeen by Dr. Lakshmi\r\nno complaints, vitals stable\r\ncontinue same treatment\n1045: No systemic c/o. Dressing today. FBS 181mg%.\r\nScheduled for d/c on Monday.\nSeen by Dr.A.K.BHAT.\r\n Dressings LEFT LEG changed.\r\n SSG clean.\r\n Continue treatment.\r\n\r\n\r\nS/B Dr.Kenny: c/o occ. pain Lt.medial malleolus area.\r\nV/S stable. Chest-better\r\nPlan- cont. same.\nDoing fine. Blood sugars are fine\nSeen by Dr.A.K.BHAT\r\nNo dressing soakage.\r\nContinue treatment.\r\n\r\n\r\nRS-Rhonchi +\r\nContinue the same\nSeen by DrA.K.Bhat.Dressing changed.SSG settling.\r\n\r\nChest- Better\r\nForair 250mcg MDI with Spacer 2puff -0-2puff\r\nLevoline MDI 1-1-1 \r\nstop Nebulisation\r\nChest PT\ncase seen by dr.lakshmi\r\nvitals stable\r\nno complaints\r\ncontinue same\nVitals stable. C/o cough.\r\nsugar well controlled.\nseen by Dr.Raees\r\nno complaints\r\nvitals stable\r\ncontinue same treatment\nSeen by Dr.A.K.Bhat.\r\nDressings changed.SSG settling well.Donor site healthy.\r\nAdviced:Dressing change alternate day-Cuticell,pad&bandage.Review 2 weeks later.Wed/Friday.'}, {'role': 'model', 'content': '\nIP Number: 305\n\nPatient Number: 4062\n\nAdmission Date: 20-02-2012\n\nDischarge Date: 05-03-2012\n\nDiagnosis: P/S SKIN GRAFTING FOR NON HEALING ULCER OVER THE LT ACHILLES\n\nClinical Exam(With BP): A 80yr old man ,admitted with the history of non healing ulcer over the Lt Achillis. During previous admission under antibiotic cover and fair glycemic control taken for wound exploration , found to have necrosis of Achillis tendon and OM calcaneum . Tendon was excisied, part of calcaneum curreted. The wound healed well with treatment and was dsicharged in a stable condition. He was asked to clean and dress the wound on alternate days. The wiound was healing well with treatment. He is admitted for SSG\n\nSystolic BP: 110.0\n\nDiastolic BP: 80.0\n\nPhysical examination: nan\n\nXray findings: Wound is granulating well- ready for SSG\n\nDiscussion: Fair glycemic control , SSG taken up well, developed chest infection, COPD Excerbation during hospital stay, controlled with I.V antibiotic ,Bronchodilator nebulisation and chest Physiotherapy.Discharged in a stable state\n\nDiet: nan\n\nRemarks: RBS, TSH, TC,DC , HB ,'}] |
365 | [{'role': 'user', 'content': "\nIP Number: 365\n\nPatient Number: 5752\n\nPatient Name: GEORGE MENACHERY\n\nGender: M\n\nDate of Birth: 11-11-1934\n\nAddress: PRIYAM HOUSE,ANACHAL ROAD,EROOR\n\nPincode: 682306.0\n\nPhNo: 2114384\n\nAdmission Date: 29-03-2012\n\nDischarge Date: 12-04-2012\n\nDiagnosis determined by the doctor when the patient was admitted: Old myocardial infarction\nDecubitus ulcer\nEssential (primary) hypertension\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: 77 y/o male, known Parkinsonism, HTN, CAD with old Rt. hemiparesis admitted with chronic Lt. trochanteric non healing decubitus ulcer x 3-4 mths. \n\nXray information: Routine labs.\r\nPus C/S: \n\nClinical examination: Elderly, evidence of wt. loss with lax s/c tissue. Bedridden.\r\nBP 130/80, pulse- 80/min, regular. Afebrile.\r\nMod. pallor, no icterus.\r\nCNS- follows verbal commands, contractures limbs with claw hands, old Rt. hemiparesis, extrapyramidal rigidity+.Incontinent. Kernigs -ve.\r\nChest- Harsh vesicular BS.\r\nCVS- S2 loud, no gallop, no pedal edema. Abd- soft, no masses.\r\nLocal exam: Deep ulcer Lt.trochanteric area with seropus discharge.\r\nUlcer extending to trochanteric tuberosity & tender.\r\nOld healed Rt. hip ulcer.\n\nPrecautions to be taken while treating the patient: Elderly with old stroke & Parkinsonism.\r\nMod. Anemia.\n\nRemarks: 11am: Old Rt. hemiparesis with Paarkinsonism, confined to bed with b/l Left> right with trochanteric decibitii ulcers admitted for evaluation.\r\nInformed Dr. Bhat- will see pt. & decide management.\r\nSend Pus c/s from Lt. sided ulcer.\n1815: S/B Dr. Kenny-\r\nTaking soft diet orally. V/S stable.\r\nHas some chest secretions.\r\nPlan- Chest P/T bd, steam bd.\r\nFollowup Pus c/s. Xray pelvis to r/o OM once G/C better.\r\n\nGC status quo. Change of positiion q 30 minutes. BP- 120/70mmHg.X-Ray lft hip AP lateral.Neurology consultation.Abilash to see to decide on Physiotheraphy.S.Electrolytes,ECG.Hannah to see.\nSeen by DrA.K.Bhat.\r\nUnhealthy left trochanteric ulcer with slough of fascia.Pus discharge +.Xray-no e/o bone involvement at present.\r\nPlan:Slough excision under LA on 31-3-2012.Preop.:consent from relative.C&D.Foley's catheterisation.\r\n\r\nS/B Dr.Suresh\r\nproblems:\r\n 1.Parkinsons Disease with motor complications ?parkinsons+, ?Sec\r\n 2.Old CVA ? multi infarct state\r\n 3. Systemic Hypertension\r\n\r\n\r\nO/E:\r\n Conscious,Dysarthria+,\r\n Neck rigidity, B/L Lt > Rt limb rigidity\r\n Motor power difficult to assess\r\n DTR + equivocal\r\n\r\nSuggest:\r\n 1.Increase dose of Syndopa Plus\r\n Tab.Syndopa Plus 1-1-1(7am-1pm-7pm)\r\n 2.Tab.Syndopa CR 0-0-1/2 later\r\n 3.Physiotherapy\r\n 4.MRI Brain\r\n 5.To bring old reports\r\n\r\n915 pm\r\n U.bladder catherisation done under aseptic measures\r\n urine collected,about 200ml.No 14 foleys catheter insitu\r\n\n8.50am: S/B Dr. Kenny-Hb improved.\r\nScheduled for slough excision today\r\nHaving hematuria since midnight ~3hrs after Foleys catheterisation. Having erythematous rashes since yesterday afternoon. Inj. Avil 1 amp stat IV.\r\nAdv: TC, DC, Plat & CRP, Blood C/S.\r\n\nS/B Dr.Kenny\r\nErythem atrunk better.\r\nV/S stable, slough excision done today.\r\nHematuria resolved.\n7.15 pm\r\nseen by dr.muneer\r\nbp-90/60 mmhg\r\nno fever\r\ncontinue same\nDoing well post op. Posistion being changed q 2 hrly. BP-110/60. CBC, Se electrolytes tomorrow. Continue same\nChest : Mild crepitations and rhonchi present.GC fair.BP: 120/70mmHg.Afebrile.Counts have come down.Dressing to be done today.\nWound \r\nPus ozzing\r\nCleaned with Oxum\r\nBetadine\r\nMetrogyl\r\n\nC/S No growth\r\nRS-Clear\r\nDressing tomorrow\r\nConstipation\r\nP Enema stat\nAspiration\r\nadviced Ryle tube\r\nWound Slough +\r\nGranulating\r\ncontinue the same\r\nRS-Clear\r\nChest Physio\nstable,RS-clear\r\nnil special\r\n\nNot willing for Ryles tube\r\nVital stable\r\nRS-Rhonchi +, Spo2 94 at room air\r\nCVS-S1S2\r\nAdded Tab.Syndopa CR@ 10pm as per Neurologist advice.\nS/B Dr. Kenny:\r\nDressing changed, wound looks healthy.\r\nTolerating Oral feeds.\r\nChest- occ. ronchi with prolonged exp.\r\nPlan- Cont. same.\nCandid mouth paint 1-1-1\nChest Clear\r\ndressing tomorrow\r\nContinue the same\nNA+,K+,HB,TC\r\nRS-Clear\r\nCVS-S1S2\r\nwound better, Granulating, little slough over the bone\r\nStop I.V\r\ncalcium, iron Liquid formula\r\nDaily dressing with betadine + metrogyl\r\n\nstable,BP-120/70mmHg\r\nRS-Clear\r\nCVS-S1S2\r\nNA+,K+,HB,TC tomorrow\n\r\n8:00 am\r\nconscious,\r\nstable\r\nhaving sips of milk\r\nRS- clear\nRS-Clear\r\nCNS-Consious/Oriented \r\nCVS-S1s2 Normal\r\nPA-NAD\r\nContinue the same\r\nNa+ 120\r\nIncrese the salt in diet\r\nFluids restricted to 1.2 lt\r\nRecheck Na+ tomorrow\r\n\r\n\r\nstable,\r\nTo check Se.Na tomorrow\nNA + -120\r\nWound Healthy\r\nReduced oral Intake to 900ml\r\n6g salt /day\r\n3% saline 200ml over 16hr\r\nRecheck NA+,K+,TC,HB\r\nDressingn with Metrogy + oxum\r\nDr.bhatt consultation\nSeen by Dr.A.K.BHAT.\r\nDressings LEFT TROCHANTERIC ULCER changed.\r\nMostly clean except thick adherent slough of periosteum.\r\nAdviced intrasite gel dressings.\r\nContinue treatment.\r\n\r\n600pm\r\ndrowsy\r\n3%saline 200ml over 12hr\r\ncontinue the others\r\n\nNa+-123\r\nmentation better\r\nTotal fluid -1000l\r\nExtra salt in diet\r\nContinue the rest\ngeneral condition better\r\nvitals stable\r\nsodium,potassium tmrw\nSeen by Dr.A.K.BHAT.\r\nDressings LEFT hip changed.\r\nUlcer slough partially excised.Rest of Wound clean.\r\nContinue treatment.\r\nS/B Dr. Kenny- cont. all above\r\nDischarge tomorrow.\r\n\nV/S stable.\r\nNa+ improved 125, K+ 3.7\r\nI/O 1050/1200\r\nConsiuos level better\r\nConstipation\r\nDulcolax suppsitory\r\nRS-Clear\r\ndressing\r\nplan for discharge as per Dr.Bhat advice"}, {'role': 'model', 'content': '\nIP Number: 365\n\nPatient Number: 5752\n\nAdmission Date: 29-03-2012\n\nDischarge Date: 12-04-2012\n\nDiagnosis: Lt. trochanteric decubitus ulcer with cellulitis ? OM\r\nParkinsons Disease/Parkisonism\r\n?Multi Infarct state\r\nOld Rt. hemiparesis with flexion contractures limbs.\n\nClinical Exam(With BP): {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Verdana;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs17 77 y/o male, known Parkinsonism, HTN, CAD with old Rt. hemiparesis admitted with chronic Lt. trochanteric non healing ulcer x 3-4 mths. \r\n\\par }\r\n\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Verdana;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs17 Routine labs.\r\n\\par Pus C/S: \r\n\\par }\r\n\n\nXray findings: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Verdana;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs17 Elderly, evidence of wt. loss with lax s/c tissue. Bedridden.\r\n\\par BP 130/80, pulse- 80/min, regular. Afebrile.\r\n\\par Mod. pallor, no icterus.\r\n\\par CNS- follows verbal commands, contractures limbs with claw hands, old Rt. hemiparesis, extrapyramidal rigidity+.Incontinent. Kernigs -ve.\r\n\\par Chest- Harsh vesicular BS.\r\n\\par CVS- S2 loud, no gallop, no pedal edema. Abd- soft, no masses.\r\n\\par Local exam: Deep ulcer Lt.trochanteric area with seropus discharge.\r\n\\par Ulcer extending to trochanteric tuberosity & tender.\r\n\\par Old healed Rt. hip ulcer.\r\n\\par }\r\n\n\nDiscussion: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Verdana;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs17 Admitted with decubitus ulcer over the lt gluteal region. fever, high white blood count, startated on empirical antibiotics, debribement was done , neurology consultation was taken for the parkisonism and adjusted the the dose of syndopa, Physiotherpy was given daily.regular dressing with betadine + oxum was carried out, wound healing satisfactory, corrected the hyponatremia with 3% saline,advice ryles tube feed in veiw of aspiration ,deffered by the bystanders.At the time of discharge, wound healing satisfactory, No further bed sore, NA +-124 meg/l,mentation improved, vital stable, chest Clear.Cath in situ.Dicharged Haemodynamicaly stable state\r\n\\par }\r\n\n\nDiet: nan\n\nRemarks: nan'}] |
398 | [{'role': 'user', 'content': '\nIP Number: 398\n\nPatient Number: 5927\n\nPatient Name: N. PARAMESWARAN NAIR\n\nGender: M\n\nDate of Birth: 19-04-2023\n\nAddress: C/O CUCKOO PARAMESWARAN,\n\nPincode: 682020.0\n\nPhNo: nan\n\nAdmission Date: 19-04-2012\n\nDischarge Date: 11-05-2012\n\nDiagnosis determined by the doctor when the patient was admitted: nan\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: Mr.N.Parameswaran Nair 89yrs male, case of Parkinsonism, bed ridden devolped decubitus ulcer over the Lt Glueal region, debrided in Medical trust hospital, admitted with spiking fever and discharing pus from the ulcer base, Labs High white blood count, Low sodium, started on broad spectrum antibiotic, C/S report awaited, sodium correction started 0.5meq/dl/hr, found have impaired blood sugars\n\nXray information: nan\n\nClinical examination: At the time of admission\r\nPR-90/min\r\nB.P-110/70mmof Hg\r\nCVS-S1S2 Normal\r\nRS-NVBS, Few Crepitation\r\nCNS-Rigitidy +\r\nDrowsy +\r\nResponse to pain\r\nLt Lower limb contracture +\r\nPEARL +\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Febrile\r\nDrowsy \r\nRespond to pain \r\nRS-Clear\r\nCVS-S1S2 Normal\r\nPA-Soft \r\nNAD\r\nNO Oral medication \r\nBed sore care\r\nCatherisation \r\nPlan tommorow\r\nDr.Mathew Abraham consultation\r\nDr.AK Bhat\r\nstop all oral medication till further orders\nHBAIC\r\nFBS\r\nNA+,K+\r\nURINE ROUTINE\r\n\nS/B Dr. Raees\r\nNo Complaints\r\nhad 102*F at around 3 pm, at 5pm had 100*F. kept paracetamol suppository,\r\nS. Na + -128meq\r\nnow temp- 99.4*F\r\nADV- Continue same treatment\r\n send for S. Na+,HB.TC,DC, S.Creat tomorrow\r\n\r\nPotassium/Protein suppl in diet\nSeen by Dr.A.K.Bhat.\r\nLarge left trochanteric pressure ulcer 8X7 CM with slough of floor.Early pressure ulcer sacral region.\r\nPlan:bedside debridement tmrw.\r\nAdvice:BD dressing-left side:betadineoint.+intrasite gel.Sacral:betadine oint.IV antibiotics.\nS/B Dr. Kenny-\r\nDebridement done & 100ml pus drained from below the slough, extending to bone? OM.\r\nAfebrile, BP 110/70.Incoherent talk.\r\nSe. K 3.1, Na better, TC & neutrophilia decreased.\r\nTaking soft diet orally. Pus c/s report awaited.\r\nPlan- gradually increase Admenta dose over few days- \r\n5mg 1-0-1, tomorrow onwards 10mg-0-5mg.\r\nGive Syp. Potchlor 10ml bd & recheck Na, K, TLC,ESR,Creat\r\n& FBS, Chol, TSH on Monday.\r\n\nS/B Dr. Kenny- \r\nWound opened,cleaned and dressing done by Dr.Bhatt.\r\nPulse : 90/min\r\nS/B Dr. Kenny- Temp 99.6*F, BP : 110/80mmHg\r\nContinue the same.\r\nSeen by DrA.K.Bhat.\r\nFor Slough excision bedside under LA.Get consent.\r\n\r\n12:30 pm \r\nS/B Dr.Mathew abraham\r\nParanoid schziophernia\r\n? Parkisonism\r\nCorrect the metabolic factor\r\nHypoprotenimia- Nutritional\r\nIncrese the dose of Admenta slow to 10mg BD\r\nContinue other.\r\n\nHad 100.6*F at 4 am in morning, given IV pactiv infusion\r\nnow temp- 98.6*F\r\nno other complaints\r\ncontinue same treatment.\r\nSeen by DrA.K.Bhat.\r\nC&D done.Left trochanteric ulcer unhealthy.Pus collection decreased in the inferior pocket.Trochanteric bone exposed.Slough of deep fascia needs further excision.Metrogyl gel instilled.Sacral ulcer clean and healing.\nstable, had catheter leakage,blood stained urine+\r\ncatheter changed and new catheter inserted under aseptic condition.\r\nno 16 foleys insitu.\r\nurine passed.blood stains +\r\ntemp 101 F\r\n\r\nTo give bladder wash and observe\r\ninj. pactiv 1g infusion stat.\nSeen by DrA.K.Bhat.\r\nUnhealthy large undermined ulcer left trochanteric region.Plenty of slough of soft tissue and deep fascia and muscle.Needs slough excision under Anesthetist supervision and high risk.Explained to the daughter.\nappitite improve\r\nmoving limbs\r\nconsious level better\r\ncontinue the rest\r\nHigh protein diet\r\nPhysiotherpy twice a day\nGC fair\r\nVital stable\r\nSystemic examination \r\nRS-Few crepoitation \r\nCNS-Obey Commonds\r\nPEARL +\r\nMoving limbs\r\nPlan \r\nWound Debridement Under Sedation in OT\r\nat around 4pm\r\nNPO after 1pm , also Clear fluids in sip\r\nHigh Risk consent\nS/B Dr. Raees at 07. 15 pm\r\npt still under the influence of GA\r\nBP- 114/90mm of hg, pulse- 112/min\r\nSPO2- 99% with 4L/min O2\r\nADV: continue same\n.Seen by DrA.K.Bhat.\r\nMinimal soakage.Continue trt.\r\n\r\n1815: S/B Dr. Kenny-\r\nNo new c/o, afebrile.\r\nCont. all above.\nS/B Dr.Sasikumar\r\nPR 100min , Irregular\r\nB.P-120/80\r\nCVS-S1S2, Ejection systolic Murmur\r\nRS-B/L air entry equal\r\nCNS - Consious\r\nAF with fast venticular rate\r\nOrder\r\nTab.calaptine 40mg 1-1-1\r\nTab.cardarone 100mg 1-1-1x 2days\r\n 1-0-1x 2days\r\n 1-0-0\r\n25/4/12- 8.45am: S/B Dr. Kenny: No further tachycardia. Withhold Calaptin.Given Dynalix 0.4ml @ 8am.\r\nAmiodarone not obtained yet.\r\nHb improved from 10.6 to 11.5gm%, TLC decreased from 18.2 to 15.8K, Lytes/RFT normal. \r\nObeys commands, BP 112/74, HR 106/min, O2 sat 97%.\r\nCheck Free T4 in next sample\r\nShift to room.\nECG-AF \r\nTab.calaptine 40 1-0-1\r\nAnkel Odema +\r\nContinue the rest\r\n\nSeen byDr.AK.Bhat.\r\nC&D done.The large raw area left trochanteric region is clean except for exposed bone for about 5x5 cm.\r\n\r\nGC fair \r\nContinue the same\r\nNo investigation tomorrow\nBP : 110/70mmHg.Doing well.Started communicating.Output well.Rpt S.electrolyte,CBC.\nSeen by DrA.K.Bhat.\r\nSoakage overpadded.\r\nCNS-conscious ,disoriented in :time place person ,pearl\r\nvitals stable \r\nBP-110/70mmHg\r\npulse -88bpm\n1800: S/B Dr. Kenny-\r\nV/S stable. BP 110/70. HR 88/min,Afebrile. Incoherent talk.\r\nHas moderate wound soakage.\r\nCont. all above.\r\n\nS/B Dr. Kenny- No fever.\r\nBP 110/80, pulse 88/min, regular.\r\nCreat, Na, K normal. TLC 10100, polys 77%, Hb 11.4gm%.\r\nECG: AF with normal vent. response, incomplete RBBB.\r\nBlood & Urine c/s - no growth, Pus c/s- no sig. growth.\r\n? DeEscalate Biopiper after surgeon sees.\r\nDecrease T.Cardarone 1-0-0\r\nLocal Laser application today.\r\n1200: Seen by Dr.A.K.Bhat.\r\nLeft trochanteric raw area is clean and granulating.Daily oxum dressing.\nCNS - conscious ,disoriented in time place person \r\nRS - chest clear \r\nvitals stable \r\nbp - 120 / 80 mmHg \r\npulse - 90 bpm.\r\nSeen by DR.A.K.Bhat.C&D done.For partial secondary wound closure under ;GA.1-5-2012.1 pm.C&D in the morning.Consent.Nil oral after 10 AM.\nLaser Therpy\r\nStill in AF , \r\nGC-Fair\r\nPR-90/min Irregular\r\nB.P-110/70mmof Hg\r\nRS-Clear\r\nCVS-S1S2 Normal , ESM +\r\nECHO and Dr.sasikumar sir review\r\nECG-Tomorrow\r\nNA-131,K+-\r\n\nParital secondary wound closure today \r\nNPO after 10am\r\ncontinue the rest\nShifted to Post Op\r\nPr-100/min Irregular\r\nB.P-110/70 \r\nCVS-S1S2 Normal\r\nRS- Few creptitation \r\nConsious, responded to Oral commonds\r\nOff the O2 maintaining Spo2 93%\r\n\n0945: S/B Dr. Kenny- Vitals stable. More alert.\r\nO2 Sat maintained at 98- 99% @ room air.FBS : 118mg%\r\nDynalix and plagrine A being withheld since yesterday AM after wound closure. Surgeon to decide restart.\r\nContinue all the above. Shift to room.\nSeen by DrA.K.Bhat.\r\nAfebrile.Continue trt.\r\n\r\n1900: S/B Dr. Kenny-\r\nGC stable, BP 130/90, pulse 90/min.\r\nChest- clear.\r\nPlan- cont. same.\nSeen by DrA.K.Bhat.\r\nC&D done.Left trochanteric ulcer clean.Suture line clean.Continue trt.\r\n\r\n\r\nStop antibiotic tommorrow\r\ncontinue the rest\nContinue the same.\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\n\r\n1845 Seen by Dr.Arun\r\nVitals stable\r\ncontinue the same\n1900: S/B Dr. Kenny-\r\nNo new c/o, answers queries.D-9 on Dynalix.\r\nPlan-Check PT, TLC on Monday AM.\r\n\nS/B Dr. Kenny:\r\nStable, Changed to oral Cipodin yesterday, pulse 84/min\r\nBP 120/80.\r\nAdv:Finger/toe Nail clipping.\r\nContinue the same.\n9am: S/B Dr. Kenny-\r\nStable.\r\nCont. all above.\r\nSeen by DR.A.K.Bhat.\r\nContinue trt.\nGC- good \r\nCNS-conscious ,obeys command ,pearl \r\nBP- 120/70mmHg\r\ntaking oral feeds \r\n\r\n\r\n\nBlood stain in Urobag\r\nPT/INR with in the limit\r\nVital stable\r\nMentation better\r\nSystemic examination -Nad\r\nContinue the rest\r\nSTop Dynalix \r\n\nSeen by DrA.K.Bhat.\r\n6th POD.Dressings changed.Wound clean.Continue trt. \r\n\r\nfine \r\nVital stable \r\ncontinue the same\r\n\nGC fair.Pt is conscious.\r\nContinue the same.\nSeen by DrA.K.Bhat.\r\n8th POD.Dressings changed.Clean.\r\n\r\n1810:Case seen by Dr.Arun\r\nGC-better\r\nplan-continue the same\nfine\r\nGC Fair \r\nNa+, K+ , Hb, TC\nSeen by DrA.K.Bhat.Continue trt.\r\nDischarge\nSuture removal\r\nDischarge tomorrow.\nPt feels good.\r\nDischarge after removing the suture.'}, {'role': 'model', 'content': '\nIP Number: 398\n\nPatient Number: 5927\n\nAdmission Date: 19-04-2012\n\nDischarge Date: 11-05-2012\n\nDiagnosis: Left Trochanteric Grade III pressure ulcer\r\nBPH\r\nParkisonism\r\nParanoid Schizophrenia\r\nAF with Fast Ventricular rate\n\nClinical Exam(With BP): {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Mr.N.Parameswaran Nair 89yrs male, case of Parkinsonism, bed ridden devolped decubitus ulcer over the Lt Glueal region, debrided in Medical trust hospital, admitted with spiking fever and discharing pus from the ulcer base, Labs High white blood count, Low sodium, started on broad spectrum antibiotic, C/S report no growth, sodium correction started 0.5meq/dl/hr,ECG in AF with fast venticular rate. \r\n\\par }\r\n\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Chest X-Ray :\r\n\\par \r\n\\par \r\n\\par }\r\n\n\nXray findings: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 At the time of admission\r\n\\par PR-120/min Irergular\r\n\\par B.P-110/70mmof Hg\r\n\\par CVS-S1S2 Normal\r\n\\par RS-NVBS, Few Crepitation\r\n\\par CNS-Rigitidy +\r\n\\par Drowsy +\r\n\\par Response to pain\r\n\\par Lt Lower limb contracture +\r\n\\par PEARL +\r\n\\par }\r\n\n\nDiscussion: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 Mr.Parameshwaran Nair a K/c/o Paranoid Schizophrenia, presented with Left Trochanteric Grade III pressure ulcer , P/s escharectomy done in medical trust.On admission pateint had high grade fever withchills , haemodynamicaly stable state, arousable drowsyness, Neurological evaluation revealed a state of negativism,akiniticrigid state. Heamatological and Biochemical parametr showed High white blood count with hyponatrimia and Hypoproteinemia.Corrected at 0.5meq/ml with 3% saline and water restiction, incresed protein intake in diet, under broad spectrum antiobiotic cover debridement of wound with partial secondary closure was done in 2 step in OT under sedation, during post operative ward , had tachycaridia with stable blood pressure, ECG revealed AF with fast ventricular rate, sought cardilogy consultation ,controlled ventricular rate on Antiarrthymic drugs,adjusted the neromedication as per neurologist advice, started on Antiplalets in view low CHADS2 score. Genaral condition better,appitite improved ,ECG -AF with controlled Ventricular rate. Sodium with in the limit, Total count became normal, wound healing satisfactory at the time of discharge. Discharge in Haemodynamicaly stable state \r\n\\par }\r\n\n\nDiet: nan\n\nRemarks: nan'}] |
404 | [{'role': 'user', 'content': '\nIP Number: 404\n\nPatient Number: 5966\n\nPatient Name: KUTTIYAMMA ISSAC\n\nGender: F\n\nDate of Birth: 15-08-1940\n\nAddress: UDAKKACHIRA HOUSE, EZHATTUMUGAM P.O\n\nPincode: nan\n\nPhNo: 0484-2451544\n\nAdmission Date: 24-04-2012\n\nDischarge Date: 12-05-2012\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nEssential (primary) hypertension\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: Mrs.Kuttiyamma Issac, a 71yr old lady was brought here with h/o recurrent abscesses over both lower limbs.Presently the abscesses over the left lower limb has become non-healing.There is also redness and swelling over the same leg.\n\nXray information: nan\n\nClinical examination: 2 Non healing ulcers over the left leg with oedema over that foot with sorrounding cellulitis.One of the ulcers looks necrotic\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: CBC,RFT,LFT,S.Electrolytes,ECG,CXR PA, Vibrometer,versalab.to show Dr.Bhatt today.\nSeen by DrA.K.Bhat.\r\nLeft leg lower 1/3 superficial ulcers which are unhealthy with surrounding cellulitis.E/O superficial varicose veins.Distal pulsations present.Wound swab C/S taken.\r\nAdviced to continue same trt.TBact+saline gauze dressings bd.Leg elevation.\r\n\r\n\r\nS/B Dr. Raees \r\nC/O pain Lt. Leg\r\npre dinner GRBS- 147mg%\r\nT. Ultracet 1 sos\r\ncontinue same treatment\n9am: S/B Dr. Kenny-\r\nV/S stable, FBS 104mg%. Get C/S report.\r\nLateral Rt.ankle ulcer has some blackish discoloration s/o Eschar-Dress with Debridase & Tbact.\r\nAdv- Cont. IV Cefbact bd.\r\n\nSeen by Dr.A.K.Bhat.\r\nEdema and redness decreased.Continue tbact/debridace dressings.\r\n\r\nS/B Dr. Kenny-GRBS 152mg%\r\nStable, cont. all above.\nSeen by DrA.K.Bhat.\r\nContinue trt.\nVitals stable.Slough ,pain redness better.\r\nContinue the rest.\r\nDressing with betadine debridase.Dressing by podiatrist.\r\nBP :130/70mHg.FBS : 145mg%\nSeen by DR.A.K.Bhat.\r\nUlcers left leg-unhealthy.For slough excision under LA 28-4-2012.Get consent.C&D.\r\nGC-good \r\nvitals stable \r\nGRBS-135\nwound looking healthier.Dress with NS ,Oxum, T-Bact with debridase + crepe bandage.\nS/B Dr. Kenny-\r\nFor slough excision under LA today.\r\nFBS 122mg%, predinner 135mg%.\nGC - good \r\ntemp - 100 *f ( at 6 : 00 pm ) -adviced inj pct \r\nBP - 140 / 80 mmHg \r\npulse - 88 bpm \r\nvitals stable.\r\n\r\n\r\nSeen by Dr.A.K.Bhat.\r\nC&D done.Ulcers left leg clean.Tbact+intrasite dressing done.\nGC fair.No fresh complaints.Continue the same\nGC - good \r\ntemp - 100 *f ( at 6 : 00 pm ) -adviced inj pct \r\nBP - 140 / 80 mmHg \r\npulse - 88 bpm \r\nvitals stable.\r\n\r\n\r\nSeen by Dr.A.K.Bhat.\r\nContinue trt.\nGC fair.Wound looks better.\r\nDressing with oxum and T-Bact/Debridase.\r\nContinue the same.\nSeen by DrA.K.Bhat.\r\nAfebrile.Continue trt.\r\n\r\n1830: S/B Dr. Kenny\r\nGenerally better, still c/o pain Lt.leg\r\nPlan: Continue same.\nGC Fair.\r\nContinue the same.\nSeen by DrA.K.Bhat.\r\nUlcers leg are clean and granulating.Continue trt.Suggested Amitone.Venous doppler.\r\n\nGC Better.Continue the same.\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\n\r\n1850:seen by Dr.Arun\r\nGC-Better\r\ncontinue the same\n1715: S/B Dr. Kenny-\r\nPain Lt.leg less, bodyaches & tiredness resolved.\r\nPT INR was 1.2( 30min after Dynalix given)\r\nGRBS 104mg%.\r\nPlan- cont. all above.\n9am: S/B Dr. Kenny-\r\nc/o pain on walking, FBS 102mg%, afebrile. BP 140/80.\r\nPlan: Anticoagulate in v/o ?partial thromosis of Lt. peroneal & Post. tibial veins.\r\nPus C/S of 27/4- heavy growth of Psuedomonas S Cefbact.\r\nBaseline PT/INR today.\n1715: S/B Dr. Kenny-\r\nPain Lt.leg less, bodyaches & tiredness resolved.\r\nPT INR was 1.2( 30min after Dynalix given)\r\nGRBS 104mg%.\r\nPlan- cont. all above.\r\n\r\n\r\n6/5/12: 9am- S/B Dr. Kenny-\r\nAmbulant, mild dyspepsia. On Anticoagulants.\r\nPlan- Check rpt. PT, APPT tomorrow AM.\n9am: S/B Dr. Kenny-\r\nc/o pain on walking, FBS 102mg%, afebrile. BP 140/80.\r\nPlan: Anticoagulate in v/o ?partial thromosis of Lt. peroneal & Post. tibial veins.\r\nPus C/S of 27/4- heavy growth of Psuedomonas S Cefbact.\r\nBaseline PT/INR today.\r\nSeen by Dr.A.K.Bhat.\r\nDressings changed.Ulcers clean except for a small area of slough lateral ulcer.Continue trt.T.Afenak SOS.\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\n\nVital stable\r\nWound over the Lt Ankel -Slough +, pain +\r\nNo H/o malena\r\nStop antiplatelet\r\nC/s Pseudomonas \r\nsensitive to Levoflox\r\nCheck PT/INR\r\nHB, PCV\nDoing well.Blood sugars well controlled.Wound healing well.\nSeen by DrA.K.Bhat.\r\nUlcers left leg clean and healing.Continue trt.\nSeen by DrA.K.Bhat.\r\nUlcers clean and healing well.Continue trt.\r\n\r\n1805:case seen by Dr.Arun\r\nnil complaints\r\nGRBS-110mg%\r\nPlan-Continue Novorapid 6-6-6\r\nLantus 8units\nfine \r\nPassive PT\r\nVital stable\r\nPain while walking \r\nContinue the same\nPT/INR- Today\r\nDischarge today.\r\nStop Dynalix \r\nStop warf\nSeen by DrA.K.Bhat.continue trt.\r\nStop warf , Dynalix \r\nRpt PT/INR on saturday\nPT/INR tomorrow\nS/B Dr.raees\r\nNo complaints\r\ncontinue same\nAdviced:Daily dressing with biofill AB and ceptigras.Review 2 weeks.'}, {'role': 'model', 'content': "\nIP Number: 404\n\nPatient Number: 5966\n\nAdmission Date: 24-04-2012\n\nDischarge Date: 12-05-2012\n\nDiagnosis: Non Healing Diabetic foot ulcers in left leg.\r\nCellulitis sorrounding the ulcers\n\nClinical Exam(With BP): {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Mrs.Kuttiyamma Issac, a 71yr old lady was brought here with h/o recurrent abscesses over both lower limbs.Presently the abscesses over the left lower limb has become non-healing. There is also redness, swelling and pain over the same leg.\r\n\\par }\r\n\n\nSystolic BP: 142.0\n\nDiastolic BP: 90.0\n\nPhysical examination: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 \r\n\\par \r\n\\par \r\n\\par }\r\n\n\nXray findings: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 2 Non healing ulcers over the left leg with oedema over that foot with sorrounding cellulitis.One of the ulcers looks necrotic\r\n\\par }\r\n\n\nDiscussion: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 71yr old Femal came with h/o recurrent abscesses,rednesss and swelling over both lower limbs.She is aknown case of DM ,her sugars were also uncontrolled.C & D done under Dr.Bhatt 's (Podiatry surgeons advise) .Ulcers cleaned and Alternate dressing with T-Bact + Intrasite done.Blood sugars controlled.Pt feels better.Discharging in a stable condition.\r\n\\par }\r\n\n\nDiet: Advised to follow a small frequent meal pattern, to increase intake of fibre and to follow Tab. Warf diet restrictions.\n\nRemarks: 2hr PPBS"}] |
446 | [{'role': 'user', 'content': "\nIP Number: 446\n\nPatient Number: 6217\n\nPatient Name: BABU V S\n\nGender: M\n\nDate of Birth: 19-05-1952\n\nAddress: VADAKKEDATH HOUSE, CHERUVYPE,\n\nPincode: 682501.0\n\nPhNo: nan\n\nAdmission Date: 19-05-2012\n\nDischarge Date: 15-06-2012\n\nDiagnosis determined by the doctor when the patient was admitted: Mixed hyperlipidaemia\nDIABETIC FOOT\nDIABETIC PERIPHERAL NEUROPATHY\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: 60 year old, k/c/o T2DM, Peripheral Neuropathy, presented here with c/o large non healing ulcer over Left foot associated with pain, swelling and redness. \n\nXray information: nan\n\nClinical examination: G/E: Afebrile, BP - 140/90. HR - 80/min. RR - 20/min.\r\nconscious, oriented.\r\nCNS, CVS, P/A, RS: NAD.\r\n\r\nL/E:Large non healing ulcer with exposed muscles and tendons and slough. \r\n Erythema and warmth over dorsum of left foot.\r\n Peripheral pulses on left foot: feeble.\r\n Another smaller non healing ulcer - shin Right foot.\r\n\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: 2000: S/b Dr Biju.\r\nDischarged at request from Amrita Hospital and brought here with a large non healing ulcer on the dorsum of the right foot.\r\n\r\nOn Admission:\r\nBP - 140/90. HR - 80/min.\r\nAfebrile. other systems - NAD.\r\nGRBS - 451mg%\r\nInsugen R 10U s/c stat.\r\nStarted on Biopiper.\nSeen by Dr.AK.Bhat.\r\nDressing changed.Left foot extensive unhealthy raw area dorsolateral aspect upto and above ankle,extending to lateral plantar aspect,exposing pockets of slough,necrotic extensor tendons of lateral 2 toes,skin gangrene of edges,?exposure of 5th MT joint/ankle joint on lateral aspect.Cellulitis/Residual necrotising fasciitis of surrounding edges.Tenderness above ankle on lateral and medial sides.Distal pulsations present.Xray shows no e/o OM at present.MRI findings noted.\r\nPlan:Step 1:Debridement left foot/fasciotomy leg under SA -May need 5th toe amputation.For 21-5-2012.Step2:skin cover at later date.\r\nAdvice:InformedConsent.C&D left foot and leg.Arrange one pint packed cells.Medical fitness for the procedure.Nil oral as per anesthetist.\r\n\r\n\r\nS/B Dr. Raees\r\nDressing changed by Dr. Bhat sir\r\nGRBS- 301 mg%\r\nprepare for debridement for tomorrow\r\nInvestigation to be done tomorrow: blood group and Rh, BT,CT, Infection screening\nVitals stable\r\nDr. Bhatt Sir to see today\r\nMRI Angio report to be got from AIMS\n9am: S/B Dr. Kenny-\r\nV/s stable. TLC/ESR elevated, BT, CT normal. Mild anemia.\r\nRelatives to consider cost & will decide re surgical procedure.\r\nECG: Leftward axis, T inversion avL, No acute isch.CXR-wnl.\r\nIs Medically Fit to undergo Surgical Procedure under SA.\nVital stable\r\nSystemic Examination -NAD\r\nStop dextrose\r\nInsugen R 15units\r\nInsugen N 22units at bed time\n9:30Am \r\nVital stable\r\nShift to room \r\nhad pain at night, relived with ultracet\r\ncontinue the rest\nVital stable\r\nSystemic Examination -NAD\r\nStop dextrose\r\nInsugen R 15units\r\nInsugen N 22units at bed time.\r\n\r\n1930: S/b Dr Biju.\r\nGRBS - 271mg%. sytems - NAD.\r\nAfebrile.\n9.45am: S/B Dr. Kenny-\r\nGenerally better. Vitals stable. Had BM.\r\nDressing in afternoon.\r\nPus C/S report awaited.\nSeen by Dr.A.K.Bhat.\r\nC&D done.Raw area lt foot clean.Continue trt.\r\n\r\n\r\n1900: S/B Dr. kenny-\r\nHas incomplete BM. c/o bloating. Dressing done.\r\nGRBS 221mg%\r\nPlan- IT works, cont. all above.\nDawn phenomena\r\nDecresed basal insulin dose\r\nContinue the rest\r\n\nSeen by Dr.A.K.Bhat.\r\nContinue trt.\r\n\r\n\r\n\nSeen by DrA.K.Bhat.\r\nDressings changed.Raw area lt foot clean.Continue trt.Oral antibiotic.\r\n\r\n1850: \r\nS/b Dr Biju.\r\ndoing well. having trouble sleeping since yesterday.\r\nAppetite - normal. Cough decreased.\r\nTab. Trica 0.5mg SOS.\nfine\r\nneed to adjust the insulin\r\nNo Hypos\r\ncontinue the same\nS/B Dr. Kenny-\r\nGenerally better. Vitals stable.\r\nFBS : 75 mg/dl.\r\nAntibiotic Changed to Oral Levostra.\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\n1900: S/B Dr.Kenny-\r\nNo new c/o, V/S stable.\r\nGRBS 213mg%.\r\nPlan: Cont.same.\n1800: S/B Dr. Kenny-\r\nDressing done in AM.\r\nNo new c/o. GRBS 341mg%- Give Insugen R 18U.\r\nCont. all above.\n9am: S/B Dr. Kenny-\r\nc/o decreased sleep.\r\nV/S stable.\r\nPlan- cont. same.\r\nSeen by DrA.K.Bhat.\r\nDressings changed.Raw area lt foot clean.Continue trt.\nfair glycemic control\r\nContinue the same\nvital stable\r\nPredinner was high, adjusted the dose pf insulin\r\ncontinue the rest\r\nPlan\r\nSkin grafting.\r\nSeen by Dr.AKBhat.\r\nContinue trt.\nMid night hypoglycemia\r\nReduced the dose of Insulin\r\nContinue the rest.\r\nSeen by Dr.A.K.Bhat.\r\nRaw area clean.Plan for SSG under SA on 5-6-2012.Tuesday.\nhad hypoglycemia at midnight\r\n18.15:seen by Dr.Arun\r\nnil special\r\nplan-continue the same\nS/B Dr. Kenny-\r\nDoing fine, No hypos. On Heparin bd since yday.\r\nadjusted the insulin doses. \r\ncontinue the rest.\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\n\r\n1800: S/b Dr. Kenny-\r\nNo new c/o. Fair glycemic control.\nFine\r\nadjusted the insulin\r\nUrea, Creatinine, Albumin Creatinine ratio\r\ncontinue the same\nSeen by Dr.A.K.Bhat.\r\nC&D done.Raw area clean.Continue trt.\r\nDaily Oxum dressing.\n19:00.\r\nGC fair, Afebrile, vitals stable.\r\nGRBS - 318mg%. Insugen R-16 U N- 12U.\r\nc/o defect in near vision, has asked for a ophthal consultation. was reassured that he will be shown to the ophthalmologist according to the doctor's availability as early as possible.\nfine\r\nVital stable\r\nadjusted the insulin\r\nVaseline body lotion\r\ncontinue the rest\n1800: S/B Dr. Kenny-\r\nHad 1 episode of hypo; when lunch delayed-54mg%.\r\nNo other systemic c/o.\r\nOverpadding done.\r\nInsulin doses decreased. Cont. all above.\n9.30am: S/B Dr. Kenny-\r\nOphthal consult today. \r\nc/o decreased sleep.\r\nPlan- Cont. same, Increase Amitone to 10mg hs & Pletoz BD\r\nFor SSG on 5/6/12.\nS/B Dr. Raees\r\nno complaints\r\nPredinner GRBS- 286mg%\r\nContinue same treatment\nfine\r\nhypo at afternoon\r\nContinue the same\nDoing well.\r\nSkin grafting tomorrow.\r\nContinue the same.\nSeen by Dr.A.K.Bhat.\r\nC&D done.Raw area clean.\r\nFor SSG under SA on 5-6-2012.\r\nPreop.\r\nConsent.C&D left foot.Shave genitalia and left thigh and betadine scrub HS &CM.\r\nInj.Cefbact-S IV 1.5 GM HS and CM.\r\n\r\n\r\nS/B Dr. Raees\r\npredinner GRBS - 307mg%\r\nT. Anxit .25mg 1HS\r\n\nS/B Dr. lakshmy and Dr. Raees\r\nNo complaints\r\nBP- 140/ 90 mm of HG\r\nPulse- 108/min\r\nGRBS-164mg%\r\nsystems-NAD\r\nno soakage\r\nADV: Trika .5mg HS\r\n continue same treatment\nposted for skin grafting today. GRBS- 93\r\nwill start on DNS buffered with 6 units regular insulin @70 cc/hr.\r\nVitals stable. Pt medically fit for surgery under SA\n10am-S/B Dr. kenny-\r\nComfortable, BP settled after Nel cath. bladder.\r\nBP 116/69, pulse-61/min, O2 sat 99%@RA.\r\nFBS 115mg%. Sl. decrease Hb.\r\nPlan- shift to ward, Add Ferox-XT 0-1-0.\nSeen by Dr.A.K.Bhat.\r\nAfebrile.Continue trt.\r\n1830: s/b Dr. Kenny-\r\nNo new c/o\r\nCont. all above.\nBlood sugars are high. Other wise well.\nCBC today.\r\nSlept well.\r\nDressing today.\nSeen by Dr.A.K.Bhat.\r\nAfebrile.Continue trt.Suggested oral antibiotics.Dressing change tomorrow.\r\n\r\n19:00 \r\nS/b Dr Biju.\r\nDoing well. vitals stable. no new complaints.\r\nStop Cefbact.Tab. Levostra 500mg 1-0-0.\r\nItching over the back decreased. \r\nGRBS - 323mg%.\n9.30AM: s/b Dr. Kenny-\r\nAsymptomatic. Pre dinner sugars still high\r\nAdjusted Insulin dose. For dressing today.\nSeen by Dr.A.K.Bhat.\r\nDRessing changed.\r\nLt foot graft taken up.Continue trt.\r\n\r\n1800: S/B Dr. Kenny-\r\nNo new c/o. V/S stable.\r\nInsulin dose adjusted.\nS/B Dr Raees\r\nNo complaints\r\ndoing well\r\nPredinner GRBS- 300mg%\r\nContinue same treatment\nSB -Dr Tom /Dr Rigith \r\ndoing well \r\nslept well \r\nappetite normal \r\nG/c -good \r\ncontinue all meds.\r\nSeen by DrA.K.Bhat.\r\nAfebrile.Continue trt.\nDoing well. BP: 120/80. FBS: 113 mg/dl. Dressing to be done by Dr. A.K. Bhat today.\nSeen by Dr.A.K.Bhat.\r\n6th POD.Afebrile.Continue trt.\r\n\r\n\r\n19:00\r\nS/b Dr Biju.\r\ndoing well. difficulty sleeping. \r\nTab. Trika 0.25mg SOS at B/T.\r\ncontinue rest.\nSeen by Dr.A.K.Bhat.\r\nDRessing changed.\r\nLt foot graft taken up.Continue trt.\r\n\r\n19:00\r\nS/b Dr Biju.\r\ndoing well. slept well yesterday. Afebrile. \r\nDressings changed today. to be dischrged on friday.\r\nGRBS - 201mg%. Insugen R - 20U, N - 12U.\r\ncontinue rest.\r\n\r\n\nSlept well during the night. FBS: 74 mg/dl. BP: 130/70.\n10am:S/B Dr. Kenny-\r\nV/s stable. FBS: 80 mg/dl. BP: 130/90.\r\nPlan for Discharge on Friday.\n1800: S/B Dr. Kenny-\r\nNo new c/o.\r\nPlan- cont. same.\nDoing well.slept well at night.\r\nHad breakfast.\r\nBP : 120/80mmHg\r\nGRBS : 148mg%\r\nCan be discharged tomorrow after dressing.\nS/B Dr. Raees\r\nNo complaints\r\nvitals stable\r\ncontinue same treatment\nSeen by DrA.K.Bhat.\r\nLeft foot SSG settled.Donor site healed.\r\nAdviced:Review 18th monday.Night splint.Vaseline to left thigh thrice a day.\r\n"}, {'role': 'model', 'content': '\nIP Number: 446\n\nPatient Number: 6217\n\nAdmission Date: 19-05-2012\n\nDischarge Date: 15-06-2012\n\nDiagnosis: DIabetic foot ulcer- dorsum of the Lt foot- S/p Debridement and SKin grafting to the dorsum of the Lt foot\n\nClinical Exam(With BP): {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\li810\\lang1033\\f0\\fs24 60 year old, k/c/o T2DM, Peripheral Neuropathy, presented here with c/o large non healing ulcer over Left foot associated with pain, swelling and redness. \r\n\\par }\r\n\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Chest X-Ray : WNL\r\n\\par \r\n\\par \r\n\\par }\r\n\n\nXray findings: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 G/E: Afebrile, BP - 140/90. HR - 80/min. RR - 20/min.\r\n\\par conscious, oriented.\r\n\\par CNS, CVS, P/A, RS: NAD.\r\n\\par \r\n\\par L/E:Large non healing ulcer with exposed muscles and tendons and slough. \r\n\\par Erythema and warmth over dorsum of left foot.\r\n\\par Peripheral pulses on left foot: feeble.\r\n\\par Another smaller non healing ulcer - shin Right foot.\r\n\\par \r\n\\par }\r\n\n\nDiscussion: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 60yr old male admitted here with c/o non Healing infected ulcer over left foot.He was started on Insulin for tight glycemic control and I.V antibiotics.Case shown to Dr.Bhatt,Wound debridemnet was done initially on 24-5-12 ands then later followed by skin grafting. .Vitals stable.Discharging under stable condition.\r\n\\par }\r\n\n\nDiet: nan\n\nRemarks: nan'}] |
451 | [{'role': 'user', 'content': '\nIP Number: 451\n\nPatient Number: 6271\n\nPatient Name: SUBAIR K A\n\nGender: M\n\nDate of Birth: 25-05-1962\n\nAddress: KANELIL HOUSE, EDAVOOR P.O\n\nPincode: 683544.0\n\nPhNo: 2640376\n\nAdmission Date: 25-05-2012\n\nDischarge Date: 13-06-2012\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC FOOT\nEssential (primary) hypertension\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: Mr. Subair. K.A., presented here with a non Healing ulcer over the Rt heel. He subsequently developed swelling, redness and pain over the Rt foot. He is a known diabetic and hypertensive on medication. He was treated in a local hospital conservatively with antibiotics. His counts were elevated (DC- 12,700 cells/ mm3)\n\nXray information: nan\n\nClinical examination: Non healing heel ulcer Rt\r\nBullous lesion over the dorsum of Rt foot\r\nCellulitis over Rt foot\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by Dr.A.K.Bhat.\r\nExtensive necrotising infection rt foot and leg extending from heel ulcer(copious pus-C/S taken),to whole of dorsum foot,palntar foot,extending to posterior leg upto upper third,with cellulitis and subcutaneous crepitus all over.Charcot,s foot ++.Xray proves the same.\r\nPlan:Debridement under SA.\r\nAdviced:Informed consent.Medical and anesthetic fitness for surgery.C&D.IV antibiotics continue.Nil oral as per anesthetist.Rpt blood RE,Urea,Creat,Fbs tomorrow.\r\n\r\n\r\n1900: S/b Dr Biju.\r\nBlood reports seen. \r\nALP - >1000, S. Creat - 1.3\r\nCRP - 32, HbA1C - 13.5\r\nNa+ - 127, SGPT - 96\r\nESR - 115, PCV - 27\r\nTC - 13600, PT - 17\r\nINR - 1.3.\r\nInformed Dr Deepak. \r\nAdviced Inj Vit K IV tid. \r\nTab. Udiliv 300mg 1-0-1.\r\n\nX- ray Rt foot AP/ Oblique\r\nECG\r\nCXR- PA\r\nCBC\r\nRFT\r\nLFT\r\nFLP- Tomorrow\r\nUrine RE\r\nTo show Dr. Bhatt\n1900: S/B Dr. Kenny-\r\nShifted from OT @1845hrs, Extensive debridement & fasciotomy done.\r\nV/S stable, GRBS 278mg%.\r\nInsulin infusion on flow.\r\nCheck Hb, TC, BU, Creat, Na/K, LFT as advised.\r\n\r\n21:30s/b Dr.Nisha\r\nbp:170/96 pulse:120 GRBS:263\r\nurine output after shiftin 450ml\r\noral intake 50ml water\r\nc/opain in rt leg\r\ninformed Dr.KENNY\r\nadviced 1.T.REVOLON XT 25mg stat\r\n 2.insugen R 20units\r\n 3.inj tramadol 1 amp iv stat\r\n 4.GRBS at 12am\r\n 5.2 hrly BP/PULSE chart\nRS-few conducted sounds.\r\nCVS-S1S2 Normal\r\nCNS-Consious/Oriented.\r\nXray Chest Pa-Incresed Bronchovascular markings\r\nECG-Normal. Fit for debridement procedure.\r\nLabs:Leucocytosis, Alk Phosphate > 1000\r\nX ray foot:? Early charcots\r\nPlan:USG Abd. in v/o deranged LFT.\r\nNPO, Debridement planned b/w 3-4pm.\r\n\r\n9.45am: S/B Dr. Kenny-\r\nTongue Red, Generalised Pity. versicolor lesions on Neck & Trunk.\r\nChest clear. BP : 150/80, afebrile. Talked to relatives, willing for the procedure. Stop plagerine. Cont. Vitamin K.\n12:15am\r\nBp:168/80 pulse:110 GRBS:273\r\nurine output 950ml\r\nhad oral food.\r\nintake of revolol xt 25mg n insugen R at 10:30pm\r\ninformed Dr.Kenny sir\r\nadvised 1.T revolon XL 25mg stat\r\n 2.insugen N 15 units\r\n 3.ECG to be taken in morning.\r\n9am: S/B Dr. kenny-\r\nBP better 150/70, HR 108/min, taking orally , No pain. \r\nALP still high, sl. increased T.Bili, Transaminases normal, Hb [email protected], TC 19.7K. Crat/ BU normal.\r\nECG: T inversion L3 & V3, no other fresh changes.\r\nPlan: check CK-MB,TSH. Keep pt. in ICU till BP improves & results come. Cont. IV Biopiper.\r\n\r\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\n\n1700: S/B Dr. Kenny-\r\nShifted to room @1pm. Not passed stool.\r\nRcd. 2 doses Vit. K. GRBS 297mg%\r\nChest clear, Abd- soft. Pus c/s report awaited.\r\nPlan- Cont. same. IT works.\nSeen by Dr.AK.Bhat.\r\nDressing changed.Large raw areas rt foot and leg,exposing bone,tendons &residual necrosis esp around the mid foot region.Pus present in tarsal spaces/bones.However pus in peroneal compartment of leg is less.\r\n?Plan,maybe can try proximal foot amputation.\nTemp 99F\r\nVital stable\r\nNeed to adjust the insulin for fair glycemic control \r\nContinue the same.\n18.30:seen by Dr.Arun\r\nc/o burning sensation\r\nStool occult blood - Negative\r\nplan-continue the same\nC/o Burning sensation\r\nPallor\r\nHB,TC\r\nIron profile\r\nStool for Occult blood.\r\nSeen by Dr.A.K.Bhat.\r\nContinue trt.\n9.30am: S/B Dr. Kenny-\r\nAntibiotic changed to IV Lactagard according to C/S\r\nLeucocytosis-Counts going up.\r\nHb-9.2 gm%\r\nCreat 1.1\r\nExplained the need of amputation to the bystanders, \r\nawaiting decision.\r\n\nNPO after Lunch. Relatives are willing for surgery.\r\n1500: s/b Dr. Kenny- \r\nV/S stable, Chest- clear. Pt. is fit for procedure.\r\nCase posted at 5pm under spinal. Informed Dr. Bhat.\r\nTake Consent.\r\nPrepare the part.\r\nInformed consent.\r\n\r\n20:00.\r\nBP - 108/63, HR - 80/min. GRBS - 327mg%.\r\ncondition stable.\nHB.9.5\r\nVital stable\r\nLess Pain \r\nRS- Crepitation +\r\nSHift after Dressing \r\nBlood transfusion 1 unit today.\r\n11am- Give 1 unit B+ve PRBC.\r\n\r\nNOrxn\nSeen by DrA.K.Bhat.\r\nRt foot and leg dressing changed.\r\nRaw areas clean.Continue trt.\r\nPlan for change of dressing on saturday.\r\n\r\nMild dehyration \r\ncontinue the same\n19:00\r\ndoing well. Afebrile, vital stats - WNL.\r\nGRBS - 150mg%. continue same.\nNo fever\r\nCOntinue the same\r\nDressing- tomorrow\r\nHb,TC,DC\n1815: S/B Dr. Kenny-\r\nNo new c/o.\r\nBP 140/80, GRBS 272mg%.\r\nChest- clear, Glossitis less.\r\nPlan- Dressing tomorrow.\n9.45am: s/b Dr. Kenny-\r\nGC fair, vitals stable. Tongue- glossitis, pallor+ \r\nNo pain on Rt. leg stump. Passed stool\r\nChest clear. TLC decreased. Stooloccult- negative, Creat N.\r\nHb holding, Low Se. Iron , TIBC & Ferritin levels. \r\nPlan- Cont. oral Hematinics & IV Lactagard.\r\nFor dressing by Podiatry today.\nDressing done, wound clean, flap viable, \r\nGC-fair\r\nInj.Tramadol 50mg I.V sos\r\nSystemic examination -NAD\r\nContinue the same\nS/B Dr. Raees\r\nno complaints\r\nPredinner GRBS- 172mg%\r\nContinue same treatment\nCBC tomorrow.\r\nFBS : 100mg%\r\nSlept well.\r\nContinue the same.\nSeen by Dr.A.K.Bhat.\r\nC&D done.Raw area rt foot and leg. Plantar residual flap distal end looks dusky.Continue trt.\r\n\r\n\r\n\r\nS/B Dr. Raees\r\nNo complaints\r\nPredinner GRBS- 199mg%\r\ncontinue same treatment\nS/B Dr. lakshmy and Dr. Raees\r\nNo complaints\r\npredinner GRBS- 143mg%\r\nContinue same treatment\r\nplan for blood transfusion tomorrow\nSeen by Dr.A.K.Bhat.\r\nContinue trt.\r\n\n9.30am: S/B Dr. Kenny-\r\nGenerally better, BP 130/80.\r\nFBS 97mg%. Passed stool twice yday.\r\nPlan-Dressing today, transfuse 1 unit PRBC today.\nSeen by Dr.A.K.Bhat.\r\nC&D done.Raw area rt foot and leg clean.Distal part of platar flap nonviable.\r\nContinue trt.\r\n\r\n1830: s/b Dr. Kenny-\r\nPRBC on flow, no systemic c/o.\r\nPlan- Cont. all above.\n19:00\r\nS/b Dr Biju.\r\ndoing well. vitals stable. \r\nc/o difficulty in sleeping. Appetite - normal.\r\nGRBS - 195mg%. continue same.\nDoing well, FBS 99mg%.\r\nCont. same.\nNo fresh complaints.\r\nDressing today.\r\nContinue the same.\nSeen by Dr.A.K.Bhat.\r\n9th POD.C&D done.Raw area clean.Continue trt.\r\n\r\n19:00\r\nS/b Dr Biju.\r\nvitals stable. slept well yesterday. dressings changed.\r\nStop IV Lactagard. Start Tab. Levostra 500 mg 1-0-0.\r\nGRBS - 222mg%. continue same.\n9.30 am: S/B Dr. Kenny-\r\nNo systemic c/o.\r\nHb holding @ 9.8gm%, Occult blood#2 report awaited.\r\nPlan- cont. same.\nSeen by Dr.A.K.Bhat.\r\nContinue trt. For change of dressing tomorrow. Plan for discharge next week.\r\n\r\n1830: s/b Dr. Kenny-\r\nFeels better, V/S stable, Fair glycemic control.\r\nCont. same.\nS/B Dr Raees\r\nNo complaints\r\ndoing well\r\nPredinner GRBS- 248mg%\r\nContinue same treatment\ndoin well \r\nslept well \r\nfbs 106 mg%\r\nplan.D/D on wednesday \r\nadv- continue all meds and insulin.\r\nSeen by DrA.K.Bhat.\r\nAfebrile.\r\nC&D done.Raw area rt foot and leg clean except for minimal slough ,part of which was excised.Continue trt.\nSeen by Dr.A.K.Bhat.\r\nAfebrile.Continue trt.\r\nSuggested oral antibiotic.\r\n\r\n18:55 \r\nS/b Dr Biju.\r\ndoing well. dressing change tomorrow. no new complaints.\r\ncontinue same.\r\n\r\n\nc/o pruritus all over the body esp limbs. hb remaining at 9.7 gm%.Pt better . sitting . more cheerful.\nFBS: 91 mg/dl. Slept well during the night.\nSeen by Dr.A.K.Bhat.\r\nDRessing changed.\r\nRaw area clean.Continue trt.\r\nPlan for discharge tomorrow.\r\n\r\n19:00 \r\nS/b Dr Biju.\r\nV/S stable. nil spl. no new complaints.\r\nGRBS - 173mg%. Insugen R - 26U, N - 26U.\r\ncontinue rest.\r\n\r\n\nperipheral smear for general blood picture.'}, {'role': 'model', 'content': '\nIP Number: 451\n\nPatient Number: 6271\n\nAdmission Date: 25-05-2012\n\nDischarge Date: 13-06-2012\n\nDiagnosis: Bullous Lesion Rt Foot with Sorrounding Cellutiltis\n\nClinical Exam(With BP): {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Mr. Subair. K.A., presented here with a non Healing ulcer over the Rt heel. He subsequently developed swelling, redness and pain over the Rt foot. He is a known diabetic and hypertensive on medication. He was treated in a local hospital conservatively with antibiotics. His counts were elevated (DC- 12,700 cells/ mm3)\r\n\\par }\r\n\n\nSystolic BP: 140.0\n\nDiastolic BP: 80.0\n\nPhysical examination: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 \r\n\\par \r\n\\par \r\n\\par }\r\n\n\nXray findings: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Non healing heel ulcer Rt\r\n\\par Bullous lesion over the dorsum of Rt foot\r\n\\par Cellulitis over Rt foot\r\n\\par }\r\n\n\nDiscussion: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 Mr.Subair K.A, 50yr old male a known case of DM and HTN came here with c/o Non healing ulcer over the right heel.He was admitted here for further investigations and procedures.Since his blood sugars were high,he was started on insulin and started on IVantibiotics.Seen by Dr.Bhatt and advised for amputation.Initial debridement and proximal foot amputation done first time on 25/5/12 and due to the severeness of the infection in the wound , fasciotomy of lateral and medial compts done.The lateral fasciotomy done upto knee level due to extensive sepsis.His blood sugars titrated , vitals normal and discharging under stable condition. \r\n\\par }\r\n\n\nDiet: Advised a small frequent meal pattern and to follow a Low Calorie Low Fat High Fiber Diet.\n\nRemarks: FBS, 2 hr PPBS'}] |
489 | [{'role': 'user', 'content': "\nIP Number: 489\n\nPatient Number: 6183\n\nPatient Name: RAJAMMA MANOHARAN\n\nGender: F\n\nDate of Birth: 16-05-1950\n\nAddress: THITTAYIL H, KADAVANTHARA\n\nPincode: 682020.0\n\nPhNo: nan\n\nAdmission Date: 16-06-2012\n\nDischarge Date: 30-06-2012\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nEssential (primary) hypertension\nDIABETIC FOOT\nDIABETIC NEUROPATHY\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: 62y/o known Diabetic, discharged on 26/5/12 after partial transmetatarsal Rt.foot amputation of lateral 4 toes, now admitted for skin grafting.\n\nXray information: nan\n\nClinical examination: BP 110/80, pulse 80/min, Temp 98.6*F, wt-46kg.\r\nChest- clear,\r\nAbd- soft, no tenderness/masses.\r\nLocal Examination :Rt.foot Raw area clean and granulated.\r\n\r\n\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: 1725: S/B Dr.Kenny-\r\nCame for SSG as advised. RBS very high. \r\nAfebrile, BP 110/80. Chest- clear.\r\nPlan- Start basal bolus Insulin.\nGC - good \r\nBP - 130/70mmHg \r\nGRBS -277 mg%\r\nc/o occ mild u/l headache\r\nADV - t.pct 650 mg tds\nSeen By DR Lakshmi, Admitted for Skin grafting yesterday,\r\nGRBS yesterday- 540, this morning 207\r\nPt alert, oriented, no complaints except hard stools\r\nChest- Clear\r\nAbdomen- soft\r\nLab- Urea- 115, Creatinine- 3.1\r\nUrine - pus cells numerous\r\nSeen by Dr. Bhat.\r\nPlan for SSG under SA on tuesday 19-6-2012.\r\nDaily Oxum dressing.Leg elevation.Daily betadine scrub of both thighs and bath.Continue trt.\nS/B Dr. Raees\r\nFor Skin grafting tomorrow\r\nNo complaints\r\nVitals stable\r\nGRBS- 188mg%\r\nNPO from tomorrow morning 6am\r\nT. Trika 0.5mg HS\n18:30\r\nS/b Dr Biju.\r\ndoing well. V/S stable. started oral feeds.\r\nBP - 135/74. HR - 78/min. \r\nC/o mild pain at suture site. \r\nK+ - 5.6. Urea & Creat. tomorrow.\r\nGRBS - 174mg%. Insugen R - 6U, N - 6U.\r\ncan be shifted out tomorrow.\nposted for skin grafting today. pt with H/o chronic renal failure, baseline creatinine- 2.6, urea- 115\r\npt lying comfortably in bed without distress\r\nchest- clear\r\nNo pedal oedema.\r\nPt is medically fit under moderate risk, because of underlying renal condition\n10am: S/B Dr. Kenny- SSG done y'afternoon.\r\nNo systemic c/o. \r\nI/O 2000,1600ml.\r\nV/S stable.BP 117/56.\r\nShift to room.\r\n\r\n\nSeen by Dr.A.K.Bhat.\r\nContinue trt.\r\n\r\n1845: S/B Dr. Kenny-\r\nUrine c/s-Candida sp.\r\nc/o pain in operated leg.\r\nV/S stable. Insulin dose titrated.\r\nT. Ultracet stat & BD.\n19:30 \r\nS/b Dr Biju.\r\nc/o pain at graft site. otherwise doing well. \r\nGRBS - 213mg% Insugen R - 8U, N - 6U.\r\ncontinue rest.\nRpt Se.Electrolytes.\r\nContinue the same.\r\nTSH was low during last admission.\r\nPlan: check TSH & free T4.\nSeen by DrA.K.BHat.\r\nDressings rt foot changed.SSG taken up.Continue trt.\r\n\r\n19:15 \r\nS/b Dr Biju.\r\nDoing well. Dressings changed. Afebrile. \r\nV/S stable. GRBS - 216mg%. \r\nRecheck K+ tomorrow. \r\ncontinue same.\nc/o not enough sleep. Dressing change today.\r\nc/p pain at the graft site\n9.40am: S/B Dr. Kenny-\r\nNo systemic c/o. FBS 148mg%, BP 140/80.\r\nChest- clear. Se. K+5.8, check Creat, BUN.\r\nTSH suppressed with high free T4.\r\nPlan: K-bind sachet 1-0-1. Low potassium diet.\n9am: S/B Dr. Kenny-\r\nNo new c/o, V/S stable.\r\nPlan: check Creat, K+, Hb, TC tomorrow.\r\nCont. all above.\nS/B Dr. Raees\r\nC/O pain at Rt medial thigh\r\nvitals stable\r\nPre dinner GRBS- 211mg%\r\nT. Ultracet 1 HS \r\ncontinue same treatment\nC/O pain,Tab.Ultracet given.\r\nSlept well.Passed stool.\r\nGC fair.\r\nDressing today and plan for discharge after discussing with Dr.Bhatt.\nSeen by Dr.AK.Bhat.\r\nDressings rt foot changed.SSG taken up.Plan for Discharge after next dressing.\r\n\r\n19:00 \r\nDoing well. V/S stable. GRBS - 187mg%\r\ncontinue same.\nSeen by DrA.K.Bhat.\r\nDonor site dressing changed.Clean.Continue trt.\r\n\r\n18:50\r\nGC - better. pain has decreased at donor site. \r\nAfebrile. Intermittent rise in systolic BP. GRBS - 179mg%\r\ncontinue same.\r\nK + tomorrow.\npain better after taking Tab ultracet . Dressing change done yesterday, SSG taken well . plan is to discharge after one more dressing change\n9.30am: S/B Dr. Kenny-\r\nGenerally better.Pain Rt.leg less. Dressing change today.\nSeen by DrA.K,.Bhat.\r\nOral antibiotic.\r\n\r\n1800: s/b Dr. Kenny-\r\nNo new c/o.\r\nCandid cream L/A tds.\nDoing well.no pain.sugars improving.dressing today\nSeen by Dr.AK.Bhat\r\nDressings rt foot changed.SSG settling down.Plan for change of dressing rt thigh tmrw&then decide about discharge.\nPain better.Discharge after Surgical consultation.Vitals stable.\r\nTC, KFT, HB, Na, K+\nSeen by DR.A.K.Bhat.\r\nDressings changed.Rt thigh healing well.Small lateral area raw.Adviced:Change of dressing once in 3 days.Neosporin powder/cuticell for thigh&cuticell to foot.Review 10 days.Wednesday.\r\n\r\n\r\nS/B Dr. Raees\r\nC/O decreased sleep\r\nsystems- NAD, Vitals- stable, pre dinner GRBS- 261mg%\r\nADV: T. Trika 0.25mg HS\r\n continue same\n10.45am: s/b Dr. Kenny-\r\nNo systemic c/o. FBS: 237 mg%.\r\nPlan - Discharge after dressing today. Catheter to be removed.\r\nAlternate day dressings here.\r\nReview after 10 days in Podiatry with PPBS & TSH."}, {'role': 'model', 'content': '\nIP Number: 489\n\nPatient Number: 6183\n\nAdmission Date: 16-06-2012\n\nDischarge Date: 30-06-2012\n\nDiagnosis: Hyperthyroidism.\r\ns/p Partial transmetatarsal Rt.foot amputation, SSG done.\r\n\r\n\n\nClinical Exam(With BP): {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 62y/o known Diabetic, discharged on 26/5/12 after partial transmetatarsal Rt.foot amputation of lateral 4 toes, now admitted for skin grafting.\r\n\\par }\r\n\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 \r\n\\par \r\n\\par \r\n\\par }\r\n\n\nXray findings: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 BP 110/80, pulse 80/min, Temp 98.6*F, wt-46kg.\r\n\\par Chest- clear,\r\n\\par Abd- soft, no tenderness/masses.\r\n\\par Local Examination :Rt.foot Raw area clean and granulated.\r\n\\par \r\n\\par \r\n\\par }\r\n\n\nDiscussion: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 62yr old female admitted here for skin grafting of right foot.She was admitted here with cellulitis over rt foot one month back.A partial transmetartasal amputation was done , now admitted for skin grafting. Her blood sugars are controlled. Dressing changed. Skin Grafting was Uneventful.Vitals stable. Discharged under stable condition.and dressing change as advised by surgeon and to follow up as an outpt\r\n\\par }\r\n\n\nDiet: nan\n\nRemarks: FBS, PPBS'}] |
670 | [{'role': 'user', 'content': "\nIP Number: 670\n\nPatient Number: 7575\n\nPatient Name: SREEKUMAR M R\n\nGender: M\n\nDate of Birth: 11-12-1958\n\nAddress: MATHUKODICKAL, ARANMULA\n\nPincode: 689533.0\n\nPhNo: 0468-2319147\n\nAdmission Date: 20-09-2012\n\nDischarge Date: 11-10-2012\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: Admitted with C/o pain Lt hip and edema both legs.\n\nXray information: X Ray Pelvis (20/09) - # NOF s/p ORIF.\r\nUSG Abd(22/09/12) - Cirrhosis with Portal HTN and Cystitis.\r\nVenous Colour Doppler LL(22/09/12) - Normal study.\n\nClinical examination: Temperature :97\r\nRespiration :22\r\nBP :150 / 60\r\ntenderness over the ant joint line Lt hip . ROM painful and restrcted on all directions.\r\ntenderness+ over the lat femoral condyle and lat tibial plateue. minimal effusion +. varus stress +\r\ndiffuse swelling both legs Lt > Rt\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Case seen by Dr Charles Panackel\r\n\r\nChild C Cirrhosis\r\n\r\nAdv\r\n1. LFT , PT, APTT\r\n2. T Lasilactone 1-0-0\r\n3. T. Ciplar 10mg 1-0-1\r\n4. T. UDILIV 300mg 1-1-1\r\nCase seen by Dr Jijo\r\nX-Ray showed neck resorption\r\nhe requires staged hemiarthoplasty.\r\nunilateral skin traction with 2.5 kg wt.\ncase seen by Dr Jijo,\r\nswelling both legs and foot +. tenderness ant joint line Lt hip and over the lat joint line of same knee.\r\nADV;\r\ndiabetology consultation for control of diabetes\r\ngastro consultation for liver problems\r\ntab thrize 1-1-1\r\ntab tramadol 50 mg bid\r\ntab razo 20 mg 1-0-0\r\nkeep limb elevated over a pillow\r\nactive ankle and foot movements.\r\nX-ray - pelvis with both hips AP ; Lt hip lat;\r\nx-ray Rt knee AP AND LAT.\r\nDOPPLER STUDY both LL TO r/o DVT\nFeels well. Oedema in the legs better. \r\nSeen By Dr charles,\r\nadvised T. lasilactone, ciplar and udiliv\r\nurine RE- RBC- 60-65, no pus cells or albumin\r\nWill discuss with DR jijo regarding traction and further plan.\r\n\nS/B Dr. Raees\r\nNO complaints, \r\ndoing well\r\nPredinner GRBS-329mg%\r\ncontinue same\nS/B Dr. Raees\r\nNo complaints\r\nPredinner GRBS- 332mg%\r\nstarted albumin infusion\r\ncontinue same\r\n\r\nAs per orders from Dr. Jijo\r\nRepeat Platelet tomorrow morning, do BT, CT tomorrow\r\nArrange 3 pint packed cell RBC\r\n 5 pint platelets\r\n 4 pint FFP\r\nto transfuse platelets tomorrow if platelet count is less\r\nto transfuse 1 pint PRBC on monday\r\nStrict I/O chart\nUSG Abd done today reveals Cirrhosis with portal HTN and cystitis.\r\nAC - 179mg%. BP - 140/80.\nS/B Dr. Radha\r\nfeels better\r\nFBS- 107mg%\r\nno hypoglycemia\r\nInj. albumin infusion on flow\r\nADV: withhold T. Tramadol\r\nPRBC, Platelet and albumin infusion coming morning\r\n\r\nS/S Dr Saheed/uro\r\nComplaints of LUTS since few days.\r\nProgressive symptoms,worsened after surgery and lack of mobility.Hematuria microscopic on evaluation.\r\nO/E: Grade I BPH.\r\nAdv;Tab. Veltam 0.4 mg HS \r\nReview as needed.\nS/B Dr. Raees\r\nC/O slight foot pain\r\nGRBS-321mg%\r\ncontinue same\nCase seen by Dr Charles Panackel. CTP- 9/15. High risk candidate for surgery. May continue on Inderal, Udiliv, Lasilactone. Please repeat PT INR.\r\nCase S/b Dr Jijo\r\nPre op orders\r\nNPO from midnight\r\nhigh risk consent\r\ninform OT, Anesthetist\r\ninj Zostum 1.5 gm IV ATD after induction\r\ninj Amikacin 500 mg after induction\r\nprepare the part \r\nFBS,PT,INR,BT,CT,TOTAL PROTIEN, A/G RATIO, Hb%,PCV,Platetcount IN THE MORNING. \r\narrange packed cell 2 pint, platelet 4 pint, fresh frozen plasma 2 pint.\r\n\r\nS/B Dr Raees\r\nTo start platelet transfusion\r\nGRBS-184mg%\r\nfollow orders\r\ncontinue same\nfeels well. pt posted for staged hemiarthroplasty. \r\nTo tranfuse 1 units of PRBC, platelets\r\nAnd to transfuse FFP post surgery.\r\nSeen by cardiology, fitness obtained to do surgery under any anaesthesia\r\n(2 FFP+ 2 Pooled PLatelets + 1 Packed RBC) to be arranged today\n07.00pm\r\nS/B Dr. Raees\r\nBP-110/60 mm Hg manually, Pulse- 66/min, SPO2- 98%,\r\nCVS- S1S2 heard, \r\nChest- B/L Mild basal crepts, \r\nP/A- Soft, Non tender, BS+\r\nOutput 150ml after shifted to ICU\r\nADV:Send S. Urea, S. Creatinine now, Send Hb, PCV, Platelet tomorrow morning. Withhold Inj. Amikacin \r\nInform SOS\nShifted to OT for Hemi arthroplasty.\n10am: s/b Dr. Kenny-\r\nFeels better. Out put less ~ 350ml, Inj lasix 20mg given.\r\nHb & PCV decreased - 9.1gm%/23, PLT - 1.0 lakh.\r\nCheck Urea, Creat and K+. Give 1 unit PRC.\r\nPlan: Shift to ward by 12 noon if Urine output is adequate.\r\n\r\n11.30am: Passed about 200ml urine, Creat & BU increased.\r\nSe. K+ normal. Nephrology consult.\r\n\r\n\n18:30 S/B Dr kenny\r\nGc-better\r\nBP-110/60 mm Hg\r\nPR-72 RR-22\r\nGRBS-300mg%\r\nafebrile\r\nPlan:cont the same\r\n\r\nS/B Dr Sooraj(Nephro)\r\n---------------------------\r\nThank you for referral\r\n\r\nProblems:\r\nCLD, trauma, underwent surgery \r\nType 2 Dm,\r\nNo DN, previously normal renal functions\r\nhad a hypotensive episode, drop in urine output and better after BP has picked up.\r\n\r\nPre renal picture likely on a background CLD.\r\n\r\nSuggest:\r\n1. Adequate hydration\r\n2. Lasix SOS\r\n3. Tab Sobisis 1-1-1\r\n\r\nurea, creat, serum albumin tomorrow. will review.\nGeneral condition much better. Urine out put -2 lits, Intake- 2 lits. BP- 120/64 mm of hg. Nepro (Dr. Sooraj) had seen yesterday. He advised to stop all the BP lowering medication.\r\nS/B Dr Lakshmi, urine output better. will hold off on diuretic meds for now.\r\n\r\nS/B Dr Sooraj\r\n-----------------\r\nImproving\r\nContinue Sobisis for one more day.\r\nUrea, creat tomorrow.\ncase s/b Dr Jijo,\r\nPt comfortable\r\npulse and BP maintaining,\r\nadequate urine output last 12 hrs is 1600 ml\r\nwound inspection done wound clean ,no collection.\r\nplatelet count reduced\r\nADV \r\nArrange and transfuse 2 pints of platelets tomorrow.\r\ncontinue rest of medications \r\ntab thrize 1-0-1\nGeneral condition much better. Urine out put -2 lits, Intake- 2 lits. BP- 120/64 mm of hg. Nepro (Dr. Sooraj) had seen yesterday. He advised to stop all the BP lowering medication.\r\nS/B Dr Lakshmi, urine output better. will hold off on diuretic meds for now.\r\n\r\nS/B Dr Sooraj\r\n-----------------\r\nImproving\r\nContinue Sobisis for one more day.\r\nUrea, creat tomorrow.\r\ncase seen by Dr Jijo\r\nplatelet count reducing . Renal function improved\r\nADV:\r\nPLATELET INFUSION 5 pints today and the patient can be shifted to ward .\r\nUnilateral skin traction with 3 kg wt to Lt side ONCE SHIFTED TO WARD\r\nphysiotherapy to continue\r\nRPT Platelet count tomorrow morning\ncase s/b Dr Jijo,\r\nPt comfortable\r\npulse and BP maintaining,\r\nadequate urine output last 12 hrs is 1600 ml\r\nwound inspection done wound clean ,no collection.\r\nplatelet count reduced\r\nADV \r\nArrange and transfuse 2 pints of platelets tomorrow.\r\ncontinue rest of medications \r\ntab thrize 1-0-1\r\n\r\n\r\nS/B Dr Blessy\r\nAfebrile\r\nGc-good\r\nVitals stable\r\nc/o mild pain over lowerlimb[left]\r\nPlan cont the treatment.\r\nPlan:cont the same\n10am: s/b Dr. Kenny-\r\nGC better, On traction since yday.\r\nWas transfused 5 units platlets yday, Plat. count improved from 79 to 90,000/mm3. Check Dengue IgM.\r\nNot passed stool x 3 days, Urine medium yellow.\r\nPlan: Syp. Looz stat & hs/prn. Check LFT, PT inr with plat. tomorrow.\r\ns/b dr Jijo,\r\nPt better , minimal pain ,on traction, \r\nADV;\r\nMobilise on crutches - Non Wt Bearing\r\nactive and active assisted exercises.\nCase s/b Dr Jijo,\r\nPt comfortable\r\npain on traction\r\nADV\r\nto release traction intermittently.\r\ncontinue rest of treatment\nCase s/b Dr Jijo,\r\nPt comfortable\r\npain on traction\r\nADV\r\nto release traction intermittently.\r\ncontinue rest of treatment\r\n\r\n\r\n06.00pm\r\nS/B Dr. Raees\r\nNo fresh complaints\r\nphysio done\r\nfeeling better\r\nGRBS- 184mg%\r\nCont. same\r\n\nc/o pain early morning. relieved after Inj tramadol.\r\non intermittent traction. PLT - 81,000.\r\nContinue same.\r\ncase seen by Dr Jijo\r\nnil specific except for reduced platelet count.\r\nADV :\r\nInj Lactoguard 1.5 mg OD from today.\r\nGastro consultation.\n07.00 pm \r\nS/B Dr. Antony Paul\r\nO/E-mild P/E +\r\n Abd UB +\r\nADV\r\nT. inderal 40 1/2-0-1/2\r\nT. Udiliv 300 1-0-1\r\nSyp looz 30ml HS\r\nC. Evion 400 1-0-1\r\nwill Review sos\r\n\r\n\r\n07.15pm\r\nS/B Dr. Raees\r\nC/O pain over surgery site, Lt Knee joint,Lt ankle joint, Lt thigh\r\nVitals stable\r\nBoth legs pedal edema+\r\nGRBS-284mg%\r\nInj Tramadol 100mg iv sos\r\n\r\nCase S/B Dr Jijo\r\nmild knee effusion+\r\nROM improved\r\nwound inspection done\r\nwound clean\r\npetichial rashes over the posterolateral aspect +\r\nADV:\r\nTAB CIPLOX 500 MG 1-0-1\r\nTAB THRIZE 1-1-1\r\n\r\n\nc/o pain in the leg present. \r\nLFT- Increase in Bilirubin\r\nINR- 3.3, started on Inj vitamin k\r\nplatelets- 90,000- / Hyprersplenism.\r\ngastro follow up today\r\nphysio seen:Had ambulated the patient with axillary crutches\n06.10PM\r\nS/B Dr. Raees\r\nNo complaints\r\nvitals stable\r\nPatient resting\nc/o pain Lt leg esp over knee and ankle. \r\nLt knee effusion +. \r\nT. Ultracet 1-0-1(as adviced by GE).\nCASE SEEN BY Dr Jijo\r\npain persisting\r\nadv tab tramadol 100 mg 1-1-1\r\ninj tramadol im sos\r\nphysio - \r\nmobilise ankle, knee and hip.\r\nNWB CRUTH WALKING\r\nDOPPLER US Scan Lt LL.\nPt Comfortable,\r\nminimal pain,\r\non Physio\r\nADV\r\nPHYSIO - TENS to thigh , hip and calf muscles.\r\nTab tramadol to reduce dose as tolerated\r\n100 mg morning, 50 mg noon and 100mg HS\r\n\ncase s/b Dr Jijo\r\npain reduced\r\nADV\r\nSTOP Inj Lactogard\r\nTab Taxim -O 200 mg 1-0-1 from tomorrow.\nCase S/B DR JIJO\r\npatient comfortable. MINIMAL PAIN\r\nSWELLING +\r\nADV\r\ncontinue same\r\ninform SOS .\r\n\r\n07:00pm Case reviewed.\r\nContinue treatment.\nCase S/B Dr Jijo \r\nwound inspection done, wound clean.\r\ncontinue same.\r\ntab tramadol 50 mg 1-1-2 from tomorrow if tolerating.\r\n\r\n09:30 AM s/b Dr Radha.\r\nGC - better, physiotherapy ongoing. \r\npersistent swelling. Increased Lasilactone to 1-1-0.\nAC - 157mg%, Passed stools. \r\none episode of coffee coloured vomitus.\ns/b dr.manoj\r\nno further episodes of vomiting\r\ncnt same\nS/B Dr Blessy\r\nGRBS-133mg%\r\nmild pain over the left side of the hip\r\nDid exercise at morning.\r\nVitals stable.\r\nPlan:cont the same.\r\n\nS/B Dr Tom\r\nGC-better\r\nDid physiotherapy yestrday\r\nSlept well\r\nPlan: cont Dr Jijo's orders.\nCASE SEEN BY DR JIJO,\r\nhad night pain . otherwise normal.\r\nadv :\r\nTo reduce tramadol to 1-0-2\nCase s/b Dr jijo\r\nminimal pain in the evening.\r\nnow pt sleeping\r\nADV continue same\r\nfor suture removal tomorrow.\n07.15pm\r\nS/B Dr. Raees\r\nC/O mild pain\r\nGRBS- 188mg%\r\nContinue same\r\nCase S/B Dr Jijo\r\nminimal pain\r\nADV\r\nTab tramadol 50 mg 1 sos\r\nTab Ciplox to stop from tomorrow after morning dose if no urinary infection\r\nUrine R/E\r\nS. Bilirubin\r\nCBC, Platelet count, fbs,PT , INR and ESR tomorrow\nPain and swelling better. Icterus better. \r\nAC - 252mg%. physiotherapy ongoing.\r\nInsulin doses adjusted.\nCase s/b Dr Jijo\r\nStop Tab Ciplox\r\ncontinue rest of the medications.\r\nCRP\nPlan to d/c today. \r\nReview after 2 weeks with GE and Dr Jijo for OGD."}, {'role': 'model', 'content': '\nIP Number: 670\n\nPatient Number: 7575\n\nAdmission Date: 20-09-2012\n\nDischarge Date: 11-10-2012\n\nDiagnosis: # NOF Lt Non Union s/p Excision Arthroplasty.\r\nCirrhosis with Portal HTN\r\nCystitis.\n\nClinical Exam(With BP): {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Admitted with C/o pain Lt hip and edema both legs.\r\n\\par }\r\n\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 X Ray Pelvis (20/09) - # NOF s/p ORIF.\r\n\\par USG Abd(22/09/12) - Cirrhosis with Portal HTN and Cystitis.\r\n\\par Venous Colour Doppler LL(22/09/12) - Normal study.\r\n\\par }\r\n\n\nXray findings: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Temperature :97\r\n\\par Respiration :22\r\n\\par BP :150 / 60\r\n\\par tenderness over the ant joint line Lt hip . ROM painful and restrcted on all directions.\r\n\\par tenderness+ over the lat femoral condyle and lat tibial plateue. minimal effusion +. varus stress +\r\n\\par diffuse swelling both legs Lt > Rt\r\n\\par }\r\n\n\nDiscussion: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 53 yr old, Mr. Sreekumar, a known diabetic was admitted here with Non Union of # NOF Lt which was treated with percutaneous screw fixation else where. He is also k/c/o CLD and a Gastro consult was taken. He still complained of persistent pain and edema both legs. He was taken up for excision arthroplasty on 25th Sept. The postop was uneventful. He was put on basal bolus insulins for his sugars and continuous physiotherapy was given postop. He was ambulated with walkers and axillary crutches. He is recovering well and has achieved fair glycemic control. He is hence discharged in a stable state on oral antibiotics and basal bolus insulins and is asked to review with us as outpt.\r\n\\par }\r\n\n\nDiet: nan\n\nRemarks: nan'}] |
692 | [{'role': 'user', 'content': '\nIP Number: 692\n\nPatient Number: 7697\n\nPatient Name: ANTONY K A\n\nGender: M\n\nDate of Birth: 04-03-1947\n\nAddress: KOODANAPPILLY HOUSE CHAKKARAPARAMBU\n\nPincode: 682032.0\n\nPhNo: nan\n\nAdmission Date: 28-09-2012\n\nDischarge Date: 15-10-2012\n\nDiagnosis determined by the doctor when the patient was admitted: Essential (primary) hypertension\nDIABETIC NEPHROPATHY WITH CRONIC RENAL FAILURE\nTYPE 2 DIABETES MELLITUS\nChronic ischaemic heart disease\nDIABETIC FOOT\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: Admitted with non healing ulcer on the Lt foot and cellulitis involving underlying tissue and bone x 3 months duration.\n\nXray information: Arterial Doppler Lt LL(21/06/12) - Diffuse atherosclerotic changes in the form of intimal thickening and calcification are seen in all arteries of Lt LL more prominent in distal vessels. Altered biphasic wave forms seen in Ant Tibial, Post. Tibial, Peroneal and Dorsalis Pedis Arteries.\r\nX-ray Lt ankle AP/Lat(29/09/12) - showed partial destruction of calcaneum with sequestrum, OM of lat malleolus.\r\nECG(01/10/12) - T inversion I, aVL, V4-V6. \r\nUSG Abd(03/10/12) - No organomegaly, Moderate fatty changes in liver, Lt kidney shows a cortical cyst of 2.9 cms. \r\nS. Ferritin(01/10/12) - 238.5 ng/mL.\r\nPus C/S(04/10/12) - Moderate growth of Multi resistant strain of Klebsiella.\r\nTIBC (01/10/12) - 258.3 ug/dL.\r\nUrine C/S (11/10/12) - Candida species grown in the culture.\r\nPBF(05/10/12) - Normocytic, normochromic anemia(Hb 7.1gm%).\n\nClinical examination: Temperature :97.5\r\nRespiration :22\r\nBP :120 / 70\r\nAfebrile, \r\nChest - clear, NVBS, AEBE.\r\nL/E - Charcots foot with osteomyelitis and septic arthritic destruction of left ankle joint.Multiple sinuses.\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: adv: cbc, KFT,LFT,S.Electrolytes.\r\nFLP,ACRc/m\r\nGRBS 8th hrly.\r\nw/h tab. loprin as there was bleeding from the wound\r\n\r\nS/B Dr Blessy\r\nVitals stable\r\nGRBS-90mg%\r\nUrea-98\r\ncreatinine-3.0\r\nPlan:Start one unit NS\r\n rest cont the same\n9.45am: s/b Dr. Kenny-\r\nStill has oozing from Lt. foot lesions. Waiting to see Dr. Bhat \r\nAC - 91mg%, FLP reports awaited.\r\nUrine and stool samples not obtained.\r\nUrea - 98mg%, Creat - 3.0, Hb 7.1gm, TC-12,900,ESR-130 Anemia of CRF. He was transfused 2 units in June,12.\r\nPlan-Check PTinr, Rpt. BU, Crossmatch\nSeen by DrA.K.Bhat.\r\nCharcots foot with osteomyelitis and septic arthritic destruction of left ankle joint.Multiple sinuses-C/S taken.Xray ankle AP/Lateral.Daily betadine dressing.Ortho opinion regarding possibilty of foot saving procedure.If not plan for Below Knee amputation.Continue trt.\r\n\r\nS/B Dr Sooraj\r\n-----------------\r\nProblems:\r\nType 2 DM - long duration\r\nHypertension\r\nCharcots joint\r\nCKD - had a few sessions of HD about 4 months back at Lisie now off HD\r\nIHD\r\nAnemia - ? anemia of chronic disease ? myeloma contributed by CKD\r\n\r\nSuggest:\r\n-Peripheral smear, serum protein electrophoresis\r\n-USG KUB if previous report cannot be traced\r\n-Tab Sobisis 1-0-1\r\nTo do serum calcium, phosphorus, iron profile - next prick.\r\nHe requires transfusins to increase hs Hb to more than 10 for adequate wound healing\r\ncase seen by Dr Jijo\r\nCASE of Diabetic foot - charcot joint \r\nO/e \r\nno ankle joint stability with lateral shift of foot on planting.\r\nX-ray showed partial destruction of calcaneum with sequestrum, OM of lat malleolus\r\nADV:\r\nas no useful function can be restored with a foot salvage- if at all possible-BK Amputation is ideal to control infection . Arthrodesis is not possible due to reduced bone stock and neuropathic joint.\n06.05pm\r\nS/B Dr. Raees\r\nNo fresh complaints\r\nfeeling better, no hypoglycemic symptoms\r\nGRBS- 202mg%\r\nCont. same\nAC - 101mg%, BP - 140/90.\r\ns/b Nephro yPM. S. Ca, P, SPE, PS, Iron Profile reports awaited. Schedule for USG KUB tomorrow.\r\ns/b Ortho yPM, Adviced BK amputation.\r\nPlan to continue same.\r\n\r\n\nSeen by DrA.K.Bhat.\r\nPlan for BKA under SA on wednesday/thursday.\r\nPreop. transfusion of packed cells.Daily betadine C&D.IV antibiotics.Arrange packed cell for surgery.Medical fitness for the proposed procedure.\r\n\r\n\r\n07.30pm\r\nS/B Dr. Raees\r\nVitals stable\r\nGRBS-189mg%\r\nTo start Packed RBC in evening\r\ncontinue same\nSugar controlled. no Hypoglycemia now. Seen By Dr JIJo and Dr SOORAJ, will Discuss with DR Bhatt regarding the BKA.\n06.00PM\r\nS/B Dr. Raees\r\nNo fresh complaints\r\nvitals stable\r\nPacked RBC on flow\r\nTo do BK amputation tomorrow 2pm after PAC\r\n\nSeen by DrA.K.Bhat.\r\nFor Below knee amputation left leg under SA on 3rd oct.\r\nPreop:Informed consent.Nil oral as per anesthetist advice.C&D HS and CM.IV antibiotics.Arrange packed cells for surgery.Rpt Hb tmrw.\r\n==================================\r\nInformed consent.:\r\nThere is extensive bone,joint and soft tissue infection of left ankle with total instability of ankle region.Pus extending to joint destroying it and adjacent bones.There is diabetes and neuropathy.There is reduced circulation of leg as seen in Arterial Doppler report.The extensive and chronic nature of infection makes any form of limb saving operation useless and continued risks for developing recurrence of infection.Hence this requires below knee amputation under Anesthesia.During surgery, depending on the findings,the exact level of amputation will be decided.After the operation,due to diabetes and decreased circulation,wound healing may be delayed.The overall recovery and function of the amputated leg will need close observation.The importance of continuing footcare esp.for the right leg have been explained.Also close medical followup is essential. The above points have been explained and understood and full consent for operation and anesthesia is given.\r\n\r\nSIGNED. \r\n==========================\r\n\r\n10 AM \r\ns/b Dr Radha\r\nAC - 81mg%, Chest - AEBE.\r\nCardio consult today. 1 unit PRC today, Rpt Hb tomorrow.\r\nScheduled for BKA tomorrow Afternoon.\n07:00pm seen by Dr.Adwaitha.\r\nContinue Treatment.\nScheduled for BKA today afternoon. NPO since 7 AM. \r\nAC - 97mg%, Vitals stable. \r\nCardio consult done yday- High risk fitness given\r\nBP-150/80 mm of hg\r\nECG- T inversions V4-V6, I AVL.\r\nFitness for surgery given (under final)\nS/p BKA Lt yday.\r\nPost op uneventful, vital stable. Started oral diet.\r\nOutput adequate. S/p transfusion 2 units PRC.\r\nHb - 10.2, Creat - 3.9, K+ 4.1, Urea - 60mg%. \r\nPlan: Shift to room. Continue same.\nSeen by DRA.K.Bhat.\r\nContinue trt.Rpt HB,PCV tomorrow.\r\n\r\n\r\nSeen by Dr Blessy\r\nC/o rashes n itching over the back of the trunk and both upperlimbs aftr applying some powder.\r\nAdv:Tab.cetrizine 1 st\r\nGC-good\r\nvitals stable\nHb - 8.9, \r\n1 unit PRC, 4000 units EPO today\nSeen by DRA.K.Bhat.\r\nAfebrile.Continue trt.C&D in OT tmrw.\r\n\r\nRpt Hb tomorrow.\r\n\r\n07:00pm Case reviewed.\r\nContinue treatment.\nHb - 9.8gm%. AC - 143mg%.\r\nPhysio consult today. \r\nIncreased the insulin doses.\r\n\nSeen by DRA.K.Bhat.\r\nDRessings changed.Drain removed.Suture line clean.Continue trt.\r\nseen by DR.Manoj\r\npt is comfortable,gng to start physio now.\r\ncont same\r\n\r\n\r\nS/B Dr Sooraj\r\n--------------------\r\nPuffiness present - well hydrated\r\ncreat - mld rise\r\n\r\nSuggest:\r\nTab Dytor 5 mg 1-0-0\r\n\r\nContinue others \r\nAsiron levels are on the lower side and as Tsat is low, to add Inj Suficient 200 mg IV (mixed in 100 ml NS over 2 hrs) once a week x 5 doses\r\n\r\nInj RPO/Eryprosafe 4000u subcutaneous once a week.\r\n\r\nMaintain a negative balance till the edema disappears.\r\n\nS/B Dr Blessy\r\nGRBS-147mg%\r\nvitals stable\r\nNo new complaints\r\nPlan:cont the same treatment.\nS/B Dr Blessy\r\nslept well\r\nAC-107mg%\r\nvitals stable\r\nPlan:cont the same.\nHb - 9.9gm%. Creat - 3.9.\r\nRpt Hb tmorrow. S/b Dr Sooraj on Sat.\r\nAdded T. Dytor 5mg 1-0-0. \r\nfeels well.\nSeen by DRA.K.Bhat.\r\nC&D done.Suture line clean.Suggested oral antibiotic,\nFeels well. AC - 108mg%, \r\nStop Evion, add Cynocal m forte. \r\nsteam inhalation. Changed to oral Abx.\r\nContinue rest.\r\ninj. sufficient 100mg i/v.\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\ninj. sufficient on flow. vitals stable\r\n remove foleys c/m\r\n\r\n07.00pm\r\nS/B Dr. Raees\r\nno complaints\r\nGRBS-194mg%\r\nContinue same\nHb - 10.2gm%, AC - 106mg%.\r\nDoing well. Physio ongoing. \r\nRemove catheter today, Send for URE.\r\nSeen by DrA.K.Bhat.\r\nC&D done .Suture line clean.Continue trt.\r\n\nhematuria with numerous pus cells on urine -ME\r\nadv: w/h Tab. clopilet and Loprin\nGC STABLE.\r\nNEPHRO CONSULT TODAY\r\nURINE SHOWED NUMEROUS PUS CELLS.RPT URINE ROUTINE TOMORROW.\r\nINJ SUFFICIENT TODAY.\r\n\r\nS/B Dr Sooraj(Nephro)\r\n---------------------------\r\nUTI\r\nSuggest:\r\n- urine culture and sensitivity,\r\n-appropriate antibiotics- continue torsemide\nInj EPO 4000 units s/c given. had a episode of pyrogenic reaction yPM. Inj Avil IM given.\r\nAC - 100mg%, To Rpt URE today and decide on Uro consult after that. \r\nRpt TC, Hb, Urea & Creat tomorrow. 3rd Inj Suficient to be given tomorrow.\nSeen by Dr.A.K.Bhat.\r\nContinue trt.\nDoing well. c/o gastric distension.\r\ndressing change yday. AC - 101mg%, \r\nplan to d/c on monday. To add Revera D. Stop Bizfer XT.\nSeen by DrA.K.Bhat.\r\nC&D done.Alternate sutures removed.Clean.Plan fr discharge on monday,.\r\n\r\n06.45pm\r\nS/B Dr. Raees\r\nno complaints doing well \r\nGRBS- 153mg%\r\nPlan for discharge on monday\n05.30pm\r\nS/B Dr. Raees\r\nNo complaints\r\nvitals stable\r\ndoing well\r\nContinue same\n10.00am\r\nS/B Dr.Radha\r\ndoing well, \r\nAC-97mg%\r\nInj. sufficient 200mg CM\nDoing well. Wound healing. AC - 92mg%. \r\nTo plan rehabilitation. \r\nTo d/c today and review as OPD.\nSeen by DRA.K.Bhat.\r\nSutures removed.Wound healed.Adviced:Dressings change once in 2 days with betdine oint.Exercises.REview 2 weeks.'}, {'role': 'model', 'content': "\nIP Number: 692\n\nPatient Number: 7697\n\nAdmission Date: 28-09-2012\n\nDischarge Date: 15-10-2012\n\nDiagnosis: Charcots foot with osteomyelitis and septic arthritic destruction of left ankle joint. s/p BKA.\n\nClinical Exam(With BP): {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Admitted with non healing ulcer on the Lt foot and cellulitis involving underlying tissue and bone x 3 months duration.\r\n\\par }\r\n\n\nSystolic BP: 120.0\n\nDiastolic BP: 70.0\n\nPhysical examination: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Arterial Doppler Lt LL(21/06/12) - Diffuse atherosclerotic changes in the form of intimal thickening and calcification are seen in all arteries of Lt LL more prominent in distal vessels. Altered biphasic wave forms seen in Ant Tibial, Post. Tibial, Peroneal and Dorsalis Pedis Arteries.\r\n\\par X-ray Lt ankle AP/Lat(29/09/12) - showed partial destruction of calcaneum with sequestrum, OM of lat malleolus.\r\n\\par ECG(01/10/12) - T inversion I, aVL, V4-V6. \r\n\\par USG Abd(03/10/12) - No organomegaly, Moderate fatty changes in liver, Lt kidney shows a cortical cyst of 2.9 cms. \r\n\\par S. Ferritin(01/10/12) - 238.5 ng/mL.\r\n\\par Pus C/S(04/10/12) - Moderate growth of Multi resistant strain of Klebsiella.\r\n\\par TIBC (01/10/12) - 258.3 ug/dL.\r\n\\par Urine C/S (11/10/12) - Candida species grown in the culture.\r\n\\par PBF(05/10/12) - Normocytic, normochromic anemia(Hb 7.1gm%).\r\n\\par \r\n\\par }\r\n\n\nXray findings: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Temperature :97.5\r\n\\par Respiration :22\r\n\\par BP :120 / 70\r\n\\par Afebrile, \r\n\\par Chest - clear, NVBS, AEBE.\r\n\\par L/E - Charcots foot with osteomyelitis and septic arthritic destruction of left ankle joint.Multiple sinuses.\r\n\\par }\r\n\n\nDiscussion: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 65 yr old, Mr Antony K A, a known diabetic and IHD was admitted here with extensive charcot's foot Lt and uncontrolled blood sugars. Was seen by the surgeon and adviced BKA, prior to which he was shown to the ortho who r/o the chance of any foot salvage procedure or arthrodesis due to reduced bone stock(secondary to severe OM) and neuropathic joints. He underwent Below Knee Amputation on 03rd Oct. A k/c/o CRF, he was shown to the nephro and cardiologist for fitness prior to surgery. 2 units of PRC was given perioperatively. He is on Inj Suficient on alternate days and EPO 4000 units weekly. He was put on IV antibiotics and basal bolus insulin for his sugars. The post period was uneventful. He is now recovering well and intermittent physiotherapy with muscle strengthening exercises is being taught. His condition is stable and satisfactory and hence is being discharged on oral antibiotics and basal bolus insulins and asked to reveiw as outpt.\r\n\\par }\r\n\n\nDiet: nan\n\nRemarks: nan"}] |
742 | [{'role': 'user', 'content': '\nIP Number: 742\n\nPatient Number: 7959\n\nPatient Name: MARY P J\n\nGender: F\n\nDate of Birth: 22-10-2026\n\nAddress: PUTHUSSERY HOUSE\n\nPincode: 683517.0\n\nPhNo: 0484-2513123\n\nAdmission Date: 22-10-2012\n\nDischarge Date: 05-11-2012\n\nDiagnosis determined by the doctor when the patient was admitted: Essential (primary) hypertension\nMixed hyperlipidaemia\nOsteoporosis, unspecified\nTYPE 2 DIABETES MELLITUS\nDIABETIC PERIPHERAL NEUROPATHY\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: Pt a known case of DM x 20yrs.Came with c/o infected wound under the big toe of left leg.Came for evaluation.\n\nXray information: Versa (22/10/12) - B/L arterial ds, moderate Lt arterial ds and severe Rt arterial ds. \r\nVibro (22/10/12) - B/L severe loss of vibratory perception.\r\nPus C/S (26/10/12) - No pathogenic organism isolated from the culture.\n\nClinical examination: Temperature :98.8\r\nRespiration :22\r\nBP :170 / 60\r\nLt foot ulcer(big toe and over 1st MTP joint) with necrotising skin and soft tissue infection ,ascending upto ankle and foot,with cellulitis and subcut.crepitus suggesting anerobic infection.Popl.and DP,PT pulsations not felt.Neuropathy+.\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by DrA.K.Bhat.\r\nLt foot ulcer(big toe and over 1st MTP joint) with necrotising skin and soft tissue infection ,ascending upto ankle and foot,with cellulitis and subcut.crepitus suggesting anerobic infection.POpl.and DP,PT pulsations not felt.Neuropathy+.\r\nInvestigation reports awaited.\r\nPlan:Will need slough excision under LA,with risks of PVD explained.\r\n\r\nseen by duty doctor (6:30pm)\r\npt g.c. same , no fresh complaints, grbs 202mg/dl\r\nvitals stable\r\n\nBP - 160/70. AC - 164mg%. \r\nTC - 19,700. Added on dalacin yday. \r\nVersa reveals severe neuropathy and severe right and moderate left arterial ds.\r\nTo rpt CBC today. to decide on further course of action after being seen by Dr Bhat.\r\nSeen by DrA.K.Bhat.\r\nC/S taken.Xray foot shows severe Osteoporosis.Previous lumbar sympathectomy fr PVD in 2003.\r\nPain decreased.Swelling and redness decreased.However there are infected blisters of midsole region.Considering the PVD the high risk of local slough excision leading to nonhealing/gangrene and the possibility of a higher amputation has been discussed with the relatives.Continue trt.\nseen by duty doctor( 6:50pm)\r\npt gc same, no fresh complaints , vitals stable \r\ngrbs 139mg/dl\r\nadv: continue same\nSeen by DrA.K.Bhat.\r\nProximal foot blisters.\r\nPlan:I&D and debridement under SA,25TH Oct.1PM.\r\nPreop:Informed consent.Nil oral as per anesthetist advice.Medical fitness for surgery.IV antibiotics.C&D left foot and leg CM.\r\n================\r\nINFORMED CONSENT:\r\n\r\nThere is infective gangrene of left foot big toe ulcer with pus and blisters extending to foot and ankle region.There is diabetes and neuropathy.There is reduced circulation of leg .This requires wound cleaning under Anesthesia.The ulcer of the toes is deep and may need amputation of the big toe depending on finding during operation.During surgery, depending on the findings,extending pus of foot and leg will also be drained.After the operation,depending on healing further operations may be be needed.Due to diabetes and decreased circulation,wound healing may be delayed.There is a possibility that the wound after operation may worsen due to nonhealing,for which then a higher amputation may be the result.The overall recovery and function of the foot will need close observation.The above points have been explained and understood and full consent for operation and anesthesia is given.\r\n=================\ns/b dr.TOM and team\r\npt is febrile,counts are increasing.\nNot taking food,not passed sools for 3 days\r\n5% dext +6 units of insugen R as maintenance\r\nproctoclysis enema stat.\r\nbig toe amputation today.\nSeen by DRA.K.Bhat,.\r\nContinue trt.\r\n\r\ns/b duty doctor\r\nBP:140/70 PR 88\r\nblood on flow\r\nContinue the same trt\nNo appetite,\r\nSlept well\r\nPassed stools\r\nPatient is depressed after being told that the amputation was done\r\nAC-62 mg/dl\r\nPre dinner- 88 mg/dl\r\nTC- 18000 cells/ mm3\r\nHB- 13 .1 gm %\r\nBP- 150/80.\nSeen by DRA.K.BHAT.\r\nC&D done .Suture line clean.Drain removed.FFP transfusion suggested.Continue trt.\r\n\r\n\r\n07.20pm\r\nS/B Dr. Raees\r\nFeeling Better\r\nvitals stable\r\nGRBS- 221mg%\r\nContinue same\r\n\r\n\r\n\n06.30pm\r\nS/B Dr. Raees\r\nNo complaints\r\nGRBS-88mg%\r\nContinue same\nSeen by DRA.K.Bhat,\r\nContinue trt.\r\n\r\n10.30am\r\nS/B Dr. Lakshmi\r\nFeeling Better\r\nAC-108mg%\r\nTo Repeat PT/INR, TC, S.Cr. tomorrow morning\nAppetite has not picked up. Slept well. No fever. passed stools.\r\nBP-150/ 60 mm of hg\r\nPre dinner- 88 mg/dl\r\nFBS- 129 mg/dl\r\nTC- 26, 000 cells/ mm3\r\nPT/ INR- 3 \r\nURE- tomorrow\r\nCBC tomorrow\nSeen by DR.A.K.Bhat.\r\nC&D done.Suture line of BKA stump is clean.Suggested oral antibiotics.\r\ns/b med\r\nurine r pus-20-25\r\nto send urine c/s\r\n\r\n06.40pm\r\nS/B Dr. Raees\r\nNo complaints\r\nGRBS-153mg%\r\ncont. same\nTC ~ 16,000, Wound clean, GC - better.\r\nHb - 13.3gm%. Afebrile. AC - 153mg%.\r\nBP - 190/90. Increased the dose CCB to 5mg. \r\nContinue rest.\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\nSeen by DR.A.K.Bhat.\r\nC&D done.Suture line clean.Continue trt.Oral antibiotics.\nTC - 16,500, AC - 149mg%, predinner - 128mg%\r\npassed stools yday. \r\nRpt CBC tomorrow. dressing change today.\r\nplan to d/c after one more dressing.\nAC - 150mg%, predinner - 241mg%.\r\nBP - 150/70mm Hg.\r\nwound clean, changed to oral abx.\r\nTC - 13,500(decreased). physio to continue.\r\ncontinue same.\nSeen by DRA.K.Bhat.\r\nContinue trt.\nDoing well. Appetite is picking up\r\nSlept well\r\nAC- 183 mg/dl\r\nPre Dinner - 244 mg/dl\r\nTC- 13,700/ Cu mm\r\nPhysio\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\n07.15pm\r\nS/B Dr. Raees\r\nNo Complaints\r\nContinue same\nAC - 212mg%.\r\nPre dinner- 208 mg/dl\r\nCase Plan\r\nTo ask Dr. Bhatt about the catheter\r\nAlternate stitch removal\r\nDischarge on Monday\nSeen by DRA.K.Bhat.\r\nAlternate Sutures removed.Clean.Continue trt.Plan fr discharge on monday 5th november.\r\n\r\n07.00pm\r\nS/B Dr. Raees\r\nNo complaints\r\nContinue same\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\n\r\ns/b duty doctor\r\ndecreased appetite\r\ncontinue the trt\nurinary catheter removed yesterday\r\nTC,Hb,s.electrolytes,creatinine CM\r\ncontinue the same\nSeen by DrA.K.BHat.\r\nSutures removed.Healed.\r\nAdviced:Dressing change once in 2 days-betadine oint.,pad,crepe bandage.\r\nPhysiotherapy.Review 1 month.\nSlept well\r\nPassed stools\r\nAC-139 mg/dl\r\nBP- 140/70 mm of hg\r\nAlternate suture removal today\r\n\r\nCase Plan\r\nHarold, Hannah and Vybhav to see before discharge\r\nMarked for discharge today\r\n\r\n'}, {'role': 'model', 'content': '\nIP Number: 742\n\nPatient Number: 7959\n\nAdmission Date: 22-10-2012\n\nDischarge Date: 05-11-2012\n\nDiagnosis: INFECTED LEFT BIG TOE s/p BKA.\n\nClinical Exam(With BP): {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Pt a known case of DM x 20yrs.Came with c/o infected wound under the big toe of left leg.Came for evaluation.\r\n\\par }\r\n\n\nSystolic BP: 170.0\n\nDiastolic BP: 60.0\n\nPhysical examination: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Versa (22/10/12) - B/L arterial ds, moderate Lt arterial ds and severe Rt arterial ds. \r\n\\par Vibro (22/10/12) - B/L severe loss of vibratory perception.\r\n\\par Pus C/S (26/10/12) - No pathogenic organism isolated from the culture.\r\n\\par }\r\n\n\nXray findings: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Temperature :98.8\r\n\\par Respiration :22\r\n\\par BP :170 / 60\r\n\\par Lt foot ulcer(big toe and over 1st MTP joint) with necrotising skin and soft tissue infection ,ascending upto ankle and foot,with cellulitis and subcut.crepitus suggesting anerobic infection.Popl.and DP,PT pulsations not felt.Neuropathy+.\r\n\\par }\r\n\n\nDiscussion: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 86 yr old lady admitted with Lt big toe ulcer extending uptoankle with associated fascitis . She was taken up for debridement ,but with such extensive involvement ,BKA was done under SA on25/10/12.. Sugars were controlled with basal bolus insulin.I/V ABS were also contd. Alternate day dressings were given.\r\n\\par }\r\n\n\nDiet: nan\n\nRemarks: nan'}] |
769 | [{'role': 'user', 'content': '\nIP Number: 769\n\nPatient Number: 6668\n\nPatient Name: NIRPAL SINGH\n\nGender: M\n\nDate of Birth: 02-07-1952\n\nAddress: SUPER AUTO AGENCIES, VYTTILA JN, VYTTILA\n\nPincode: 682019.0\n\nPhNo: 9020177002\n\nAdmission Date: 01-11-2012\n\nDischarge Date: 17-11-2012\n\nDiagnosis determined by the doctor when the patient was admitted: Obesity\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: Known diabetic, admitted here with non healing wound procured while riding his scooter. A slough excision and I & D was done. Now the wound is healing well and is now readmitted for SSG.\n\nXray information: Pus C/S (05/11/12) - no pathogenic organism in the culture.\n\nClinical examination: Temperature :96.8\r\nRespiration :22\r\nBP :140 / 70\r\nLocal Examination :Ulcer Lt leg clean.\n\nPrecautions to be taken while treating the patient: POVD, T2DM.\n\nRemarks: Admitted for SSG.\nSeen by DrA.K.Bhat.\r\nPlan for SSG under SA on 5th November(monday).Preop:Rest and leg elevation.Daily Oxum dressing.IV antibiotics.Medical fitness for the procedure.Daily betdine scrub thighs.\r\n\r\ns/b duty doctor\r\nBP:140/80 PR:84\r\ncontinue the same medicine\nAC - 90mg%\r\nhad an episode of hypo today.\r\ninsulin doses adjusted.\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\n\r\n08.30pm\r\nS/B Dr. Raees\r\nNo Complaints\r\nContinue same\n07.20pm\r\nS/B Dr. Raees\r\nNo complaints\r\nContinue same\nSeen by DRA.K.Bhat.\r\nPosted for SSG under SA on 5th nov,1.30 PM.Preop:Nil oral as per anesthetist.Consent.IV antibiotics.C&D lt leg.Shave lt thigh tmrw morning and betadine scrub.Medical fitness for surgery.\nscheduled for skin grafting tomorrow afternoon\r\nvitals stable\r\nbipap ongoing\r\nno fresh complaints\r\ncontinue the same\nHad mild hypo today iv dextrose was given\r\nplan for skin draft today.\r\nto check body weight today\r\nGRBS-130\r\n 5 % dext +6 units insulin maintenance\nseen by duty doctor (7:30pm)\r\npt c/o pain in the left lower limb, no other complaints , vitals stable\r\nadv: t. welcet 500 mg stat\r\n9:15 pm\r\npt c/o of severe pain due to catheter, pt also restless due to pain \r\nadv: inj tramadol 50mg iv stat\r\n inj emcet 1 amp iv stat\nAfebrile. slept well. \r\nno irritation at the catheter. \r\nAC - 442mg%. \r\nInsulin doses adjusted.\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\nInj.Dynalix 0.4 ml SC od.\nPain less. AC - 88mg%.\r\ninsulin doses adjusted. \r\nto start on dynalix 0.4ml OD.\r\ncontinue same.\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\n\r\n\r\n07.30pm\r\nS/B Dr. Raees\r\nNo complaints\r\nGRBS-86 mg%\r\nContinue same\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\n\r\n\r\n\r\n\r\ns/b duty doctor\r\nBP:140/90 PR-86\r\nafebrile,catheter removed.not yet passed urine after tat\r\ncontinue the same\nc/o mild pain at catheter site. \r\nVitals stable. AC - 129mg%. \r\nInsulin doses adjusted. \r\nTo decide on removal of catheter after being seen by Dr Bhat. \r\nDental consult.\nSeen by DRA.K.Bhat.\r\nDressings left leg changed.SSG taken up.Oral antibiotics.\r\n\r\n\r\n\r\ns/b duty doctor\r\npt doing well.vitals stable\r\ncontinue the same medicine\r\n\n07.30pm\r\nS/B Dr. Raees\r\nNo complaints\r\nGRBS- 235mg%\r\nContinue same\n06.40pm\r\nS/B Dr. Raees\r\nNo complaints\r\ndoing well\r\nGRBS-212mg%\r\ncontinue same\n9.50am \r\nS/B Dr. TOM\r\nNo complaints doing well\r\nslept well\r\nGRBS- 176mg%\r\nContinue same\nAC - 193mg%. dressing change today.\r\nInsulin doses adjusted. \r\ncontinue same.\nSeen by DrA.K.Bhat.\r\nSSG taken up.Continue trt.Dynalix last dose today.\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\n\r\n\r\n07.45pm\r\nS/B Dr. Raees\r\nNo complaints\r\nPhysiotherapy done\r\nGRBS-254mg%\r\nContinue same\ndoing fine\r\nno special complaints\r\nplan for dental consult at OP(BY WHEEL CHAIR)\r\nto add glucerna powder today twice daily\r\nphysio for upper body exercise.\nDoing well. c/o itching at the donor site. \r\nAC - 189mg%. \r\ncontinue same. \r\n\nSeen by Dr.A.K.Bhat.\r\nContinue trt.\r\n\r\n\r\n07.10pm\r\nS/B Dr. Raees\r\nNo complaints\r\nGRBS-185mg%\r\nPlan to discharge tomorrow after dressing by Dr. Bhat\nGC - better. dressing change. \r\ncontinue same.\r\nplan to d/c after being seen by Dr Bhat.\nSeen by Dr.A.K.Bhat.\r\nC&D done.SSG settling.Donor site healing well.\nDressing change.\r\nAC - 201mg%\r\nPlan to d/c tomorrow on oral abx.\nSeen by Dr.AK.Bhat.\r\nPlan fr discharge tmrw.\r\n\r\n\r\n\r\n07.15pm\r\nS/B Dr. Raees\r\nNo complaints\r\nGRBS-224mg%\r\nPlan to discharge tomorrow\nDoing well. dressing change today. \r\nPlan to d/c today on oral abx and basal bolus insulins.\nSeen by DR.A.K.Bhat.\r\nDressings changed.SSG taken up.Donor site healed.\r\nAdviced:Review on tuesday 20th and friday 23 rd november-cuticell,pad,crepe bandage dressings.Rest and leg elevation.Oil application left thigh for 1 month.'}, {'role': 'model', 'content': '\nIP Number: 769\n\nPatient Number: 6668\n\nAdmission Date: 01-11-2012\n\nDischarge Date: 17-11-2012\n\nDiagnosis: Old CAD - post CABG.\r\nPOVD.\r\nCongestive heart failure - on BiPAP.\r\ns/p SSG.\n\nClinical Exam(With BP): {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Known diabetic, admitted here with non healing wound procured while riding his scooter. A slough excision and I & D was done. Now the wound is healing well and is now readmitted for SSG.\r\n\\par }\r\n\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Pus C/S (05/11/12) - no pathogenic organism in the culture.\r\n\\par }\r\n\n\nXray findings: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Temperature :96.8\r\n\\par Respiration :22\r\n\\par BP :140 / 70\r\n\\par Local Examination :Ulcer Lt leg clean.\r\n\\par }\r\n\n\nDiscussion: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 60 yr old, Mr Nirpal Singh, a known diabetic presented initially to us with a non healing wound. Slough was excised and the wound healed well. Now readmitted for SSG. Graft from Lt thigh was used. He underwent the procedure on 5th Nov under full aseptic precautions. The postop was uneventful. The dressings were changed periodically. Meanwhile, his blood sugars were kept under fair control on basal bolus insulins. The graft is taken up well and the donor site is also healthy and healing. He is hence discharged in a stable state on oral abx and basal bolus insulins and asked to review with us as outpt. \r\n\\par }\r\n\n\nDiet: nan\n\nRemarks: nan'}] |
771 | [{'role': 'user', 'content': '\nIP Number: 771\n\nPatient Number: 8098\n\nPatient Name: HAMZA PAKKIPURA\n\nGender: M\n\nDate of Birth: 01-11-1945\n\nAddress: PAKKIPURA HOUSE, KALPENI, LAKSHWADEEP\n\nPincode: 682557.0\n\nPhNo: 4895252367\n\nAdmission Date: 01-11-2012\n\nDischarge Date: 15-11-2012\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC PERIPHERAL NEUROPATHY\nTYPE 2 DIABETES MELLITUS\nPeripheral vascular disease, unspecified\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: Pt a known case of DM x 15yrs.Came with c/o Infection in the Amputated 2nd toe of right leg x 1month.Came for evaluation.\n\nXray information: Versa (01/11/12) - B/L moderate arterial ds.\r\nVibro (01/11/12) - B/L severe loss of vibratory perception.\r\nX Ray Rt foot AP/Obl (01/11/12) - OM of the residual bone of 2nd toe.\r\nPus C/S(05/11/12) - Heavy growth of Staph Aureus most sensitive to Linezolid and Clindamycin. \r\nUSG Abd (08/11/12) - No organomegaly, No mass or calculus detected.\r\nFNAC Thyroid (08/11/12) - Aspirate from thyroid is suggestive of nodular colloid goitre.\r\nS. Ammonia (09/11/12) - 109mmol/L.\r\nS. Ammonia (14/11/12) - 74mmol/L.\r\nOGD (15/11/12) - Grade I Esophageal Varices, Reflux esophagitis, Gastropathy due to portal HTN. \n\nClinical examination: Temperature :97.2\r\nRespiration :22\r\nBP :120 / 80\r\nWeight :70\r\nHeight :171\r\nLocal Examination :Rt 2nd toe nonhealing ulcer stump of amputated toe exposing Mpx bone and slough plantar aspect.C/S taken.Distal pulsations not felt. Xray shows OM of residual bone of 2nd toe.\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Versalab,vibro.Xray rt foot AP &OBlique.Blood RE,FBS,PPBS,Urea,Creat,LFT,BT,CT,PT.\r\n\nSeen by DRA.K.Bhat.\r\nXray shows OM of residual bone of 2nd toe.Posted for rt 2nd toe revision amputation under LA on 3th november.Preop:Consent.C&D rt foot.IV antibiotics.\r\n\r\n\r\n\r\n07.25pm\r\nS/B Dr. Raees\r\nC/O Both foot numbness\r\nContinue same\nedema better. X Ray Rt foot & ECG Today.\r\nFBS - 138mg%. \r\ncontinue same.\r\n\n07.00pm\r\nS/B Dr. Raees\r\nNo complaints\r\nContinue same\nAC - 90mg%.\r\nscheduled for revise amputation today.\r\n\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\n\r\ns/b duty doctor\r\nvitals stable,pt better\r\ncontinue the same\ndoing well,c/o mild occasional shooting pain frm surgical site radiating to shin\r\nvitals stable\r\ncontinue the same\nSeen by DR.A.K.Bhat.\r\nDressing changed,.Drain removed.Suture line clean.Continue trt.\r\n\r\nseen by duty doctor (7:00pm)\r\npt has no fresh complaints, gc same , vitals stable\r\ngrbs 355\nc/o pain and burning sensation of foot\r\nAC-167\r\nchanged analgesics\r\ntab ultracet 1-0-1\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\n\r\n\r\ns/b duty doctor\r\npt better\r\ncontinue the same\nmild disorientation. \r\nmemory intact. to rpt TC today.\nSeen by DrA.K.Bhat.\r\nDressings changed.Suture line clean.Oral antibiotics.\r\n\r\n07.00pm\r\nS/B Dr. Raees\r\nC/O intermittent disorientation\r\nGRBS- 211mg%\r\nINV: S. Na+\r\nContinue same\nhavent slept well last night., \r\nflapping tremors +, to check serum NH4, Stool for OB, Hb.\r\ncase plan:\r\nSyp looz 15ml BD. \r\nto do bowel wash. \r\nGE consult today.\nSeen by DrA.K.Bhat.\r\nSuture line clean.Continue trt.\r\n\r\n\r\ns/b duty doctor\r\nfebrile,BP:120/70 PR:70\r\nInj Hepamerz in 500 ml on flow\r\nTab welset given at 5\r\nadviced tepid sponging now.repeat temp after one hr\ns/b DR.TOM/team\r\nfever persisting\r\nstool occult blood +\r\nHb-9.2\r\nGE opinion-change of antibiotic\r\nINJ.BIOPIPER 4.5 gm iv BD\r\nGE scopy later\r\ninj.HEPAMERZ 6 amps in NS over 12 hours\r\ntab rifagut 200 1-1-1\nAC - 157mg%, predinner - 223mg%.\r\npassed stools. AG - 92cm. Afebrile.\r\nS. NH4 - 109. wound clean. \r\nRpt TC today. \r\n\n07.15pm\r\nS/B Dr. Raees\r\nNo complaints\r\nGRBS- 143mg%\r\nContinue same\n07.15pm\r\nS/B Dr. Raees\r\nNo complaints\r\nGRBS- 170mg%\r\nContinue same\n10.00am\r\nS/B Dr. TOM\r\nC/O pain in foot\r\nvitals stable\r\nGRBS- 109mg%\r\nPhysiotherapy\nSeen by DrA.K.Bhat.\r\nSuture line clean.Continue trt.\nSpike of fever yday. T. Tramadol 50mg.\r\nO/E - shifting dullness +.\r\nRestart Lasilactone. S. NH4 rpt awaited. \r\nphysio to teach bergers exercise.\nPain less. oral intake adequate. passed stools. \r\nhad a spike of fever yday night. \r\nmild redness at the arch of the Rt foot noted. \r\nplan to d/c after removal of sutures day after. \r\nAG - 91cm(reduced 3 cm).\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\n\r\n\r\n07.15pm\r\nS/B Dr. Raees\r\nFeeling better\r\nGRBS- 128mg%\r\nContinue same\nSeen by Dr.A.K.Bhat.\r\nSutures removed .Healed.Adviced:Daily betadine dressing for 2 weeks.\r\n\r\n\r\n06.45pm\r\nS/B Dr. Raees\r\nNo complaints\r\nGRBS-190mg%\r\nContinue same\r\nPlan to discharge tomorrow\ns/b med\r\npain has come down\r\nto check-tc/hb/ectrolytes/creat/uric acid\r\nAC-100\r\nTO CONT SAME\nupper GE done\r\nGrade 1 varices\r\nreflux esophagitis\r\ngastropathy due to portal hypertension\r\n\r\nto decide on pletoz after opinion from GE. \r\nAfebrile, Wound clean, Tramadol SOS. \r\nClinically better, AC - 105mg%. \r\nplan to d/c today on basal bolus insulin, \r\nPodiatry for footwear, Follow up with diabetic educator. \r\nOral levo on d/c for one week.'}, {'role': 'model', 'content': '\nIP Number: 771\n\nPatient Number: 8098\n\nAdmission Date: 01-11-2012\n\nDischarge Date: 15-11-2012\n\nDiagnosis: Cirrhosis with Portal HTN.\r\nLeft Infected Diabetic Foot Ulcer-5th Toe Amputated\r\nGrade II Esophageal Varices\n\nClinical Exam(With BP): {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Pt a known case of DM x 15yrs.Came with c/o Infection in the Amputated 2nd toe of right leg x 1month.Came for evaluation.\r\n\\par }\r\n\n\nSystolic BP: 120.0\n\nDiastolic BP: 80.0\n\nPhysical examination: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Versa (01/11/12) - B/L moderate arterial ds.\r\n\\par Vibro (01/11/12) - B/L severe loss of vibratory perception.\r\n\\par X Ray Rt foot AP/Obl (01/11/12) - OM of the residual bone of 2nd toe.\r\n\\par Pus C/S(05/11/12) - Heavy growth of Staph Aureus most sensitive to Linezolid and Clindamycin. \r\n\\par USG Abd (08/11/12) - No organomegaly, No mass or calculus detected.\r\n\\par FNAC Thyroid (08/11/12) - Aspirate from thyroid is suggestive of nodular colloid goitre.\r\n\\par S. Ammonia (09/11/12) - 109mmol/L.\r\n\\par S. Ammonia (14/11/12) - 74mmol/L.\r\n\\par OGD (15/11/12) - Grade I Esophageal Varices, Reflux esophagitis, Gastropathy due to portal HTN. \r\n\\par }\r\n\n\nXray findings: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Temperature :97.2\r\n\\par Respiration :22\r\n\\par BP :120 / 80\r\n\\par Weight :70\r\n\\par Height :171\r\n\\par Local Examination :Rt 2nd toe nonhealing ulcer stump of amputated toe exposing Mpx bone and slough plantar aspect.C/S taken.Distal pulsations not felt. Xray shows OM of residual bone of 2nd toe.\r\n\\par }\r\n\n\nDiscussion: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 67 yr old, Mr Hamza Pakkipura, a known diabetic and CLD, admitted here with stump infection of the 2nd toe Rt. He was empirically started on IV antibiotics and X Ray revealed OM of the distal phalynx. A revise amputation was done on 3rd Nov with full asceptic precautions. Basal bolus insulin regimen was initiated for control of blood sugars. He was found anemic on routine investigations and Stool OB was sent which came back +ve. GE consult was taken and OGD was done which revealed Grade I varices and reflux esophagitis. His wound is healing well and blood sugars under control. He is hence discharged on oral antibiotics and basal bolus insulins and is asked to review as outpt. \r\n\\par }\r\n\n\nDiet: nan\n\nRemarks: nan'}] |
786 | [{'role': 'user', 'content': '\nIP Number: 786\n\nPatient Number: 7835\n\nPatient Name: P K JOSE\n\nGender: M\n\nDate of Birth: 10-10-1947\n\nAddress: PUTHENVEETIL HOUSE\n\nPincode: 680741.0\n\nPhNo: 4802719683\n\nAdmission Date: 07-11-2012\n\nDischarge Date: 23-11-2012\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC FOOT\nChronic ischaemic heart disease\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: Previously admitted here with gangrene of 2nd to 5th toes of the Lt foot. \r\nAmputation was done and he was sent home on oral antibiotics and basal bolus insulins. Now readmitted for SSG. \n\nXray information: Pus C/S (13/11/12) - Moderate growth of Pseudomonas most sensitive to Oflox and Levoflox.\n\nClinical examination: Temperature :97.4\r\nRespiration :22\r\nBP :130 / 70\r\nLocal Examination :Raw area clean and well granulated.\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Daily oxum dressing after bath.\r\nBlood RE,FBS,PPBS,URea,Creat.,LFT.Leg elevation.\r\n\r\n\r\n\r\n07.15pm\r\nS/B Dr. Raees\r\nNo complaints\r\nGRBS-334mg%\r\nContinue same\nWound healing well. stopped clopilet since yday. \r\nHb - 12.7gm%, TC - 8800. \r\nAdd monoscot SB BD.\nAC - 111mg%, predinner - 208mg%.\r\nscheduled for SSG on monday.\r\nIT works today.\n07.15pm\r\nS/B Dr. Raees\r\nNo complaints\r\nGRBS- 197mg%\r\nContinue same\nswelling and warmth less. \r\nfor SSG on monday. AC - 90mg%.\r\ncontinue same.\r\nSeen by DrA.K.Bhat.\r\nC/S taken.\r\nPosted for SSG under SA on monday 12th november 1.30 pm.\r\nPreoperative:\r\nGet consent.Clean&dress area.\r\nNil oral as per Anesthetist advice.\r\nShave rt thigh&betadine scrub on monday morning.\r\nIV antibiotics.\r\nMedical &Anesthetic fitness for the procedure.\r\n\r\n\n07.10pm\r\nS/B Dr. Raees\r\nNo complaints\r\nGRBS- 202mg%\r\nContinue same\n10.05 am\r\nS/B Dr. TOM\r\nHad disturbed sleep\r\nno other complaints\r\nSSG tomorrow under SA\r\nGRBS- 152mg%\nScheduled for SSG today afternoon. \r\nAC - 88mg%. \r\nphysician fitness to be given.\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\nRpt Hb.\r\n\r\n\r\n07.20pm\r\nS/B Dr. Raees\r\nFeeling better\r\nGRBS- 169mg%\r\nContinue same\ndoing fine\r\nto cont the same\r\n\nAfebrile, Doing well. \r\nPus C/S - Moderate Pseudomonas sensitive to Levo.\r\n\nSeen by Dr.A.K.Bhat.\r\nRemove foleys tmrw.Continue trt.\r\n\r\n\r\n06.45pm\r\nS/B Dr. Raees\r\nC/O mild pain at surgery site\r\nGRBS-155mg%\r\nContinue same\nCatherter removal today.\r\nAC - 85mg% passed stools. \r\ndressing change today.\r\ncontinue same.\nSeen by Dr.A.K.Bhat.\r\nContinue trt.For C&D in OT tmrw.\nDressing change today. AC - 99mg%.\r\nhavent slept well last night. feels weak. \r\nContinue same. \r\n\r\n\nSeen by Dr.AK.Bhat.\r\nDressings changed.Lt foot SSG taken up.Continue trt.Oral antibiotics.\r\n\r\n\r\n07.00pm\r\nS/B Dr. Raees\r\nNo complaints\r\nGRBS-174mg%\r\nContinue same\nAC - 136mg%, predinner - 174mg%. \r\nBP - 120/80. c/o mild pain at donor site. \r\nHb - 12.5gm%.\r\nContinue same.\nSeen by Dr.A.K.Bhat.\r\nContinue trt.Oral antibiotics.\r\n\r\n07.00pm\r\nS/B Dr. Raees\r\nNo complaints \r\nFeeling better\r\nContinue same\nDressing change today.\r\nAC - 88mg%. Changed to oral Levo.\r\nInsulin doses adjusted.\nSeen by DR.A.K.Bhat.\r\nC&D done.SSG taken up.Continue trt.\r\n\r\nseen by duty doctor 8 pm\r\npt gc same , no fresh complaints, \r\nvitals stable\r\n\nAC - 87mg%. plan for d/c after 2 more dressings. \r\nGC - fair. SSG taken up. Insulin doses adjusted. \r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\nAC-104\r\nto continue same\nSSG taken up. dressing change today.\r\nplan to d/c tomorrow after change of dressing. \r\nsleep and appetite normal.\r\nvaseline and candid lotion. \r\ncontinue rest.\r\n\nSeen by DRA.K.Bhat.\r\nDressings changed.SSG takenup.Continue trt.\r\n\r\n08.15pm\r\nS/B Dr. Raees\r\nGRBS- 201mg%\r\nNo complaints\r\nContinue same\nAC - 143mg%, pre dinner - 201mg%. \r\nVitals stable.\nSeen by DrA.K.Bhat.\r\nAdviced:Change of dressing once in 2 days-Lt thigh neosporin powder,jelonet-1 week.Lt foot-jelonet,pad,crepe bandage for 1 month.Review 2 weeks.'}, {'role': 'model', 'content': '\nIP Number: 786\n\nPatient Number: 7835\n\nAdmission Date: 07-11-2012\n\nDischarge Date: 23-11-2012\n\nDiagnosis: Gangrene 2nd - 5th toes Lt - s/p amputation & SSG.\n\nClinical Exam(With BP): {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Previously admitted here with gangrene of 2nd to 5th toes of the Lt foot. \r\n\\par Amputation was done and he was sent home on oral antibiotics and basal bolus insulins. Now readmitted for SSG. \r\n\\par }\r\n\n\nSystolic BP: 160.0\n\nDiastolic BP: 90.0\n\nPhysical examination: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Pus C/S (13/11/12) - Moderate growth of Pseudomonas most sensitive to Oflox and Levoflox.\r\n\\par }\r\n\n\nXray findings: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Temperature :97.4\r\n\\par Respiration :22\r\n\\par BP :130 / 70\r\n\\par Local Examination :Raw area clean and well granulated.\r\n\\par }\r\n\n\nDiscussion: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 65 yr old, Mr P K Jose, a known diabetic was initially brought to us with Gangrenous toes in the Lt foot. The toes were amputated and later discharged without any untoward event. Now is readmitted for Skin Grafting. Antiplatelet agents were stopped 5 days prior to procedure. He was taken up for SSG on 12th Nov under SA. The postop was uneventful. He was kept on basal bolus insulins and insulin doses were adjusted to maintain euglycemia. He was also put on antibiotics prophylactically. The SSG is taken up and the donor site is also healing well. All his metabolic parameters are within normal range. Hence he is being discharged in a stable state on oral abx and asked to review as outpt. \r\n\\par }\r\n\n\nDiet: nan\n\nRemarks: nan'}] |
863 | [{'role': 'user', 'content': '\nIP Number: 863\n\nPatient Number: 8697\n\nPatient Name: THOMAS T\n\nGender: M\n\nDate of Birth: 09-12-1958\n\nAddress: MUTHUPLACKAL (H) KALATHOOKADAVAU\n\nPincode: 686579.0\n\nPhNo: 9447734755\n\nAdmission Date: 09-12-2012\n\nDischarge Date: 09-01-2013\n\nDiagnosis determined by the doctor when the patient was admitted: Peripheral vascular disease, unspecified\nTYPE 2 DIABETES MELLITUS\nDIABETIC RETINOPATYH WITH PDR\nDIABETIC PERIPHERAL NEUROPATHY\nDIABETIC NEPHROPATHY WITH MICROALBUMINUREA\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: c/o right foot discolouration,swelling,fever\r\ncame from amritha hospital at request\r\n\n\nXray information: Vibro (11/12/12) - Moderate loss of vibratory perception Lt, Normal study Rt.\n\nClinical examination: pt stable,afebrile\r\nsystem NAD\r\nLocal Exam : Necrotising gangrene rt foot including medial 4 toes,infection extending to ankle region both plantar and dorsal aspects of foot.Hemorrhagic blisters extending upto ankle.Crepitus felt suggesting anaerobic sepsis.-C/S taken.Ulcer base of big toe plantar aspect.Cellulitis upto leg.Distal pulsations not felt.Popl.A.feeble.Spo2 revealed nil signal in medial 4 toes.\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: X Ray Rt Foot AP/Obl, CXR, CBC, RFT, LFT, ACR, S. Elect, HbA1c, FLP, FBS/PPBS, ECG.\r\nDr Bhat consultation tomorrow.\nSEEN BY DUTY DOCTOR \r\nPT C/O PAIN IN THE FOOT , NO OTHER COMPLIANTS, VITALS STABLE\nSeen by DRA.K.Bhat.\r\nNecrotising gangrene rt foot including medial 4 toes,infection extending to ankle region both plantar and dorsal aspects of foot.Hemorrhagic blisters extending upto ankle.Crepitus felt suggesting anaerobic sepsis.-C/S taken.Ulcer base of big toe plantar aspect.Cellulitis upto leg.Distal pulsations not felt.Popl.A.feeble.Spo2 revealed nil signal in medial 4 toes.\r\nPlan:Midfoot amputation under SA.\r\nPreoperative Instructions:\r\nGet informed consent.\r\nNil oral as per Anesthetist advice.\r\nClean&dress area.\r\nBetadine scrub HS&CM.\r\nIV antibiotics.\r\nMedical &Anesthetic fitness for the procedure.\r\n====================\r\nInformed consent.:\r\nThere is infective gangrene of right foot with gangrene of 1st,2nd,3rd and 4th toes and pus extending to foot and ankle.There is diabetes and neuropathy.There is reduced circulation of leg as seen in Arterial Doppler report.This requires wound cleaning under Anesthesia.The gangrene of the toes needs amputation of the toes.The 1st,2nd,3rd and 4th toes of right foot will be amputated.During surgery, depending on the findings,extending pus of foot and ankle will also be drained.This may end up in amputation at mid or proximal foot level.After the operation,depending on healing further operations may be be needed.Due to diabetes and decreased circulation,wound healing may be delayed.Depending on control of infection and healing further procedures may be needed.The overall recovery and function of the foot will need close observation.The above points have been explained and understood and full consent for operation and anesthesia is given.\r\n\r\nSIGNED. \r\n=========================\ncase seen by duty doctor \r\npatient afebrile\r\nvitals stable\nPost op uneventful. AC - 183mg%\r\nInsulin dose adjusted. \r\nInsugen R 22-22-22, Lantus 22 units at bed time. \r\nPactiv infusion q8h. to start Glucerna SR.\r\nIT works. continue rest. to rpt TC tomorrow.\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\n\r\ncase seen by duty doctor\r\nvitals stable\nGC - better. Chest - clear. Afebrile. \r\nnot passed stools since admission. \r\nBP - 130/70. pain less. AC - 185mg%, predinner - 155mg%.\r\nTC - decreased to 20,000. DVT prophylaxis. \r\ncontinue same.\r\nSeen by DR.A.K.Bhat.\r\nDressing changed.Clean.Continue trt.\nseen by duty doctor\r\npt gc better, complains of pain, no other complaints\r\nvitals stable\nSeen by DrA.K.Bhat.\r\nContinue trt.Change of dressing tomorrrow.\ndressing changed yday, wound clean. \r\nvitals stable. Afebrile. AC - 109mg%. \r\nCandid mouth paint. passed stools. Start on Serta 25 mg \r\nContinue same. Rpt TC and S. Elect tomorrow.\nhad an episode of hypo yday morning. \r\nAC - 128mg%, TC awaited. insulin doses adjusted. \r\nInj Heparin 5000 units BD. Chest - clear.\r\ndressing change today.\r\ncatheter removed. Continue same.\nsleep disturbed.had 2 episode of hypo and 1 episode fever yesterday night.c/o lack of appetite and nausea\r\nplan to reduce insulin R 14-14-14\r\n insulin N 12 at bedtime\nSeen by DRA.K.BHat.\r\nC&D done.Proximal raw area granulating.Ankle and foot stump area ischemic.Tib.anterior exposed.Needs observation..Adviced:Inj.Cefoperazone/sulbactum\ns/b dr.tom\r\nac-213\r\ndoing fine\ngc-stable\r\nhad one episode of sweting ,fever was present in the morning.\r\nAC-147.\r\nSeen by DrA.K.Bhat.\r\nContinue trt.\nseen by duty doctor\r\npt condition same , no fresh complaints, \r\nvitals stable\nSeen by DRA.K.Bhat.\r\nC&D done.Raw area rt leg granulating.However the midfoot stump looks unhealthy-needs bone nibbling and slough excision under SA-20th dec. 8AM.C&D rt foot and leg.IV antibiotics.Consent.Nil oral as per anesthetist advice.Continue trt.\ns/b dr.tom/team\r\nac-176\r\npredinner\r\ntc-17800\r\nwound inspected-slight improvement than before\r\nadjusted insulin doses\ncase seen by duty doctor\r\nc/o pain left lower limb\r\nT. ULTRACET 1 SOS\nS/B dr Tom &co\r\npain+\r\nFBS 161mg%\r\nTC/DC,HB,CREAT\r\nBLOOD C/S\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\n\r\nSEEN BY DUTY DOCTOR\r\npt complains of sever pain, vitals stable\r\nadv: inj tramadol 50 mg im\nSeen by DRA.K.Bhat.\r\nDressings changed.Raw area leg clean.Change of dressing on 24TH AND 26TH december.Suggested Oral levoflox.\r\n\r\nseen by duty doctor\r\nnil special\r\nvitals stable\r\ncontinue same\npatient had one episode of chills yday night.\r\nfever one episode yday night\r\nto do urine R today.\r\ntotal counts have down\r\nbetter\ns/b Dr Radha\r\npt doin wel,no fresh complaints\r\ncontinue the same\nDoing well. C/O pain pver the amputation stump. Slept well.\r\nPassed stools\r\nLabs\r\nAC- 110 mg/dl\r\nPre Dinner - 181 mg/dl\r\nCase Plan\r\nDressing today ( inform Doctors when the wound is open)\r\nCBC tomorrow\ns/b duty doctor\r\npt doing wel,mild pain over wound\r\nvitals stable\r\ncontinue the same\nNo fever, TC- 11000, GRBS- 104\r\nPlan- on oral antibiotic now.\r\nDressing change done yesterday\ncase seen by duty doctor\r\nvitals stable\r\ncontinue same\ns/b dr.tom\r\ndoing fine\r\ntc-11100\r\nslept well\r\nappetite good\r\n\r\nac-113\r\npredinner-125\nslept well\r\nac-124\r\npassed stools\nAC-148\r\npredinner-220\r\ndoing fine\nSeen by DrA.K.Bhat.\r\nDressings changed.Stump of rt foot partly granulated.Slough exposed inbetween tarsal bones.Slough of lateral heel.C/S taken.Condition of wound explained to bystanders and guarded prognosis regarding wound viability and healing has been explained.\r\nContinue trt.\r\n\r\nseen by duty doctor\r\npt complaints of pain, inj tramadol given\nSeen by DRAK.BHAT.\r\nC&D done.Residual slough present in heel pad and intertarsal regions.Needs obserevation.Continue trt.\ndoing fine\r\nac-116\r\ncbc tomorrow\r\ncontinue same\nS/B DR.MANOJ\r\ndoing fine\r\nno complaints\r\nAC-103\r\npredinner-172\r\nsugars are well controlled,GRBS od\r\ncont same\nSeen by DRA.K.Bhat.\r\nC&D done.Continue trt.\r\n\r\n\r\ncase seen by duty doctor\r\nvitals stable\r\nT. ultracet 1 sos\ndoing fine\r\ncouldnt sleep yday\r\notherwise no complaints\r\nac-159\r\nperipheral smear today\r\n\nSeen by Dr.AK.Bhat.\r\nContinue trt.\r\n\r\ncase seen by duty doctor\r\nvitals stable\r\n\ns/b Dr. Tom& co\r\nPt doing well.\r\nFBS 115 mg %\r\ncase plan\r\ncont same tt. .\nSeen by DRA.K.Bhat.\r\nDressings changed.Continue trt.\r\n\r\n\r\n07.05 pm\r\nS/B Dr. Raees\r\nC/O slight pain\r\ncontinue same\ndoing fine\r\nAC-102\r\ncont same\nSeen by DrA.K.Bhat.\r\nPlan for debridement on saturday under GA.Stop heparin.\r\n\r\ns/b duty doctor\r\nnil special\r\nvitals stable\ns/b dr.tom/co\r\ndoing fine\r\ndiscussed the benefit of one more debridement for faster healing.\r\nAC-98\nPosted for Slough excision on 5-1 2013 Under GA 11 AM.\r\nPreoperative Instructions:\r\nGet consent.\r\nNil oral as per Anesthetist advice.\r\nClean&dress area.\r\nIV antibiotics.continue.\r\nMedical &Anesthetic fitness for the procedure.\r\n\r\nSEEN BY DUTY DOCTOR:\r\nPT GC GOOD, C/O OF PAIN ,NO OTHER COMPLAINTS\r\nADV: T. ULTRACET\r\n\ns/b dr.tom/co\r\nAC-83\r\ninsulin adjusted\npatient resting well\r\nc/o pain \r\nGRBS :254 mg/dl\r\n\nGRBs 98 mg/dl\nSeen by DR.A.K.Bhat.\r\nContinue trt.\r\n\r\nS/B Dr Lakshmi\r\n\r\nPlan: continue current treatment.\nSeen by DrA.K.Bhat.\r\nC&D done.Plan fr discharge on wednesday.Continue trt.\r\n\r\n\r\n07.11pm\r\nS/B Dr. Raees\r\nNo complaints\r\nContinue same\ns/b dr.tom/co\r\nac-101\r\nc/o pain of the nibbled area\r\ncase plan-d/c after 2 days\r\n\nSeen by DrA.K.Bhat.\r\nPlan for discharge tomorrow.\r\n\r\n\r\n\r\n\r\n07.20pm\r\nS/B Dr. Raees\r\nNo Complaints\r\nContinue same\ns/b dr.tom/co\r\npatient is having novopen 4, advised to continue regular insulin by pen(insulin educator )\r\nplanning for d/c tomorrow.\nSeen by DRA.K.Bhat.\r\nDRessing changed.Clean.\r\nAdviced:Cleaning with saline.Change of dressing once in 2 days-cuticell,oxum gauze and pad.Oral antibiotics 2 weeks.'}, {'role': 'model', 'content': '\nIP Number: 863\n\nPatient Number: 8697\n\nAdmission Date: 09-12-2012\n\nDischarge Date: 09-01-2013\n\nDiagnosis: DIABETIC FOOT\r\ns/p midfoot amputation(11/12/12)\r\ns/p Lt SFA angioplasty and stenting done on 16/12/11.\r\n\n\nClinical Exam(With BP): {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 c/o right foot discolouration,swelling,fever\r\n\\par came from amritha hospital at request\r\n\\par \r\n\\par }\r\n\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Vibro (11/12/12) - Moderate loss of vibratory perception Lt, Normal study Rt.\r\n\\par }\r\n\n\nXray findings: {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 pt stable,afebrile\r\n\\par system NAD\r\n\\par Local Exam : Necrotising gangrene rt foot including medial 4 toes,infection extending to ankle region both plantar and dorsal aspects of foot.Hemorrhagic blisters extending upto ankle.Crepitus felt suggesting anaerobic sepsis.-C/S taken.Ulcer base of big toe plantar aspect.Cellulitis upto leg.Distal pulsations not felt.Popl.A.feeble.Spo2 revealed nil signal in medial 4 toes.\r\n\\par }\r\n\n\nDiscussion: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}{\\f1\\fnil\\fcharset0 Courier New;}}\r\n{\\colortbl ;\\red0\\green0\\blue0;}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 54 year old male came to the hospital from amritha hospital at request with diabetic foot(Right).He was advised to have an amputation there for the diabetic foot.When he came his bllod sugars were very high and he was put on insulin infusion and later changed to basal-bolus regimen.IV antibiotics and other supportive care were given .Examination revealed gangrene of the medial four toes(right) and the infection extending uptill the ankle with absent arterial pulsations on the foot.After explaining the situation he was taken to the operation theatre,amputation was done at the level of tarso-metatarslal and excised uptill lower 1/2 of leg.Intermittent fever persisted even after surgery but his general condition improved.Nine days later nibbling of the tarsal bones were done and necrotised tissue removed.His fever gradually settled and became afebrile.Dressings were changed during the stay in the hospital and sugar levels were controlled with basal-bolus regimen.Oral antibiotics continued and alternate day dressings also continued.Patient is discharged in a stable state on oral antibiotics and advised to have change of dressing on alternate days.\\cf1\\f1\\fs20 \r\n\\par \\cf0\\f0\\fs24 \r\n\\par }\r\n\n\nDiet: nan\n\nRemarks: nan'}] |
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