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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'}] |
867 | [{'role': 'user', 'content': '\nIP Number: 867\n\nPatient Number: 8708\n\nPatient Name: HASSAINAR.M\n\nGender: M\n\nDate of Birth: 10-12-1947\n\nAddress: MADAKKAMMOOLA H, BADOOR P O, VIA KUMBLA\n\nPincode: 671321.0\n\nPhNo: 0499 8245243\n\nAdmission Date: 10-12-2012\n\nDischarge Date: 31-12-2012\n\nDiagnosis determined by the doctor when the patient was admitted: Peripheral vascular disease, unspecified\nTYPE 2 DIABETES MELLITUS\nEssential (primary) hypertension\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: Large non healing stump infection Rt foot big toe.\n\nXray information: nan\n\nClinical examination: On examination:Large unhealthy ulcer rt foot with missing big toe and gangrene of 2nd and 3rd toes.The ulcer in medial aspect exposes unhealthy bone of 1st MT,Slough,with no e/o granulation,suggesting ischemia.Distal pulsations not felt.\r\nxRay foot shows missing big toe.Calcified arteries seen.\r\n\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: seen by duty doctor ,\r\npt condition same, c/o pain in the foot, no other complaints, vitals stable\nSeen by Dr.AKBhat.\r\nRt foot big toe amputated in KMC mangalore 1 month ago.Later developed gangrene of 2nd and 3rd toes.Nonhealing ulcers.Pain occasional.\r\nOn examination:Large unhealthy ulcer rt foot with missing big toe and gangrene of 2nd and 3rd toes.The ulcer in medial aspect exposes unhealthy bone of 1st MT,Slough,with no e/o granulation,suggesting ischemia.Distal pulsations not felt.\r\nxRay foot shows missing big toe.Calcified arteries seen.\r\nPlan:Midfoot amputation under SA,12-12-2012.with risks explained.\r\nPreop:Preoperative 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 2nd and 3rd toes and pus extending to foot.Already the big toe has been amputated in another hospital and ulcer not healing.There is diabetes and neuropathy.There is reduced circulation of leg.This requires wound cleaning under Anesthesia.The gangrene of the toes needs amputation of the toes.The 2nd and 3rd toes of right foot will be amputated.During surgery, depending on the findings,extending pus of foot will also be drained.The status of the remaining 4th and 5th toes will also be assessed and if found unhealthy then they may need amputation as well.After the operation,depending on healing further operations may be be needed.Due to diabetes and decreased circulation,wound healing may be delayed.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 complains of pain\r\nvitals stable\r\n adviced \r\nINJ tramadol 50 mg iv [slow] sos\ns/b dr.tom/team\r\nposted for surgery today\r\no/e tachycardia noted\r\nto do TFT\r\ntab.nebivilol 5mg 1-0-0\nPain less. havent slept well last night. \r\nAppetite adequate. started on nebilong, HR better. \r\nAC - 107mg% Hb - 10.4gm%. \r\nContinue same.\r\nSeen by DR.A.K.Bhat.\r\nContinue trt.\nseen by duty doctor\r\npt gc good, complains of mild pain, vitals stable\nAC - 172mg%, Culture specific antibiotic started - Lactagard. profuse sweating. hypotab given .\nSeen by DrA.K.Bhat.\r\nContinue trt.Dressing changed.Clean.Continue trt.\nGC - fair, passed stools. AC - 105mg%.\r\nPactiv infusion SOS. continue same.\nFBS-106 dressing done in morning.didnt sleep wel\r\nc/o pain yesterday night-inj tramadol given\r\nvitals stable.continue the same medication\r\nadv inj tramadol IV SOS\nSeen by DRA.K.BHat.\r\nC&D done.ISCHEMIC ULCER FOOT AND ANKLE.Tissues of foot are ischemic,with NO evidence of healing.Continue trt.\ns/b dr.tom\r\nAC-127\r\nintermittent spiking of fever.\r\ncase to be discussed with dr.bhatt\r\nchest-clear\ns/b dr.tom\r\npt feels better.\r\nSeen by DrA.K.Bhat.\r\nContinue trt.\nseen by duty doctor\r\npt condition good no fresh complaints, vitals stable\nSeen by DRA.K.Bhat.\r\nC&D done.Ischemic raw area rt foot with gangrene.Plan for BK amputation under SA 20th dec 8 AM.\r\nPreop:INFORMED CONSENT.IV antibiotics.Nil oral.C&D leg.Medical fitness.One pint packed cells to be arranged.\r\nInformed consent:\r\nThere is extensive bone,joint and soft tissue gangrene infection of right ankle and foot,with missing 3 toes.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.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 left leg have been explained.Also close medical followup is essential. The above points have been explained and understood and full consent for right belowknee amputation operation and anesthesia is given.\r\n\r\nSIGNED.\ntc-9200\r\nhb-10.5\r\nac-192,pre-dinner-213\r\n\r\nwound inspected-not looking healthy.discussed the need of BKA with the son vs lower limb perfusion scan and revascularization.\ncase seen by duty doctor\r\npatient c/o pain\r\nvitals stable\r\nafebrile\r\nadv:\r\n inj tramadol 50 mg im hs/sos\ns/b dr.tom\r\nBKA done today morning\r\nprocedure went uneventfull\r\npt is conscious/oriented\nS/B Dr. Tom&co\r\nPain better, Hb-10.2gm%\r\nFBS 196mg%\r\ncase Plan:continue same Tt.\r\nBP-120/80MMHG\r\n\npatient had some discomfort at around 1.00 pm\r\nBP-100/90 mmhg\r\ncvs s1s2+\r\nrs-nvbs\r\nECG-normal\r\nSeen by DrA.K.Bhat.\r\nContinue trt.InJ.LMWX.\r\n\r\nSEEN BY DUTY DOCTOR, \r\nPT GC GOOD, NO COMPLAINTS OF PAIN OR ANY OTHER DIFFICULTY, VITALS STABLE\nSeen by DRA.K.Bhat.\r\nDressings changed.Drain removed.Betadine wash given.\r\nContinue trt.Suggested oral antibiotics.Change of dressing on 24TH AND 26TH december.\r\n\r\nseen by duty doctor\r\nc/o mild pain\r\nvitals stable\nac-238\r\npain is less\r\nto give mouth care.\r\ninsugen R 6 units stat.\ns/b Dr Radha\r\nc/o tiredness\r\nafebrile,systems NAD\r\nadviced egg white,increase food intake\r\nstart on oral abs Tab Xpand 625 BD\r\nContinue the rest\nc/o increased weakness, says he passes urine without his knowledge. Slept well. Passed stools\r\nLabs\r\nAC- 114 mg/dl\r\nPre Dinner - 116 mg/dl\r\nNA+-125 mEq/l\r\nHb- 10 gm %\r\nCreat- 0.8 mg/dl\r\nCase Plan\r\n4 gms added salt\r\nRpt Electrolytes tomorrow\ns/b duty doctor\r\npt doin fine,no fresh complaints\r\ncontinue the same\nC/o feeling tired. Na -123, GRBS- 175\r\nAdvice- salt capsules\r\nwill recheck na and assess\ncase seen by duty doctor\r\nvitals stable\r\nno signs of dehydration\r\nsalt enhanced diet\r\ncontinue same\nS/B DR.TOM\r\ndoing fine \r\nAC-142\r\npassed motion \r\nno loose stools\r\nNa-123\r\no/e wasting of thenar muscles lt>rt\r\nplan for cervical x ray\nac-108\r\npre dinner-159\r\ndoing fine.\r\nchest is clear\r\npassed stools.\r\n\ncase seen by duty doctor\r\nvital stable\r\nnil special\nDoing well. Slept well.\r\nLoose stools - ? antibiotic induced dairrhea\r\nLabs\r\nAC- 106 mg/dl\r\nCase plan\r\nDressing today\r\nTomorrow\r\nCBC\r\nSe Electrolytes\r\nSe Creat\nSeen by DrA.K.Bhat.\r\nDressings changed.\r\nAlternate staples removed.\r\nContinue trt.\r\n\r\nseen by duty doctor\r\npt gc same , pt complaints of pain , vitals stable\r\nadv inj tramadol sos\nPain is better. Difficulty in sleeping. c/o left sided chest pain\r\nStools normal.\r\nLabs\r\nTC- 8400 cells/ mm3\r\nHB- 10.4 gm/dl\r\nAC- 136 mg/dl\r\nPre dinner- 165 mg/dl\r\nO/E\r\nChest clear\r\nCase Plan\r\nECG\r\n\ns/b dr.manoj\r\ndoing fine \r\nno specific complaints\r\nchest discomfort is not there today\r\nAC-95\r\nPREDINNER-157\r\nelectrolytes tomorrow\nDoing well. No loose stools. Slept well.\r\nLabs\r\nAC- 108 mg/dl\r\nNa+- 127 mmol/lit\r\nCase Plan\r\nStitches to be removed completeley\r\nDischarge today after Dr. Bhatts rounds\nSeen by DRA.K.Bhat.\r\nAll staples removed.Clean.Adviced:Change of dressing once in 2 days-betadine oint,pad,crepe bandage.POP slab at night for 1 week.REgular exercises.Review 2 weeks.'}, {'role': 'model', 'content': '\nIP Number: 867\n\nPatient Number: 8708\n\nAdmission Date: 10-12-2012\n\nDischarge Date: 31-12-2012\n\nDiagnosis: 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 Large non healing stump infection Rt foot big toe.\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 On examination:Large unhealthy ulcer rt foot with missing big toe and gangrene of 2nd and 3rd toes.The ulcer in medial aspect exposes unhealthy bone of 1st MT,Slough,with no e/o granulation,suggesting ischemia.Distal pulsations not felt.\r\n\\par xRay foot shows missing big toe.Calcified arteries seen.\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 Pt was admitted with a large non healing ulcer of rt foot, with amputated stump of big toe, gangrene of 2nd and 3rd toes.The ulcer on the medial aspect of the rt foot exposes tendons and s/o unhealthy slough.Amputation of 2nd and 3rd toe at TM junction with desloughing was done under SA on 12/12. The perioperative period was uneventful..He was given I/V AB \r\n\\par coverage with Bipiper and Lactagard. Packed cell transsfusion were also given.Post operatively , the pt continued to have fever most days . He also had an episode of hyponatremia.dressings were continued .and it was observed that there was there was an unhealthy and ischaemic raw area of rt foot around the stump.Various modalities of treatment including BKA , Revascularisation etc were discussed with the relatives. With informed consent BKA was done under SA on 18/12. Recovery was uneventful. By 24/ 12 we could change over to oral ABS. Pt remained afebrile. Blood sugars were controlled with basal bolus insulin.Alternate dressings were given and wound healing was good . By 31 /12 , Pt could be discharged. with advice to review.\r\n\\par }\r\n\n\nDiet: nan\n\nRemarks: nan'}] |
882 | [{'role': 'user', 'content': '\nIP Number: 882\n\nPatient Number: 2247\n\nPatient Name: FATHIMA.M\n\nGender: F\n\nDate of Birth: 09-07-1956\n\nAddress: MAVADIKAGOTH HOUSE,MINICOY.P.O\n\nPincode: 682559.0\n\nPhNo: 9496120120\n\nAdmission Date: 15-12-2012\n\nDischarge Date: 31-12-2012\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC NEPHROPATHY WITH MICROALBUMINUREA\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: Admitted for SSG on 18th Dec. \n\nXray information: nan\n\nClinical examination: Local Examination :Clean raw area rt foot.\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: pt doing better,slept wel yesterday night\r\nFBS-94,vitals stable\r\nplan to do SSG on tuesday\r\ncontinue the same\nSeen by DRA.K.BHat.\r\nPosted for SSG&K wire rt foot under SA on tuesday 18thdec.\r\nPreoperative Instructions:\r\nDaily OXUM dressing.Betadine scrub of leg and thigh tomorrow.Leg elevation.Consent.One pint packed cells to be arranged.Inj.Monoscot 1gm IV bd.\r\nMedical &Anesthetic fitness for the procedure.\ns/b dr.tom\r\nAC-103\r\nplanning for skin graft tomorrow.\nseen by duty doctor\r\npt condition good, no c/o pain , vitals stable\nS/B DR.TOM\r\nSSG done yday\r\nac-119\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\n\r\ns/b dr.tom\r\nstools passed after giving suppository\r\n\nseen by duty doctor\r\nvitals stable,nil special\r\ncontinue same\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\nSEEN BY DUTY DOCTOR\r\nNO FRESH COMPLAINTS VITALS STABLE\ns/b dr.tom/team\r\npatient is stable\r\nto start ihj.heparin s/c (DVT)prophylaxis\r\nrest all to continue\nSeen by DRA.K.Bhat.\r\nDressings changed.SSG taken up.\r\nContinue trt.Suggested oral antibiotics-Xpand.Change of dressing on 25TH december.\nbetter\r\ncontine same\ns/b Dr Radha\r\npt doing wel,no fresh complaints.dressing on 26th\r\ncontinue the same\nDoing fine. Slept well. Appetite normal. Passed stools\r\nLabs\r\nAC- 93 mg/dl\r\nPre Dinner - 124 mg/dl\r\nCase Plan\r\nCBC, RFT - tomorrow\r\nDressing Graft site and donor site on 26-12-12\r\nFriday Discharge after Dr. Bhatts return\ns/b duty doctor\r\nc/o fever\r\nfebrile T-100.2 F\r\nRS:chest clear\r\nadv:Tab welset 500mg 1 st\nfeels well. GRBS- 93\r\nDressing change today.\r\nlabs- normal\r\ncontinue the same\nS/B DR.TOM\r\ndoing fine\r\n\ncase seen by duty doctor\r\npatient consious ,oriented\r\nafebrile\r\ncontinue same\ndoing fine\r\nno specific complaints\nSeen by DrA.K.Bhat.\r\nDressings changed.SSG taken up.Thigh healing well.\r\nContinue trt.\r\nseen by duty doctor \r\npt gc same no fresh complaints, vitals stable\nplan for d/c today\nS/B Dr.Tom\r\nnil complaints \r\nFBS:87 mg%\r\ncase plan: Inj. insugen-N 8 units HS\r\ncont rest\nSeen by DRAK.BHAT.\r\nContinue trt.\ndoing fine\r\nno complaints\r\ncont same\nSeen by DRA.K.Bhat.\r\nC&D done.SSG Clean.Adviced:Change of dressing once in 2 days-betadine oint,jelonet,pad to foot.Oil application to thigh for 1 month.Review 10 days-wednesday9th jan.'}, {'role': 'model', 'content': '\nIP Number: 882\n\nPatient Number: 2247\n\nAdmission Date: 15-12-2012\n\nDischarge Date: 31-12-2012\n\nDiagnosis: admitted for 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 Admitted for SSG on 18th Dec. \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 Local Examination :Clean raw area 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 56 yr old with H/o DM admitted for skin gratfting to the RT foot, Ot was strted on I.V antibioitcs, insulin basal bolus regimen for tight glycemic control. seen by surgeon, SSG to the RT foot along with K- wiring of the 3 rd toe RT foot was done. regular dressings done. Pt discharged under stable condition\r\n\\par }\r\n\n\nDiet: nan\n\nRemarks: nan'}] |
1,090 | [{'role': 'user', 'content': '\nIP Number: 1090\n\nPatient Number: 10229\n\nPatient Name: SARASWATHY\n\nGender: F\n\nDate of Birth: 16-03-1948\n\nAddress: PALAMATTOM HOUSE\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 16-03-2013\n\nDischarge Date: 02-04-2013\n\nDiagnosis determined by the doctor when the patient was admitted: Peripheral vascular disease, unspecified\nDIABETIC NEPHROPATHY WITH MICROALBUMINUREA\nDIABETIC PERIPHERAL NEUROPATHY\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: A known diabetic of long duration, presented to us with non healing ulcer on the Lt foot. Initially taken to Medical Mission Hosp. and MCH Kottayam, where last two toes were amputated. \n\nXray information: ECG (17/03/13) - Normal axis, Sinus tachy(115), ST depression II, III, aVF, V4-V6. \r\nVibro (16/03/13) - B/L severe loss of vibratory perception. \r\nVersa (16/03/13) - B/L moderate arterial ds. \r\nPus C/S (18/03/13) - Heavy growth of Pseudomonas sensitive to Quinolones and cephalosporins. \r\nArterial Color doppler Lt lower Limb (18/03/13) - Normal arterial blood flow in the Lt femoral artery. Moderate decrease in flow in popliteal and anterior tibial arteries as well as in Lt posterior tibial, peroneal and dorsalis pedis arteries(50-70% stenosis). \n\nClinical examination: Temperature :96.8 °F\r\nRespiration :22\r\nBP :160 / 80\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: s/b duty doctor\r\nno specific complaints\n10.30 AM\r\ns/b Dr Biju\r\npatient does not have any complaints\r\ninsulin dose altered\r\nrepeat ECG.\r\nSeen by DR.A.K.Bhat.\r\nIschemic ulcer lt foot following 4th and 5th toe amputations.No e/o granulation.Dorsalis and Post.tib. not felt.Arterial Doppler.Intrasite and betadine daily dressing.Continue trt.\n7.30pm\r\ns/b Dr Jaya\r\npatient is doing well\r\nno complaints\nAC - 123mg%. Arterial doppler Lt - poor flow. \r\nT. Amitone 1/2 0-0-1. T. Cynocal M Forte.\nSeen by DR.A.K.Bhat.\r\nArterial doppler-50-70% stenosis in ATA,PTA And dorsalis.\r\nDiscussed the possibilities of operation like BKA,MIdfoot amputation etc. with the daughter.\n8PM\r\nseen by Dr Jaya\r\nno complaints\r\n\r\n\nDoing well. AC - 122mg%. \r\nGiven consent for mid foot amputation. \r\nScheduled for mid foot amputation tomorrow under SA. \r\n\r\nInformed Consent:\r\nThere is infective ulcerative gangrene of Left foot at the site of previous amputation. There is also decreased circulation of the leg. Infection may be deep involving bone and joint also.There is diabetes and neuropathy.This infection requires mid foot amputation under Anesthesia. During surgery, depending on the findings,extending pus of leg will also be drained by a fasciotomy.After the operation,healing will need observation.Depending on healing further operations (higher amputations) may be needed.Due to diabetes and decreased blood circulation ,wound healing may be delayed.The importance of offloading of the foot during recovery has been explained.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.\nSeen by DRA.K.Bhat.\r\nPreop:C&D.Informed consent.IV antibiotics.Nil oral.Medical fitness.\nMid foot amputation done yday. \r\nPost op uneventful. BP - 150/80.\r\nS. Elect. Hb - 9.3%. have not slept well yday night. \r\nT. Zargo 25mg 1-0-0.\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\n8pm\r\nseen by Dr Jaya\r\nhas mild leg pain\r\n\nAC - 133mg%. GC - stable. \r\ndressing change today. continue same.\nSeen by DRA.K.BHat.\r\nDressings changed.The wound edges look viable.Continue trt.Suggested oral ciproflox.\r\n7.45pm\r\ns/b Dr Jaya\r\nno complaints\r\nvitals stable\nGC - better, Urine output. \r\nRFT, TC. I/O chart. S. Elect. Shift to oral abx.\ns/b dr.manoj\r\nc/o pain\r\nslept well\r\nFBS-85,K-2.9\r\nINS.INSUGEN r 8--8--8\r\nINS.Insugen N 8 units at bed time\r\nto continue rest.\r\nSeen by DRA.K.Bhat.\r\nDRessings changed.Clean.\r\nREmove foleys tomorrow.\n6.50 pm\r\ns/b Dr Jaya\r\nno leg pain\r\nno complaints\r\nvitals stable\nSlep t well. AC - 82mg%. \r\nInsulin doses adjusted. physio consult. \r\nDRise sachet. S. Elect tomorrow.\nAC - 97mg%. Insulin doses adjusted. \r\nInj Insugen R 4-4-4 units, Insugen N 6 units.\r\nSeen by DRA.K.Bhat.\r\nDRessings changed.Suture line and wound edges viable and clean.Continue trt.\r\n\r\nT. Platloc A. Repeat Hb tomorrow.\nGC - better. Will d/c after 2 more dressings. \r\nHb - 7.6gm%. To transfuse 1 PRC. \r\ncontinue same.\nSeen by DRA.K.Bhat.\r\nPt has wet the dressing.C&D done.Clean.Continue trt.\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n7.45 pm\r\nS/B Dr Jaya\r\npatient is comfortable\r\nno complaints\r\nvitals stable\nGC - stable. Afebrile. \r\nHad an episode of vomiting today morning. \r\nContinue same. \r\nAC ~80mg%. Insugen R 4-4-4, Insugen N 4. \r\nPlan to d/c on monday after 2 more dressings.\nSeen by DRA.K.Bhat.\r\nC&d done.Clean.Plan for discharge on Monday.\r\n\nAC - 135mg%. Hb - 9.7gm%(28/03). \r\nCreat - 0.9mg%.\nSeen by DR..A.K.BHat.\r\nContinue trt.\r\n7.20Pm\r\nS/b Dr Jaya\r\npatient does not have any complaints\r\nvitals stable\n7.15pm\r\nS/B Dr Jaya\r\npatient has no complaints\r\nvitals stable\ns/B Dr radha \r\nnil special\r\ncont same Tt\nAC - 112mg%. \r\nGC - better. Rpt Hb on review. \r\ncontinue same.\nSeen by DRA.K.BHat.\r\nAdviced:Dressings once in 2 days with betadine oint. and cuticell and pads,.Oxcip for 500mg bd for 15 days.REview 2 weeks.No weight bearing on operated foot.\r\n7.15PM\r\nS/B Dr Jaya\r\npatient is better\r\nno complaints'}, {'role': 'model', 'content': "\nIP Number: 1090\n\nPatient Number: 10229\n\nAdmission Date: 16-03-2013\n\nDischarge Date: 02-04-2013\n\nDiagnosis: S/p Mid foot Amputation Lt.\n\nClinical Exam(With BP): {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 A known diabetic of long duration, presented to us with non healing ulcer on the Lt foot. Initially taken to Medical Mission Hosp. and MCH Kottayam, where last two toes were amputated. \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 ECG (17/03/13) - Normal axis, Sinus tachy(115), ST depression II, III, aVF, V4-V6. \r\n\\par Vibro (16/03/13) - B/L severe loss of vibratory perception. \r\n\\par Versa (16/03/13) - B/L moderate arterial ds. \r\n\\par Pus C/S (18/03/13) - Heavy growth of Pseudomonas sensitive to Quinolones and cephalosporins. \r\n\\par Arterial Color doppler Lt lower Limb (18/03/13) - Normal arterial blood flow in the Lt femoral artery. Moderate decrease in flow in popliteal and anterior tibial arteries as well as in Lt posterior tibial, peroneal and dorsalis pedis arteries(50-70% stenosis). \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 \\'b0F\r\n\\par Respiration :22\r\n\\par BP :160 / 80\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, Mrs. Saraswathy, a known diabetic presented to us with a non healing ulcer of the Lt foot. Preliminary investigations revealed low Hb and 50-70% stenosed arteries in the Rt lower limb. The various options and their prognostic values were discussed with the relatives. She was taken up for mid foot amputation under SA on 20th March with strict aseptic precautions. She was put on basal bolus insulins for better glycemic control and insulin doses were titrated according to BSL. The post op was uneventful. She was transfused 1 PRC each preop and postop. 1 more PRC was adviced but the pt party was not willing. She is symptomatically much better, the wound is healing well and her blood sugars are under control. Hence discharged in a stable condition and adviced to review as outpt. \r\n\\par }\r\n\n\nDiet: nan\n\nRemarks: nan"}] |
1,304 | [{'role': 'user', 'content': '\nIP Number: 1304\n\nPatient Number: 8416\n\nPatient Name: JEROM PETER \n\nGender: M\n\nDate of Birth: 30-09-1952\n\nAddress: PUTHENVEETTIL HOUSE\n\nPincode: 680665.0\n\nPhNo: nan\n\nAdmission Date: 15-05-2013\n\nDischarge Date: 12-06-2013\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC FOOT\nEssential (primary) hypertension\nChronic ischaemic heart disease\nTYPE 2 DIABETES MELLITUS\nMixed hyperlipidaemia\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: A known diabetic, presented to our OPD with pain and swelling Rt big toe 5 days.\n\nXray information: Arterial Doppler Rt leg (18/05/13) - Normal/mildly dampened arterial blood flow in the Rt femoral, popliteal arteries. Poor flow with dampening of flow in Rt posterior tibial, anterior tibial and dorsalis pedis arteries.\r\nPus C/S (20/05/13) - Heavy growth of Ecoli most sensitive to Biopiper and Cefperazone.\r\nECHO (06/06/13) - Dialated LA & LV, Global Hypokinesia, Impaired LV function, Moderate MR.\n\nClinical examination: Temperature :97.2 °F\r\nRespiration :22\r\nBP :140 / 80\r\nWeight :73.5\r\nHeight :161.5\r\nLocal Examination :Infective gangrene rt big toe.Cellulitis foot.\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: 8.25pm\r\nseen by Dr Jaya\r\n2 episodes of vomiting\r\ninj emeset given\r\n\nSeen by DRA.K.Bhat.\r\nGangrenous rt big toe.Continue trt.\r\n7.30 pm\r\nseen by Dr Jaya\r\nno comlaints\r\npatient is doing well\r\nvitals stable\nAC - 103mg%. Had breakfast. \r\nHad a spike of fever in the morning. \r\nWill discuss with Dr Bhat regarding further course of action.\nSeen bY DR.A.K.Bhat.\r\nInfective gangrene rt big toe extending to foot dorsum.Cellulitis present extending to foot.?Ischemia.\r\nAdviced:Arterial Doppler.IV antibiotics.Plan for rt big toe amputation under SA on 18th may afternoon.Informed consent.Medical fitness.C&D,.Nil oral as per anesthetist advice.\nAC - 146mg%. \r\n\ns/b duty doctor\r\nfoleys catheter (14fr)inserted under aseptic precautions, clear urine collected in the urobag\nDoing well. AC - 110mg%. \r\nGC - better. c/o pain. \r\nhad a spike of fever.\r\nContinue same.\nSeen by DRA.K.Bhat,.\r\nNo soakage.Continue trt,.\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\n\r\nSeen by Duty Doctor\r\npatient stable.nil complaints.\r\n\r\n9:10pm-c/o pain \r\nInj Pactive stat\ns/b dr.tom\r\nac-85\r\nins.insugen r 10-10-10\r\ninsugen n 10\r\n\nAC - 116mg%. GC - better. \r\nContinue same. Rpt TC tomorrow.\r\nS/BDr.AK.Bhat.\r\nC&D done.Dorsum foot raw area pale.RAW area viability needs further observation.Continue trt.Suggested Clopilet+Aspirin.\nAC - 99mg%.\r\ndone dressing yday\r\nc/o pain\r\nHb-8.9\r\nplan to transfusse 1 unit PRC today\r\nPatloc AS 0-1-0\nSeen by DrA.K.BHat.\r\nContinue trt.\nAC - 96mg%. Doing well. \r\nChange to oral abx. C. Clindamycin 600mg 1-1-1. \r\nT. Nitrest 5mg 0-0-1. \r\nOphthal consult tomorrow.\nSeen by DR.A.K.BHat.\r\nDressings changed.Rt foot raw area is pale and looks ischemic.NO granulation tissue response seen.No proximal extension of infection.?PLAN.Continue trt. Suggested culture specific antibiotics.\r\n7.30 pm\r\nseen by Dr Jaya\r\ncomplaints of minimal leg pain\r\nvitals stable\r\nadvised tab ultracet\nAC - 98mg%. Opthal consult was due yday at Krishna Hosp by Dr Varma.\r\nRpt TC today. \r\nWIll discuss with Dr Bhat.\nSeen by DRA.K.Bhat.\r\nC&D done.Raw area rt foot showes poor e/o granulation response-needs further observation.Metrogyl and intrasite dressings done.Continue trt.\nAC - 96mg%. TC - 11,600. Insulins doses adjusted.\r\nInsugen R 8-8-8, Insugen N 8 units at bed time s/c.\r\nStarted on Inj Hepaviz 5000 units s/c bd. \r\nBT/CT today. Start X tor and Pletoz.\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\ns/b dr anish\r\npt complains of retching,\r\nadv - tab pantoprazole +domperidone stat\n7.30pm\r\ns/b Dr Jaya\r\nhad an episode of vomiting in the afternoon.\r\ninj emeset 4mg iv given\r\nvitals stable\nSeen by DRA.K.Bhat.\r\nC&D.Same findings.\r\n11 am\r\nseen by Dr Tom/Dr Jaya\r\nwound is healing well\r\nhas rashes over chest\r\npatient is better\r\ncontibnue same treatment\r\n\nSeen by DRA.K.Bhat.\r\nC&D done.Same fidings of ischemic raw area with poor granulation response.?Plan.\nURE, CBC. \r\nhad a spike of fever today morning. \r\nContinue t/t.\n8 pm\r\nseen by Dr Jaya\r\nc/o nausea\r\nfeeling feverish\r\nantibiotics on flow\r\nvitals stable\nWill discuss with Dr Bhat regarding further course of action. \r\nRpt URE and Creat.\r\nS/B Dr Bhat.\r\nC&D done.\nSeen by DR.A.K.Bhat.\r\nContinue trt.\r\n7.45 pm\r\nS/b Dr Jaya\r\nno complaints\r\nvitals stable\r\n\ns/b dr.tom/co\r\nto transfuse 1 unit PRC \r\n\nSeen by duty doctor\r\nTemp-101 F\r\nTab Dolo 500mg stat given\nWound - status quo. No e/o granulation. \r\nHold Platloc.\nSeen by Dr.A.K.BHat.\r\nLarge raw area shows no e/o granulation.Plan for debridement and proceed under SA 1-6-2013.\r\nPreop:Informed consent.Nil oral.Consent.C&D.IV antibiotics.\r\n========================\r\nInformed consent.\r\nThere is a large raw area of right foot following bigtoe amputation and debridement done 2 weeks earlier.This raw area is showing poor evidence of healing,with areas of slough and dead tissues.This also involves the bones of the foot.There is diabetes and neuropathy.There is reduced circulation of leg .During surgery, depending on the findings,the exact level of amputation will be decided.This may be limited to middle or proximal foot level or if no healthy tissues are seen at foot level then a below knee amputation may have to be done.After the operation,due to diabetes and decreased circulation,wound healing will be delayed.The overall recovery and function of the operated leg will need close observation.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.\nStop Biopiper & Dalacin. \r\nPus C/S - Heavy growth of Ecoli sensitive to Biopiper and Lactagard. \r\nStart Inj Lactagard 1/2 dose.\nSceduled for Mid foot today afternoon. \r\nPhysician fitness given.\nseen by dr anish\r\npt was shifted at 730 to the ward, 815 pt complained of breathlesness, \r\nchest- b/l scattered ronchi left and right lower zones\r\nsp02 89,\r\nnebulisation with combimist given, oxygen thru o2 mask\r\nspo2 came up to 95\r\nadv :t deriphyllin retard stat\n10 AM\r\nseen by Dr Lakshmi/Dr Jaya\r\nmid foot amputation done yesterday,had respiratory distress at night\r\nsaturation dropped which improved with oxygen\r\nno breathing difficulty at present,not on oxygen now\r\nchest-clear\r\nspo2-94\r\nc/o nausea\r\ninj pantocid and inj emeset given\r\n\nSeen by DR.A.K.Bhat.\r\nC&D done.No active bleeding.Plantar flap viable.Continue trt.Rpt Hb tmrw.\r\n7.30 pm \r\ns/b Dr Jaya\r\nno complaints\r\npatient is doing well\r\nvitals stable\nHb-9.3%\r\n\r\nHad breathing difficulty on the day of operation\r\n\r\nI/O chart\r\nRFT/ELECTROLYTES\r\nECG\r\nHb-Daily\nSeen by Dr.A.K.Bhat.\r\nC&D done.Clean.Plantar flap looks viable.Continue trt.Restart heparin Lowmolecular weight.\r\n7.15 PM\r\nseen by Dr Jaya\r\nno complaints\r\npatient is doing well\r\nblood sugar and vitals normal\nAC - 94mg%. Continue same. \r\nRestarted on dynalix yday.\nSeen by DRA.K.Bhat.\r\nDressings changed.Clean raw area.Continue trt.\r\n7.20 pm\r\nseen by Dr Jaya\r\nno complaints\r\nblood sugar levels normal\r\nvitals stable\ns/b dr.tom/co\r\none episode of vomiting\r\n\nAC - 114mg%. T. Domstal 10mg 1-1-1. \r\nECHO today. Continue t/t.\nSeen by DRA.K.Bhat.\r\nDressings changed.Raw area clean and granulating.Oral Dalacin 300mg tds.Continue trt.\r\n\r\n8pm\r\nc/o breathing difficulty\r\nSPO2 88%room air\r\nadviced o2 4l/min with nebulisation wth budecort and combimist\r\n\nDoing well. Dressing change today. \r\n\nSeen by DrA.K.Bhat.\r\nC&D done.Clean ulcer,granulating..\r\nmild dyspnoe+\r\nchest -occ wheeze+\r\nInj.Lasix 20mg i/v stat\r\ncombimist nebulisation TDS\nAC - 170mg%. Slept well. Dyspnea better. \r\nInj Insugen R 6-6-6, Inj Insugen N 6 units at bed time s/c.\r\nSpO2 - 89mg%.\r\nInj Levo 500mg 1-0-0. Inj Lasix 40mg 1-0-1.\r\nChest - RLZ to MZ - crepts.\nSeen by DR.A.K.Bhat.\r\nDRessings changed.Clean.Continue trt.\ns/b Dr Radha\r\npt comfortable\r\nnot dyspneic chest near clear\r\nC/o Decreased sleep\r\nTab. Librium 10mg 0-0-1\r\ncont rest including Heparin\r\ncatheter removed\nAC - 134mg%. Chest - clear. Had an episode of vomiting today morning. GC - better. \r\nContinue t/t.\r\nPlan for d/c on wed.\nSeen by DrA.K.Bhat.\r\nDRessings changed.Clean.\r\n7.45 pm\r\nseen by Dr Jaya\r\npatient is feeling better\r\nno complaints\r\nvitals stable\nAC - 113mg%, GC - better. \r\nPlan to d/c tomorrow. \r\nOn oral abx and basal bolus insulin regimen. \r\n\r\n'}, {'role': 'model', 'content': "\nIP Number: 1304\n\nPatient Number: 8416\n\nAdmission Date: 15-05-2013\n\nDischarge Date: 12-06-2013\n\nDiagnosis: post op (le)for cat sx\n\nClinical Exam(With BP): {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 A known diabetic, presented to our OPD with pain and swelling Rt big toe 5 days.\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 Arterial Doppler Rt leg (18/05/13) - Normal/mildly dampened arterial blood flow in the Rt femoral, popliteal arteries. Poor flow with dampening of flow in Rt posterior tibial, anterior tibial and dorsalis pedis arteries.\r\n\\par Pus C/S (20/05/13) - Heavy growth of Ecoli most sensitive to Biopiper and Cefperazone.\r\n\\par ECHO (06/06/13) - Dialated LA & LV, Global Hypokinesia, Impaired LV function, Moderate MR.\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 \\'b0F\r\n\\par Respiration :22\r\n\\par BP :140 / 80\r\n\\par Weight :73.5\r\n\\par Height :161.5\r\n\\par Local Examination :Infective gangrene rt big toe.Cellulitis 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 60 yr old, Mr. Jerom, a known diabetic, presented to us with gangrene of the Rt big toe with fever and uncontrolled blood sugars. He was seen by our poditric surgeon and started on IV abx and the gangrenous toe was amputated along with necrotic tissue. He continued to be febrile and the wound showed signs of ascending infection. He was taken up for a mid foot amputation after consent from relatives. The post op was uneventful. Meanwhile, he was put on basal bolus insulins and doses were titrated according to ambient blood sugars to acheive euglycemia. An ECHO was done as edema was noticed in the peripheries. ECHO revealed impaired LV function and global hypokinesia. A cardio consult was taken and adequate duretics was adviced. He is symptomatically much better and the wound is healing well and the blood sugars are under control. Hence discharged in a stable condition and adviced to review as outpt.\r\n\\par }\r\n\n\nDiet: nan\n\nRemarks: nan"}] |
1,345 | [{'role': 'user', 'content': "\nIP Number: 1345\n\nPatient Number: 8140\n\nPatient Name: THOMAS T.T\n\nGender: M\n\nDate of Birth: 05-11-1937\n\nAddress: THUDIYAM PLACKAL H, IRATTAYAR P O\n\nPincode: 685603.0\n\nPhNo: 04868 276136\n\nAdmission Date: 25-05-2013\n\nDischarge Date: 08-06-2013\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nPeripheral vascular disease, unspecified\nEssential (primary) hypertension\nChronic ischaemic heart disease\nDIABETIC PERIPHERAL NEUROPATHY\nDIABETIC NEPHROPATHY WITH CRONIC RENAL FAILURE\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: Pt presented with fever, lethargy and non healing ulcer Rt leg. \n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by DRA.K.Bhat.\r\nDry gangrene extends to big toe.Rt 3rd toe tip infection.Betadine dressings.Continue trt.Inj.Dynalix 0.4 SC od.\n7.30 pm\r\ns/b Dr Jaya\r\nno complaints\r\nvitals stable\nSeen by DRA.K.Bhat.\r\nContinue trt.Plan for right midfoot amputation under SA on tuesday 28th may.Medical fitness for the procedure.\r\n11 am\r\nseen by Dr Tom/Dr Jaya\r\ngeneral condition good\r\n1 episode of hypoglycemia last night\r\npre lunch blood glucose to be checked\r\ninsugen R adjusted to 6-6-6\r\ninsugen N 8 U\r\nc/o cough\r\nchest- clear\r\nantibiotics on flow\r\ngive steam inhalation\r\ncan be posted for surgery on tuesday\r\n\nAC - 142mg%. Chest X Ray today. Routine preop investigations. \r\nCardio fitness tomorrow.\r\n\nSeen by DRA.K.Bhat.\r\nPosted for right midfoot amputation under SA 28th may 12 noon.\r\nPreop:Informed consent.Nil oral.C&D.Arrange one pint packed cells.IV antibiotics.\r\n===========================\r\nInformed consent for operation:\r\nThere is infective gangrene of right foot with gangrene of big toe and gangrenous nonhealing ulcer after previous amputation of toes and pus extending to foot.There is diabetes and neuropathy.There is reduced circulation of leg as seen in Arterial Doppler report.This requires amputation of the foot at middle level.During surgery, depending on the findings,extending pus of foot will also be drained.After the operation,depending on healing further operations may be be needed.Due to diabetes and decreased circulation and renal dysfunction wound healing will be delayed.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=================================\n8 pm\r\nseen by Dr Jaya\r\nno complaints\r\nvitals stable\nScheduled for Rt mid foot amputation today afternoon. \r\nBP - 150/70. Physician fitness to be given. \r\nCardiac fitness. AC - 160mg%\r\nT. Nebilong 2.5mg 1-0-0.\nSeen by DR.A.K.Bhat.\r\nC&D done.Stump edges look viable.Continue trt.\r\n7.45 pm\r\nS/b Dr Jaya\r\nno complaints\r\nvitals stable\r\n\npost op day 1\r\n\r\ntramadol was given yday night fror pain\r\noutput-1450/550\r\nHb-11.3\r\n\r\nto do electrolytes/\nSeen by dutydoctor\r\nPatient stable\r\nnil spl\ns/b dr.tom/co\r\n\r\npost-op day 2\r\nafebrile yday\r\nAC-106mg/dl\r\nNa-135\r\nK+-4.5\r\n\r\nto do TC/chest physio\r\ninsulin to continue-same dose\r\n\nS/b Dr tom & team. \r\nAC - 170mg%.\r\nInj Insugen R 12-12-12, Insugen N 12 units at bed time s/c.\r\nSigns of dehydration. \r\nRpt TC, S. Elect, RFT. IVF DNS with 6 units buffered Insugen R and 1 amp polybion. \r\nRyle's tube if not improving with IV fluids.\nSeen by DRA.K.Bhat.\r\nC&D done.Continue trt.\nAC - 299mg%. GC - status quo.\r\nAfebrile. Combimist nebs. 1-1-1.\r\nChange positions every 1 hr. \r\nTC - 18900, Creat - 2.6mg%\n10 AM\r\nseen by Dr Lakshmi/Dr Jaya\r\npatient is better\r\nopening eyes and talking\r\non feeding tube\r\nblood sugars normal\r\nto check TC,electrolytes tomorrow\r\ncontinue same treatment\r\n\nSeen by DR.A.K.Bhat.\r\nC&D done.No e/o healing of foot stump. Continue trt.\r\n7.30 pm \r\ns/b Dr Jaya\r\nno complaints\r\npatient is doing well\r\nvitals stable\nSeen by Dr.A.K.Bhat.\r\nPlan for ?BKA.\r\n7.15 PM\r\nseen by Dr Jaya\r\nno complaints\r\npatient is doing well\r\nblood sugar and vitals normal\nc/o cough\r\nurea-100/creat-3.0\r\n\r\no/e\r\nconscious,not fully poriented\r\ni/o-2800/1250\r\nchest-b/l scattered creps\r\n\r\nadv-chest physio to be given\r\nRT feed to cont-100ml/hr\r\n\nGC - status quo. Inj Dynalix 0.4ml s/c OD. \r\nRpt CBC, RFT, S. Elect tomorrow. \r\nWill discuss with Dr Bhat regarding further course of action,\nSeen by DRA.K.Bhat.\r\nDressings changed.Ischemic raw stumo of left foot.Left heel pressure sore.Continue trt.\r\n7.20 pm\r\nseen by Dr Jaya\r\nno complaints\r\nblood sugar levels normal\r\nvitals stable\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\n\r\nS/B Dr Sooraj\r\n\r\nGC fair\r\ncontinue same\ns/b dr.tom/co\r\npatients general condition remains the same\r\nconscious not oriented\r\nadv\r\ncont same\nAlert, conscious. AC - 132mg%. \r\nDressing change today.\r\nContinue t/t.\nSeen by DRA.K.Bhat.\r\nRt foot dressings changed.No e/o healing.?Plan.Continue trt.\nAC - 128mg%. Pt disorientated. \r\nMucomist Nebs. \r\n\nSeen by DrA.K.Bhat.\r\nchange the RT\r\nTry 50ml of RT feed ,if tolerating dav 50ml /2 hrly\r\nMucomist neb and suction well\r\n\r\nseen by dr anish, \r\npt resting, b/l creps and inspiratory ronchi +\r\npt condition expalined to bystander, \r\n\r\n9:45pm - pt bystander wants to refer the patient top a higher center , refernce letter given, pt taken to lourde hospital"}, {'role': 'model', 'content': '\nIP Number: 1345\n\nPatient Number: 8140\n\nAdmission Date: 25-05-2013\n\nDischarge Date: 08-06-2013\n\nDiagnosis: Hypothyroidism\r\nCVA -Multinfarct state- left hemiparesis\r\nDiabetic Foot with infection. s/p Mid Foot Amputation.\n\nClinical Exam(With BP): {\\rtf1\\ansi\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Pt presented with fever, lethargy and non healing ulcer Rt leg. \r\n\\par }\r\n\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: nan\n\nDiscussion: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 75 yr old elderly, Mr Thomas, a known diabetic, presented with fever and non healing ulcer on the Rt foot. He was seen by our surgeon and adviced BKA owing to the poor and dampened blood supply below the knee. But since the relatives were not willing, mid foot amputation was done and gaurded prognosis was explained to the bystanders. He was put on culture specific IV abx and he was put on basal bolus insulins for better glycemic control. However, his condition deteriorated and Ryles tube feeding was started. Though he showed marginal improvement, his general condition remained status quo. The wound was cleaned and dressed on alternate days and it shows no signs of ascending infection. He is currently referred to another hospital at the request of the bystanders due to financial constraints.\r\n\\par }\r\n\n\nDiet: nan\n\nRemarks: nan'}] |
1,499 | [{'role': 'user', 'content': "\nIP Number: 1499\n\nPatient Number: 11729\n\nPatient Name: ANNAMMA MATHEW\n\nGender: F\n\nDate of Birth: 25-06-1940\n\nAddress: CHANAYIL HOUSE, VADUTHALA P O\n\nPincode: 682023.0\n\nPhNo: 0484 2400725\n\nAdmission Date: 25-06-2013\n\nDischarge Date: 13-07-2013\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC NEPHROPATHY WITH CRONIC RENAL FAILURE\nEssential (primary) hypertension\nDIABETIC NEPHROPATHY\nPeripheral vascular disease, unspecified\nTYPE 2 DIABETES MELLITUS\nDIABETIC PERIPHERAL NEUROPATHY\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: Came with cellulitis rt foot with infected callosity on the plantar surface of rt foot.K/c T2DM on inj. mixtard.\n\nXray information: Vibro (25/06/13) - B/L Severe loss of vibratory perception. \r\nVersa (25/06/13) - Normal Lt arterial study with pressure difference of more than 30mmHg b/w post. tibial and dorsalis pedis. Moderate Rt arterial ds with pressure difference of more than 30mmHg b/w post. tibial and dorsalis pedis on both sides. Critically low toe pressure. \r\nECHO (27/06/13) - Normal chamber dimensions, No RWMA, Normal LV function, No valvar pathology. (EF - 54%).\r\nPus C/S (27/06/13) - Moderate growth of Klebsiella.\r\nCT Thorax (02/07/13) - Minimal linear plate atelectasis involving lingular segment of Lt upper lobe. No air space disease/consolidation/mass lesions. Enlarged Rt paratracheal Lymph nodes (2.3cms). \n\nClinical examination: Temperature :99.2 °F\r\nRespiration :22\r\nBP :140 / 90\r\n\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by DR.A.K.Bhat.\r\nPlantar Subcallus abscess right foot.Pus discharge-C/S taken.Cellulitis foot and leg,.Early blistering of dorsum of foot.Charcot's foot.Dorsalis pulsation not felt.Adviced:Betadine dresssings.IV antibiotics.Offloading of ulcer.Medical treatment.\r\n7.30 pm\r\nseen by Dr Jaya\r\npatient is doing well\r\nblood sugar levels controlled with insulin infusion\r\nvitals stable\r\n\nTo do CBC, RFT,LFT, TFT, ACR, GRBS, S.electrolytes\r\nDr Bhat consultation\r\nVersa/Vibro\nSeen by DRA.K.Bhat.\r\nFoul smelling pus from ulcer rt foot.Pus filled blisters around base of big toe and dorsum foot.Cellulitis foot&leg.ABI rt side 0.6.\r\nFor I&D Rt foot under SA 27th JUne 2PM.\r\nPreop:Informed consent.IV antibiotics.Nil oral.Medical fitness.C&D.Transfuse one pint Packed cells tomorrow and one for operation.\r\n==============\r\nInformed consent.\r\nThere is pus filled infection of right foot extending from previous ulcer of mid foot region.This pus infection is extending to the region of big toe all around it and its base,possibly upto bone and joint.There are multiple pus filled blisters in this region of foot and on dorsum of foot also.There is infection extending to foot and leg.There is diabetes and neuropathy and nephropathy and decreased circulation of leg.The infection of foot needs incision and drainage and slough excision under anesthesia.During operation the spreading infection will be opened up and dead and necrotic skin and soft tissues will be removed.In diabetes the initial wound will be small,but spreading infection will extend below the skin and hence after surgery the wound will be much larger than the present wound.Due to diabetes and decreased circulation,control of infection and healing will be delayed.Repeat surgery may be needed.Due to extent of infection the healing and circulatory condition of big toe will need observation.Due to Charcot's neuropathy and diabetes ,the importance of long term foot care and footwear and control of diabetes has been explained.Understanding the above consent for anesthesia and operation is given.\r\n=====================\r\n7.30 pm \r\nseen by Dr Jaya\r\nposted for I&D tomorrow\r\nno complaints\r\n\nperipheral smear\nposted for surgery today\r\none unit of blood transfused\r\ntachypnea at rest\r\ndehydration+\r\nSPO2-99\r\ncardio consult today\r\nECG-wnl\r\n1 pint DNS with 6 units of insulin-to start at 11 am\nAC - 122mg%. \r\nChest - clear. Continue t/t.\r\nRpt TC, Hb and Creat tomorrow.\n10:30 AM, \r\ns/b Dr Tom and Team. \r\nHad a hypo yday night at 1 AM. SpO2 - 98%\r\nCT Thorax after d/c. TC - 16000, Creat - 1.5mg%. \r\nAC - 269mg%. Inj Actrapid 18-18-18, Inj Lantus 20units. \r\nStop pansec, Start T. Axipan 40mg 1-0-0.\nSeen by DR.A.K.Bhat.\r\nDRessing changed.No pus.Swelling decreased.Plantar aspect big toe ray is unhealthy-needs observation.Suggested restart heparin.\r\nTab Ceftum 500mg 1-0-1 if no i/v line is there\nGC stable \r\nFBS 136mg%\r\nInj Actrapid 16-16-16\r\nInj.Lantus 16 units HS\r\nTab. Ceftum 500mg 1-0-1\nSeen by Duty Doctor\r\n6pm GRBS-179mg/dl\r\nNIL SPL\nSeen by DRA.K.Bhat.\r\nDressings changed.Granulation tissue plus.However the big toe plantar aspect tissues are black.Will need amputation-decide after next dressing.Continue trt.\r\n\r\nSeen by Duty Doctor\r\nBP-160/90\r\nGRBS-377mg/dl\r\nnil spl\r\nGC fine\nc/o\r\nbreathing difficulty\r\no/e\r\nb/l rhonchi +\r\nspO2-96%\r\nGRBS-140mg/dl\r\nBP-150/90\r\n\r\nAdv\r\nInj Deriphyllin 100mg iv stat\r\nInj Dexona 8mg iv stat\r\n\r\n10:20 AM\r\ns/b Dr Tom and team.\r\nRpt Chest X Ray. \r\nT. Lasix 20mg 1-0-0. \r\nCombimist and derinide nebs. \r\nContinue t/t. T. Aspirin 75mg 0-1-0. Rpt URE. \r\nT. Levostra 500mg 1-0-0.\n7.30 pm\r\nseen by Dr Jaya\r\nno complaints\r\nvitals stable\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\nTo send for HRCT Thorax today. \r\nAC - 210mg%. \r\nInj Actrapid 18-18-18, Inj Lantus 20 units at bed time s/c.\r\nTo inform Dr Bhat.\nAC - 84mg%, predinner - 139mg%. \r\nCreat - 1.3mg%, Na - 133mEq/L, K - 4.8mEq/L.\r\nCT Thorax shows enlarged paratracheal LN (2.3cm). \r\nInj Actrapid 18-18-16, Inj Lantus 18 units at bed time s/c.\r\nDressing change today by Dr Bhat. \r\n\nSeen by DRA.K.Bhat.\r\nDRessing changed.Plantar Big toe looks unhealthy-MTP joint is dessicated and Bones of big toe are bare..PLan for amputation of right big toe and slough excision under SA on saturday6th july.\r\n7.30 pm \r\nseen by Dr Jaya\r\npatient is doin well\r\nno complaints\r\nvitals stable\nAC - 162mg%, predinner - 145mg%. \r\nDressing change tomorrow. \r\nWill decide on further course of action after discussing with Dr AKB. \r\nSteam Inhalation 1-1-1.\nSeen by DR.A.K.Bhat.\r\nWithold heparin and aspirin.\r\nPlan for big toe amputation under SA on saturday.\r\n\r\nSeen By Duty Doctor\r\nC/O cough,afebrile\r\nR/S;Chest clear,Nvbs\r\n\r\nT.Levocet 10 mg hs\nSeen by DRA.K.Bhat.\r\nDressings changed.\r\nPosted for amputation rt big toe under SA 6TH JUly.12 NOON.\r\nPreop:Informed consent.Nil oral.IV Monoscot 1gm bd.C&D.\r\n\r\nAC - 136mg%. \r\nPlan for amputation Rt big toe tomorrow. Explained to the pt and bystanders. w/h Aspirin and heparin. \r\nECG. Rpt Hb.\nseen by dr anish\r\npt gc good, no complaints of pain nov\nposted for surgery today afternoon\nseen by dr anish\r\npt complains of pain, \r\nadv inj tramadol im\nSeen by DRA.K.Bhat.\r\nAfebrile.Pain.No soakage.Continue trt.\r\n11AM\r\nseen by Dr Jaya\r\nc/o minimal pain right leg\r\ncontinue same\nAC - 170mg%. predinner - 160mg%. \r\nRpt TC and Hb, Creat and S. Elect tomorrow. \r\nRestarted on Inj Hepaviz 5000 units s/c HS from yday.\nSeen by DRA.K.BHat.\r\nContinue trt.\r\n7.30 pm\r\nseen by Dr Jaya\r\nno complaints\r\ncontinue same\r\nCase s/b Dr Jijo\r\nc/o pain Rt > Lt knee\r\nO/e minimal effusion\r\nMJLT LJLT RPT +\r\nSYNOVIAL THICKENING\r\nIMP b/l OA Knee , Rt knee synovitis\r\nAdv\r\n tab thrize 1-1-1\r\ntab orcerin 50 mg 1-0-1\r\ntab ultracet 1-0-1\n10:20 AM.\r\ns/b Dr Tom and Team. \r\nAC - 160mg%. \r\nOrtho consult done yday. Continue t/t.\r\n1st dressing today.\r\nSeen by DrA.K.Bhat.\r\nDressings changed.Clean.Stop IV antibiotics.Start oral Ceftum.Ultracet SOS.Plan fr discharge after second dressing on saturday.\n7.30PM\r\nSeen by Dr Jaya\r\nno complaints\r\npatient is doing well\r\nvitals stable\r\ncontinue same treatment\n10:30 AM. \r\ns/b Dr Tom and team. \r\nAC - 175mg%, predinner - 354mg%. \r\nPlan to d/c after 2 more dressings. \r\nContinue t/t.\nSeen by DR.A.K.Bhat.\r\nContinue trt.\r\n\r\nSeen by Duty doctor\r\nnil spl\r\nGC good\r\nVitals stable\n10:40 AM. \r\ns/b Dr Tom and team. \r\nAC - 144mg%. c/o itching after applying cetaphil. \r\nVaseline + lycor for L/A.\r\nInj Avil 1 amp IV Stat. \r\nPlan to d/c on saturday.\r\n\nSeen by DRA.K.Bhat.\r\nC&D done.Clean.\n10:20 AM. \r\ns/b Dr Tom and team. \r\nAC - 138mg%. T. Calcheck 5mg 1-0-0. \r\nPlan to d/c tomorrow.\nSeen by DRA.K.Bhat.\r\nPlan to d/c tomorrow.\n10:20 AM. \r\ns/b Dr Tom and team. \r\nGC - better. Afebrile. \r\nPlan to d/c today. T. Atarax 10mg 0-0-1. \r\nTo come for dressings after 1 week.\nSeen by DR.A.K.Bhat.\r\nDRessing changed.Clean.\r\nAdviced:Dressing once in 2 days cuticell,oxum gauze.Review 2weeks."}, {'role': 'model', 'content': "\nIP Number: 1499\n\nPatient Number: 11729\n\nAdmission Date: 25-06-2013\n\nDischarge Date: 13-07-2013\n\nDiagnosis: Cellulitis Rt foot-following infected callosity base of Rt foot\r\n? Charcots foot\r\ns/p Amputation of the big toe.\n\nClinical Exam(With BP): {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Came with cellulitis rt foot with infected callosity on the plantar surface of rt foot.K/c T2DM on inj. mixtard.\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 (25/06/13) - B/L Severe loss of vibratory perception. \r\n\\par Versa (25/06/13) - Normal Lt arterial study with pressure difference of more than 30mmHg b/w post. tibial and dorsalis pedis. Moderate Rt arterial ds with pressure difference of more than 30mmHg b/w post. tibial and dorsalis pedis on both sides. Critically low toe pressure. \r\n\\par ECHO (27/06/13) - Normal chamber dimensions, No RWMA, Normal LV function, No valvar pathology. (EF - 54%).\r\n\\par Pus C/S (27/06/13) - Moderate growth of Klebsiella.\r\n\\par CT Thorax (02/07/13) - Minimal linear plate atelectasis involving lingular segment of Lt upper lobe. No air space disease/consolidation/mass lesions. Enlarged Rt paratracheal Lymph nodes (2.3cms). \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 :99.2 \\'b0F\r\n\\par Respiration :22\r\n\\par BP :140 / 90\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 73 yr old, Mrs. Annamma, a known diabetic presented to us with an infected callosity on the Rt foot big toe with surrounding cellulitis. She was seen by our podiatric surgeon and started on IV abx and wound debridement was done. She was also shifted to basal bolus insulin for better glycemic control. She was given alternate day dressings and was reassessed by our surgeon. Since she only showed marginal improvement, big toe amputation was advised. She was taken up for the procedure on 06th July 2013 with strict aseptic precautions. The post op was uneventful. The wound is healing well and her blood sugars are under control. Hence discharged in a stable condition and advised to review as outpt.\r\n\\par }\r\n\n\nDiet: nan\n\nRemarks: nan"}] |
1,616 | [{'role': 'user', 'content': '\nIP Number: 1616\n\nPatient Number: 12166\n\nPatient Name: ABDU SAMAD\n\nGender: M\n\nDate of Birth: 24-07-1960\n\nAddress: MORAYUR P O\n\nPincode: nan\n\nPhNo: 9746707590\n\nAdmission Date: 24-07-2013\n\nDischarge Date: 08-08-2013\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nEssential (primary) hypertension\nDIABETIC NEPHROPATHY WITH CRONIC RENAL FAILURE\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: patient came with complaints of blackish discoloration of the right 2nd toe for the last 2 months.Getting treatment from an outside hospital.Planned for amputation,but due to peripheral vascular disease it was not done.\r\nAdviced to get vasclar surgeons opinion.\r\n\r\ncase plan\r\nDiabetic control\r\nIV antibiotics for infection control\r\nPodiatric surgeons opinion regarding further management\n\nXray information: nan\n\nClinical examination: Respiration :22\r\nBP :150 / 80\r\nL/E: Gangrenous Rt 2nd toe with cellulitis extending till mid-foot\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: CBC/RFT/ELECTROLYTRES/URINE R+acetone/ECG/\r\nbhatt sirs opinion.\r\nSeen by DRA.K.Bhat.\r\nRt foot 2nd and 3rd toe gangrene with suppuration extending deep on both plantar and dorsal aspect upto ankle region.PVD proven by investigations.\r\n?Plan-Midfoot Amp.or BKA.Will decide tmrw.\r\n7.30PM\r\nseen by Dr Jaya\r\nno complaints\r\nvitals stable\r\ncontinue same\n11 AM. \r\ns/b Dr Tom and Team. \r\nAC - 179mg%. A known Type 1, presented with gangrene 2nd and 3rd toe Rt leg. Insulin infusion given yday to break glucotoxicity. Creat - 3.5mg%. \r\n\r\nCase Plan: \r\nBasal bolus insulins. Inj Insugen R 20-20-15, Inj Basalog 15 units at bed time s/c. S. Elect today. To discuss with Dr Bhat regarding further course of action.\nSeen by DRA.K.Bhat.\r\nXRay foot shows OM of MTP joints.Calcified arteries.\r\nPlan:Under SA,Plan for MID foot amputation,if not feasible then BKA-26TH jUly 2.30PM.\r\nPreop:Nil oral as per anesthetist advice.Informed consent.C&D.IV antibiotics.Medical fitness for procedure.Arrange one pint packed cell for operation.\r\n==========\r\nInformed consent.\r\nThe 2nd and 3rd toes of right foot there is gangrene infection and slough and pus extending to rest of foot in deep layers ,upto and above ankle region.There is also decreased circulation.There is diabetes and neuropathy.This requires wound cleaning under Anesthesia.The dead tissues of the foot will be removed.Pus of the ankle and leg will be drained.The right foot will be amputated at mid foot level and assessment during operation will be done,and if found not healthy,an amputation of the leg at below knee level will be done.The wound after surgery will be larger in size, due to the fact that in diabetes,the extent of infection in the deeper tissues will be more than what is seen in the skin surface.After the operation,depending on healing further operations may be be needed.Due to diabetes and decreased blood circulation ,wound healing may be delayed.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==================\r\n\r\nseen by dr anish\r\npt c/o severe pain\r\nadv t. ultracet stat\nAC - 245mg%\r\nScheduled for mid foot amputation today. \r\nphysician fitness to bed given. \r\nContinue insulin infusion at 1 ml/hr.\r\nS/b Dr Sasikumar at 10:25 AM. \r\nk/c/o DM. \r\nFebrile. PR - 120/min, regular, Lt side. Rt side not felt. \r\nBP - 130/80. \r\nNo pallor or edema. \r\nHeart - normal. No murmurs. \r\nLungs - clinically clear. \r\nInvest - ECG - normal.\r\nCXR - normal. lung fields clear. \r\nCreat - 3.3mg%. \r\nImp:\r\nHis cardiac status is stable. He can undergo surgery under any kind of anaesthesia.\nSEEN BY DR ANISH\r\nPT COMPLAINS OF SEVERE PAIN\r\nINJ TRAMADOL 50MG IV GIVEN \r\nNO RELIF, SO PACTIV INFUSION GIVEN\r\n\n10:24 AM. \r\ns/b Dr Tom/Dr Lakshmi. \r\nAC - 276mg%. Mild pain. Slept well last night. \r\nHas a ruptured carbuncle on the Rt buttock. \r\n\r\nCase Plan: \r\nAdded salt in the diet. TC and Creat tomorrow. \r\nDr Bhat consult for the carbuncle.\nseen by dr anish\r\npt passed urine, no fresh complaints, no c/o pain\n8PM\r\nSeen by Dr Jaya\r\npatient is doing well\r\nc/o mild leg pain\r\nadvised tab ultracet 1 HS\nSeen by DRA.K.Bhat.\r\nPain decreased.\r\nFor C&D and gluteal abscess I&D under LA 29th july 1pm.\r\nNil oral after 12 noon.Get consent.\r\n\r\n11 AM.\r\ns/b Dr Biju/Dr Jaya. \r\nAC - 138mg%. pain less. \r\n\r\nCase Plan: \r\nGluteal abscess I & D tomorrow under LA. Continue t/t.\n10:16 AM. \r\ns/b Dr Tom/Dr lakshmi. \r\nHit a hypo early morning. AC - 159mg%. \r\nScheduled for Carbuncle I & D today under LA. \r\n\r\nCase Plan: \r\nInsulin doses adjusted. \r\nInj Insugen R 30-30-18 units, Inj Basalog 20 units at bed time s/c. I & D today under LA. Rpt TC tomorrow.\nSeen by DR.A.K.Bhat.\r\nRt foot dressing changed.Midfoot stump is clean.\r\n7.30 pm\r\nseen by Dr Jaya\r\npatient is doing well\r\nno complaints\r\ncontinue same\n10:47 AM .\r\ns/b Dr Tom/Dr Manoj.\r\nAfebrile. Mild pain. Pus C/S - moderate growth of Staph. \r\nTC - 16, 000. \r\n\r\nCase Plan: \r\nC & D as advised by Dr Bhat. Omitted the night dose of regular insulins. Other wise continue same. \r\nInj Insugen R 15-15-0, Inj Basalog 10 units at bed time s/c.\r\n\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n8pm\r\nseen by Dr Jaya\r\nno complaints\r\npatient is doing well\r\ncontinue same\n11 AM. \r\ns/b Dr Tom and team. \r\nAC - 423mg%. Pain minimal. Passed stools. \r\n\r\nCase Plan: \r\nCatheter to be removed today. Insulin infusion @ 3ml/hr for tight glycemic control. Nephro Consult.\r\nRpt RFT, S. Elect, URE and TC.\nSeen by DRA.K.Bhat.\r\nDressings changed.Clean.The foot wound needs observation regarding viability and healing.Continue trt.Tab.Cetrizine 10 mg 0-0-1.\r\n\r\n\r\nSeen by Duty Doctor\r\nInsulin infusion going on at 1ml/hr\r\nGRBS 160mg/dl at 7:45pm\nSeen by DRA.K.Bhat.\r\nContinue trt.Rt gluteal C&D done.Ulcer clean.\r\n\r\nSeen by Duty Doctor\r\nPt c/o gen redness over both UL and neck and over the back,no itching . ??Urticaria\r\nInformed Dr Biju\r\nInj Avil 1amp slow iv stat\r\nPt feeling better after the injection\ns/b DR SOORAJ\r\n\r\nLong standing DM,\r\nfound to have diabetic nephropathy with CKD a few years back ( had nephrotic range proteinuria)\r\nirregular follow up\r\n\r\ncreat around 2.5 till recently. Now acute on CKD because of infection\r\n\r\nNo pedal edema, facial puffiness.\r\n\r\nSuggest:\r\n1. tab Sobisis 1-1-1\r\n2. Tab Nefrosave 1-0-1\r\n\r\nContinue others\r\nClose follow up\r\nTo with hold ARB as of now\r\n\r\n10:45 AM. \r\ns/b Dr Tom and team. \r\nTC - 10500, Creat - 3.1mg%. K+ - 5.6mEq/L. \r\nAfebrile. Wound clean. \r\n\r\nCase Plan: \r\nContinue insulin infusion @ 2ml/hr. Continue Dalacin. Stop Biopiper. Bed side mobilization by physio.\n10:41 AM. \r\ns/b Dr Lakshmi/Dr Manoj. \r\nAC - 267mg%. 9AM - 356mg%. \r\nInsulin infusion on flow at 3ml/hr.\r\nc/o Macular rash all over the body, blanching +. \r\nUrine retention +. \r\n\r\nCase Plan: \r\nw/h Nefrosave and Sobisis. Rpt TC, Creat today. \r\nContinue same. ? Foleys.\nSeen by Dr.A.K.Bhat.\r\nC&D done.Rt foot stump clean.Viability needs observation.Rt gluteal ulcer clean.\r\n\r\nSeen By Duty Doctor\r\nInsulin infusion 5ml/hr on flow.\r\nNil spl\r\nVitals stable\r\n6pm-GRBS-338MG/DL\r\n\nAC - 337mg%.\r\nStop infusion at 9 PM. Start insulin infusion early at 5 AM. \r\npassed stools. Continue rest.\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\nSeen by Duty Doctor\r\nAc-280mg/dl\r\nStop infusion at 9 PM. Start insulin infusion early at 5 AM. Continue rest.\n1 amp 25%D given\r\nGRBS:109mg/dl\r\n\r\nnil other complaints\nSeen by Dr Lakshmi and Team\r\nGC-better\r\n302mg/dl at 9am\r\nContinue infusion. Sent for electrolytes.\r\n\r\n\r\n\r\nSeen by DRA.K.Bhat.\r\n9th POD.C&D done.Rt foot stump clean and looks viable.RT gluteal ulcer clean.Continue trt.Suggested oral antibiotics.\n10:58 AM. \r\ns/b Dr Tom and team.\r\nHit a hypo yday night. Pain minimal. \r\nGC - fair. \r\n\r\nCase Plan:\r\nInsulin doses adjusted. \r\nInj Insugen R 15-15-15 units, Inj Basalog 15 units at bed time s/c. Continue allegra. Stop IV Dalacin. \r\nC. Dalacin 300mg 1-1-1. Cetaphil cream for L/A.\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\nseen by dr anish\r\n9:30pm pt had an episod of hypoglycemia\r\ngrbs 50, 25% dextrose given iv, oral glucose given\r\nadv to chk grbs at 10 30 before givin basalog insulin\nSeen by DRA.K.Bhat.\r\nDRessings changed.Clean.\r\n\r\n10:55 AM. \r\ns/b Dr Tom and team. \r\nAC - 121mg%, Had one episode of hypoglycemia yesterday at night. Started on basal bolus insulin regimen from yesterday. Wound is clean. \r\n\r\nCase Plan:\r\nInsulin doses adjusted. \r\nInj Insugen R 2-2-2 units, Inj Basalog 6 units at bed time s/c.\r\nPlan to discharge on monday(12th Aug).\nseen by dranish\r\npt condition better no fresh complaints\r\nvitals stable\nAC - 138mg%, predinner - 109mg%.\r\n\r\n10:56 AM\r\ns/b Dr. Tom and team\r\n\r\nFBS - 132 MG/DL\r\nG/c better\r\nNo hypos\r\n\r\n\r\nCase plan\r\nInsugen R 2-1-1\r\nBasalog 6 units at bed time\n10.10 AM \r\nc/o central and retrosternal chest pain since morning\r\nBP 160/90mmHg\r\nECG taken at 10.15 am showed ST elevation in chest s/o Anterior wall MI \r\nS/b Cardiologist\r\nshifted to icu\r\nTab. Ecosprin 325mg stat\r\nTab . Clopilet 300mg stat\r\nTab. Xtor 40mg stat\r\nInj. Dynalix 0.6 ml S/c stat\r\niNJ stk 1.5 LAKH in 50ml NS to go over 45 mins.\r\nCPK-MB, Trop -I sent\r\nPt Hemodynamically stable with BP at 180/90mmHg\r\nHR 118/min\r\nChest -B/L clear'}, {'role': 'model', 'content': '\nIP Number: 1616\n\nPatient Number: 12166\n\nAdmission Date: 24-07-2013\n\nDischarge Date: 08-08-2013\n\nDiagnosis: Gangrenous RT second toe\n\nClinical Exam(With BP): {\\rtf1\\ansi\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 patient came with complaints of blackish discoloration of the right 2nd toe for the last 2 months.Getting treatment from an outside hospital.Planned for amputation,but due to peripheral vascular disease it was not done.\r\n\\par Adviced to get vasclar surgeons opinion.\r\n\\par \r\n\\par case plan\r\n\\par Diabetic control\r\n\\par IV antibiotics for infection control\r\n\\par Podiatric surgeons opinion regarding further management\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\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Respiration :22\r\n\\par BP :150 / 80\r\n\\par L/E: Gangrenous Rt 2nd toe with cellulitis extending till mid-foot\r\n\\par }\r\n\n\nDiscussion: nan\n\nDiet: nan\n\nRemarks: nan'}] |
1,617 | [{'role': 'user', 'content': "\nIP Number: 1617\n\nPatient Number: 12171\n\nPatient Name: GEORGE K M ( V )\n\nGender: M\n\nDate of Birth: 24-07-1961\n\nAddress: KANNI PARAMBIL H,\n\nPincode: nan\n\nPhNo: 0484 3107988\n\nAdmission Date: 24-07-2013\n\nDischarge Date: 07-08-2013\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC FOOT\nDIABETIC NEPHROPATHY WITH MICROALBUMINUREA\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: patient was adimtted in a hospital for wound on the rt 5th toe.Amputation had been done\r\nnow the 4 th toe is also gangrenous.\r\ngot discharged at request\r\n\r\nCase plan:\r\n\r\nIV ANTI-BIOTICS\r\nDiabetic control\r\nsurgeons opinion\n\nXray information: USG Abd (26/07/13) - No organomegaly, Early benign prostatic hypertrophy is present. \r\nVibro (25/07/13) - B/L Severe loss of vibratory perception. \r\nVersa (25/07/13) - B/L incompressible arterial ds. Adequate Lt toe pressure. Reduced Rt toe pressure. \n\nClinical examination: Respiration :22\r\nBP :110 / 70\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: CBC/RFT/ELECTROLYTES/A1C/URINE R\r\nVERSA/VIBRO.\r\nSeen by DRA.K.Bhat.\r\nLarge gangrenous infected necrotic raw area rt foot after previous 5th toe amputation.Ulcer extends deep and exposes bare proximal tarsal bones and slough and infection extends deep thru ankle into leg compartments.Tenderness lower leg suggesting ascending synovial infection.Another necrotic ulcer dorsum of 1 MTP joint-deep.Dorsal pulsations not felt.?Plan-Debridement-BKA.Will decide tmrw.\r\n7.30PM\r\nseen by Dr Jaya\r\nno complaints\r\nvitals stable\r\ncontinue same\n10:55AM. \r\nAdmitted with gangrene 4th toe Rt. \r\nGRBS - 122mg%. Creat - 1.3mg%, Hb - 8.5gm%. \r\nTC - 16700. \r\n\r\nCase Plan: \r\nInj Biopiper 4.5gm 1-0-1, Inj Dalacin 600mg 1-0-1. \r\nPreop investigations to be done. To discuss with Dr Bhat regarding further course of action. USG Abd. \r\n\nSeen by DRA.K.Bhat.\r\nXRay foot shows OM of tarsal joints including proximal row.Calcified arteries.\r\nPlan:Under SA,Plan for proximal foot amputation,if not feasible then BKA.\r\nPatient wants to wait.\r\nAdviced:Oxum dressing.IV antibiotics.\r\n\r\nseen by dr anish\r\npt c/o difficulty in sleepingt\r\nadv t. trika .25mg hs stat\n11:06 AM. \r\ns/b Dr Tom/Dr Lakshmi. \r\nAfebrile.\nSeen by DRA.K.Bhat.\r\nFor debridement and ?proceed BK amputation right foot under SA 27th july 11 AM.\r\nPreop:Informed consent.C&D.IV antibiotics.Arrange 1 pint packed cells.Medical fitness for procedure.\r\n==================\r\nInformed consent.\r\nThe 5th toe of right foot has previously been amputated. Now there is gangrene of 4th toe and there is ulcer gangrenous infection and slough of right foot and pus extending to rest of foot in deep layers,upto and above ankle region.There is also decreased circulation.There is diabetes and neuropathy.This requires wound cleaning under Anesthesia.The dead tissues of the foot will be removed.Pus of the ankle and leg will be drained.The right foot will be amputated at proximal foot level and assessment during operation will be done,and if found not healthy,an amputation of the leg at below knee level will be done.The wound after surgery will be larger in size, due to the fact that in diabetes,the extent of infection in the deeper tissues will be more than what is seen in the skin surface.After the operation,depending on healing further operations may be be needed.Due to diabetes and decreased blood circulation ,wound healing may be delayed.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==================\n10:20 AM. \r\ns/b Dr Tom/Dr Lakshmi.\r\nAC - 134mg%. Scheduled for ? BKA today. \r\nPhysician fitness given.\nSeen by DRA.K.Bhat.\r\nFor debridement and ?proceed BK amputation right foot under SA 27th july 11 AM.\r\nPreop:Informed consent.C&D.IV antibiotics.Arrange 1 pint packed cells.Medical fitness for procedure.\r\n==================\r\nInformed consent.\r\nThe 5th toe of right foot has previously been amputated. Now there is gangrene of 4th toe and there is ulcer gangrenous infection and slough of right foot and pus extending to rest of foot in deep layers,upto and above ankle region.There is also decreased circulation.There is diabetes and neuropathy.This requires wound cleaning under Anesthesia.The dead tissues of the foot will be removed.Pus of the ankle and leg will be drained.The right foot will be amputated at proximal foot level and assessment during operation will be done,and if found not healthy,an amputation of the leg at below knee level will be done.The wound after surgery will be larger in size, due to the fact that in diabetes,the extent of infection in the deeper tissues will be more than what is seen in the skin surface.After the operation,depending on healing further operations may be be needed.Due to diabetes and decreased blood circulation ,wound healing may be delayed.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==================\r\n\r\n\r\nseen by dr anish\r\npt c/o sverepain, inj tramadol 50 mg im stat\r\ninj pactiv stat\n8pm\r\nseen by Dr Jaya\r\npatient is doing well\r\nno complaints \r\ncontinue same\nSeen by DRA.K.Bhat.\r\nPain decreased.Continue trt.Rpt HB tomorrow.\r\n\r\n11 AM. \r\ns/b Dr Biju/Dr Jaya.\r\nAC - 138mg%, doing well. slept well after Inj Tramadol. \r\nPain tolerable now. Hb - 9.5gm%. \r\n\r\nCase Plan:\r\nContinue t/t. Inj Tramadol 50mg IV SOS. \r\nRpt Hb tomorrow.\n10:11 AM. \r\ns/b Dr Tom/Dr Lakshmi. \r\nACR +ve. AC - 113mg%. Chest - clear. \r\nMild pain. \r\nPus C/S - heavy growth of Pseudomonas. \r\n\r\nCase Plan: \r\nInj Heparin 5000 units s/c OD. T. Trika 0.25 mg 0-0-1. \r\nInj Tramadol 50mg IV 1-1-1. Dressing change today. \r\nStop Dalacin. Continue Biopiper. Physio to ambulate\nSeen by DR.A.K.Bhat.\r\nContinue trt.Transfuse 1 pint packed cells.C&d in OT tomorrow.\r\nseen by Dr Jaya\r\npatient is doing well\r\nno complaints\r\ncontinue same\n10:41 AM. \r\ns/b Dr Tom and team. \r\nAC - 120mg%, Afebrile. 1 PRC transfused given yday.\r\nChest - clear. Hb - 9.7gm%. \r\n\r\nCase Plan:\r\nT. X Tor 10mg 0-0-1. T. Ecosprin 75mg 0-1-0. \r\nPhysio to ambulate. Continue t/t.\nSeen by DRA.K.Bhat.\r\nC&D done.DRain removed.Suture line clean.Continue trt.\r\nseen by Dr Jaya\r\nno complaints\r\npatient is doing well\r\ncontinue same\n10:57 AM. \r\ns/b Dr Tom and team. \r\nAC - 110mg%, predinner - 157mg%.\r\nInj Varin 5000 uints s/c BD given. \r\n\r\nCase Plan: \r\nContinue same.\nSeen by Duty Doctor\r\nNil spl\r\nGC better\r\nVitals stable\n10:41 AM. \r\ns/b Dr Tom and team. \r\nAC - 111mg%, Hb - 9.0gm%. \r\nTC - 8700. Creat - 1.0mg%. Passed stools. \r\nGC - stable. \r\n\r\nCase Plan: \r\nTo start on oral Levostra from tomorrow. Dressing today. \r\nRemove foley's today(after concurrence from Dr Bhat). \r\nStop Heparin. Continue rest.\nSeen by DRA.K.Bhat.\r\nC&D done.Clean.REmove foleys tomorrow.\r\nOral antibiotic levofloxacin.Continue trt.Plan fr D/C next wednesday.\r\n\r\nSeen by Duty Doctor\r\nNil spl\r\nGC good\r\nNo pain\n10:39 AM. \r\ns/b Dr Lakshmi/Dr Manoj/Dr Biju.\r\nAC - 103mg%.\r\nSwitch to oral Levo. Catheter removed today morning. \r\n\r\nCase Plan: \r\nPlan for d/c on tuesday. Continue same.\nSeen by Dr.A.K.Bhat.\r\nContinue trt.\r\n\r\nSeen by Duty Doctor.\r\nNil spl.\r\nGC good.\n11:09 AM. \r\nAC - 99mg%.\r\n\r\nSeen by DRA.K.Bhat.\r\nC&D done.Clean.Continue trt.Plan fr discharge after suture removal on wenesday.\nSeen by Duty Doctor\r\nNil spl\r\nGC-good\r\nNo pain\nSeen by Dr Lakshmi and team\r\nNil spl\r\nGC-good\r\n\r\n\r\n\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\nnil spcl\r\nGC:stable\n10:54 AM. \r\ns/b Dr Tom and team. \r\nGC - status quo. Pain less. \r\n\r\nCase Plan: \r\nContinue same. Plan to d/c by wednesday. \r\nSuture removal tomorrow.\nSeen by DrA.K.Bhat.\r\nContinue trt.Plan fr Suture removal tuesday and D/C on wednesday.\nSeen by DRA.K.Bhat.\r\nAlternate sutures removed.Clean.\r\n\r\n10:52 AM. \r\ns/b Dr Tom and team. \r\nAC - 112mg%. GC - better\r\nAlternate sutures removed by Dr Bhat. \r\n\r\nCase Plan:\r\nPlan to d/c tomorrow. Continue same.\nseen by dranish\r\npt comfortable, gc good\n10:52 AM\r\ns/b Dr. Tom and team\r\n\r\nAC-107 mg/dl\r\n\r\nCase plan:\r\nPlan to discharge today.\r\nMultiple daily dose insullin\r\nOral antibiotics\r\nReview after one month.\nSeen by DR..AK.Bhat.\r\nSutures removed.Clean.\r\nAdviced:Daily cleaning with betadine solution and dressing with betadine oint.pad and crepe bandage.Exercises.REview 1 month."}, {'role': 'model', 'content': '\nIP Number: 1617\n\nPatient Number: 12171\n\nAdmission Date: 24-07-2013\n\nDischarge Date: 07-08-2013\n\nDiagnosis: BKA Rt side\n\nClinical Exam(With BP): {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 patient was adimtted in a hospital for wound on the rt 5th toe.Amputation had been done\r\n\\par now the 4 th toe is also gangrenous.\r\n\\par got discharged at request\r\n\\par \r\n\\par Case plan:\r\n\\par \r\n\\par IV ANTI-BIOTICS\r\n\\par Diabetic control\r\n\\par surgeons opinion\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 USG Abd (26/07/13) - No organomegaly, Early benign prostatic hypertrophy is present. \r\n\\par Vibro (25/07/13) - B/L Severe loss of vibratory perception. \r\n\\par Versa (25/07/13) - B/L incompressible arterial ds. Adequate Lt toe pressure. Reduced Rt toe pressure. \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 Respiration :22\r\n\\par BP :110 / 70\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 52 yr old with H/o DM admitted with gangrene of the 5th toe RT foot with extensive infection of the plantar aspect of the Rt foot. Pt was started on I.V antibiotics, Insulin basal bolus regimen for adequate glycemic control. seen by surgeon, below knee amputation was done on 27-7-12, regular dressings were done. sutured removed and discharged under stable condition\r\n\\par }\r\n\n\nDiet: nan\n\nRemarks: nan'}] |
1,638 | [{'role': 'user', 'content': "\nIP Number: 1638\n\nPatient Number: 11490\n\nPatient Name: RAJKUMAR MENON\n\nGender: M\n\nDate of Birth: 30-07-1944\n\nAddress: G 350\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 31-07-2013\n\nDischarge Date: 26-08-2013\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: Pt presented with a large non healing ulcer on the Rt heel. \n\nXray information: nan\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by DRA.K.Bhat.\r\nCellulitis rt leg surrounding the large raw area-?residual necrotising fasciitis.\r\nAdviced:Daily cuticell,pad dressing.LEG elevation.IV Biopipper.\r\n\r\n\r\nSeen by Duty Doctor\r\nNil spl\r\nTrt continued as per Dr Bhatt's orders\n11:14 AM. \r\ns/b Dr Tom and team. \r\nWound better. \r\n\r\nCase Plan: \r\nStop Oxetol. Continue rest. \r\nT. Zempred 8mg 1-0-1.\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\n\r\nSeen by Duty Doctor\r\nNil spl\r\nGC good\r\nNo pain\n11:19 AM. \r\ns/b Dr Lakshmi/Dr Manoj. \r\nWound clean. Dermat consult done. \r\n\r\nCase Plan: \r\nContinue same. Clean exfoliated skin with saline gauze and afterwards to apply Venusia.\nSeen by DRA.K.Bhat.\r\nEdema decreased.Raw area clean.\r\n\r\nSeen by Duty Doctor.\r\nNil spl.\r\nGC better.\n10:35 AM. \r\ns/b Dr Tom/Dr Manoj. \r\nGC - fair. Wound clean. \r\nHad some disturbed sleep last night. \r\nCurrently on T. lonazep 0.5mg 0-0-1. \r\n\r\nCase Plan:\r\nContinue Dynalix, abx and Lonazep. \r\nPhysio to ambulate (upper body exercises).\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\nS/B Duty Doctor\r\nGC - fair\r\nNil spl\r\nDoing good\nSeen by Dr Lakshmi and team\r\nDoing good.\r\nGC-stable\r\nNil spl\r\n\r\n\r\n\r\nSeen by DrA.K.Bhat.\r\nClean raw area.Continue cuticell dressings.\ns/b duty doctor\r\n\r\nNil spcl\r\nGC:fair\n11:23 AM. \r\ns/b Dr Tom and team.\r\nAC - 80mg%. GC - better, Wound clean. \r\n\r\nCase Plan: \r\nInj Methpred 20mg IV x 2 days. Continue abx, lonazep and Dynalix. \r\nPlan to d/c by wednesday. \r\nT. Allegra 120mg 0-0-1.\nSeen by DRA.K.Bhat.\r\nContinue trt.Continue dynalix upto wednesday and continue after air travel also,to reduce risk of DVT.Leg elevation during travel.\n11:17 AM\r\ns/b Dr Tom and team. \r\nAC - 86mg%. Doing well. Ulcer clean. \r\n\r\nCase Plan: \r\nContinue same. Plan to d/c tomorrow. \r\nStart on oral steroid (Zempred) tomorrow before discharge. \r\nContinue Venusia.\nseen by dranish\r\npt gc good, no pain or any othr complaints\n11:32 AM\r\ns/b Dr. Tom and team\r\nChange to oral steroids\r\n\r\n\r\nCase Plan:\r\nContinue rest.\nSEEN BY DR ANISH\r\nNO FRESH COMPLAINTS VITALS GOOD\nSeen by Dr Bhatt.\r\nRaw area rt leg granulating.Surrounding skin inflamed and excoriated.C/S taken.\r\nPlan:Leave open in day,tbact oint. to surrounding skin tds.Cuticell dressing by night.Plan for SSG next week.\r\n\r\nS/b duty Doctor\r\nNil complaints\nSeen by DR.A.K.Bhat.\r\nDressings changed.Plan fr SSG under SA next week.Medical fitness for operation.Leave wound and leg open in daytime.Tbact oint. to raw area and adjacent skin bd.Dry dressing by night.Stop IV antibiotics today..Stop dynalix from sunday.\r\n\r\n10:52 AM \r\ns/b Dr. Tom and team\r\nG/c better.\r\n\r\nCase plan:\r\nReduce Zempred to 8mg 1-0-0. \r\nStop IV abx, topical agents.\r\nDry dressings in the evening.\nstable\r\nnil complaints\n11:01 AM. \r\ns/b Dr Tom and team. \r\nAC - 86mg%. GC - status quo. \r\n\r\nCase Plan:\r\nStop Dynalix tomorrow. Chest X Ray and ECG on monday. \r\nScheduled for SSG on tuesday. Continue rest.\ns/b dr anish\r\npt gc same, no fresh complaints, vitals good\ns/b Dr radha\r\ndoing well\r\ncase plan \r\nstop inj dynalix from today\ns/b dr anish\r\npt gc same no fresh complaints\n11:29 AM\r\ns/b Dr. Tom and team\r\n\r\nCase plan:\r\nSchedule for SSG tomorrow.\r\nDermat review tomorrow.\r\n\ns/b Dr.Binoy\r\nnil complaints\r\nstable.\r\ncase posted for SSG on 15/08\n11:25AM\r\ns/b Dr.Tom and team\r\n\r\nCase plan:\r\nTake off all agents(steroids).\r\nKeeo wound open.\r\nPlan to SSG on 15th.\r\n\nSeen by DRA.K.Bhat.\r\nPlan fr SSG under SA on thursday 15th august.\r\nPreop:Medical fitness.Repeat Venous doppler.\r\n\r\nSeen by Duty Doctor\r\nNil spl\r\nGC good\n11:12 AM\r\ns/b Dr. Tom and team\r\nOedema and swelling present.\r\n\r\nCase plan:\r\nSSG tomorrow.\nSeen by DRA.K.Bhat.\r\nPosted for SSG on 15th august under SA ,11AM.\r\nPreoperative Instructions:\r\nGet consent.\r\nNil oral as per Anesthetist advice.\r\nClean&dress area on morning of operation.\r\nBetadine scrub both thighs ,morning of operation.\r\nIV antibiotics-Inj.Biopiper 4.5 gm IV and Inj.Gentamicin 80 mg IV 1/2 hr before operation.\r\nInj.Hydrocortisone 100mg IV strat. before operation.\r\nMedical &Anesthetic fitness for the procedure.\r\n\nseen by dr anish\r\npt no fresh complaints, vitals good\n11:16 AM \r\ns/b Dr.Tom and team\r\nChest clear.\r\n\r\nCase plan:\r\nInj. dynalix 0.4 mg OD\r\nRep. creatinine tomorrow\nSeen by DRA.K.Bhat.\r\nDressing soakage.Changed.SSG taken up.EDema decreased.Inj.Dynalix 0.4 SC od.IV antibiotics.Inj.DEcadron 4mg IV HS&CM.FRequent change of position.\r\n\r\nSeen by Dr Anees\r\nGC better\r\nFrequent change of position as advised by Dr Bhat\r\nRep. creatinine tomorrow\n07:35pm\r\nS/b Dr.Binoy(duty doctor)\r\n\r\npt comfortable,stable\n11:19 AM\r\ns/b Dr. Tom and team\r\nAC-131mg/dl\r\nwound better.\r\nDressing changed yesterday.\r\n\r\nCase plan:\r\nFBS(Venous sample) tomorrow.\r\nContinue anti biotics \r\nFBS coming morning.\r\nDr. Bhat to decide on steroid dose.\r\nCatheter may be removed on monday.\r\nSeen by DRA.K.Bhat,.\r\nRt thigh superficial dressings changed.Continue trt.\r\nInJ.Decadron 4mg IV bd.\n9:25am\r\n\r\nS/b Dr.Tom and Dr.Binoy\r\n\r\ncomfortable,slept well\r\n\r\nFBS:63mg/dL\r\nBP:90/60mmHg (130/80mmHg,6:00 am)\r\ncheck BP after 1 hr\r\n\r\ncase plan:\r\nto be seen by Dr.Bhat today\r\nremove metal clips.\r\ncontinue inj.DM 4mg IV BD.\r\nstop inj.Pactiv/continue dynalix.\r\nSeen by DR.A.K.Bhat.\r\nDRessings changed.Staples removed.SSG clean.Fasciotomy wounds clean.Continue trt,.\r\n\ns/b dr anish\r\nno fresh complaints, vitals good ,\n11:18 AM \r\ns/b Dr.Tom and team\r\nAC-91mg%\r\n\r\nCase plan:\r\nTab.Zempred 8mg BD\r\nStop Inj. Gentamycin\r\nIT works 2tsp at night.\r\nCreat today.\r\nCatheter removal today.\r\nSeen by DrA.K.Bhat.\r\nContinue trt.\ns/b dr anish\r\nno fresh complains , vitals good, gc bettr\n11:18 AM\r\ns/b Dr. Tom and team\r\nAC- 98mg%\r\n\r\nCase plan:\r\nProtoclysis enema.\r\nContinue the same\nSeen by DRA.K.Bhat.\r\nDressings changed.SSG settling.Stored SSG applied to fasciotomy wounds.Donor thigh clean and healing.Stop Inj.Biopiper. Suggested oral levofloxacin.\r\n\r\n6pm\r\nSeen by Dr Anees\r\n\r\nStill c/o difficulty in passing stools.\r\nInformed Dr Biju\r\n\r\nProtoclysis enema stat.\r\n8:30pm\r\nFeeling better.\r\nBP-130/80\n11:26 AM\r\ns/b Dr. Tom and team\r\nLittle stool was passed after enema.\r\n\r\nCase plan :\r\nManual evacuation of the bowel.\r\n\r\n\r\n\r\n\n11:16 AM\r\ns/b Dr. Tom and team\r\nAC-95 mg/dl\r\nGC better.\r\n\r\nCase plan:\r\nCap Yogut 1-0-1\r\nPhysio consult today.\r\nTo plan on futher course of action after consultation with Dr. Bhat.\n11:15 AM\r\ns/b Dr. Biju, Dr. Radha and Dr. Lakshmi\r\nGC better.\r\n\r\nCase plan:\r\nPlan to d/c on monday.\r\nContinue Tab. Zempred 4 mg\nSeen by DrA.K.BHat.\r\nSSG and donor sites healing well.Continue trt.\r\n\r\n\r\nSeen by Dr Anees\r\nNil spl\r\nVitals stable\r\nGC good\nSeen by DR.A.K.Bhat.\r\nContinue trt.\r\n\r\ns/b Dr. Tom and team\r\nAC-91 mg/dl\r\n\r\nCase plan:\r\nPlan to d/c on monday\r\n\ns/b dr anish\r\nno fresh complaints, vitals good\ns/b Dr Biju/Dr Anish. \r\nNo fresh complaints. \r\nBowel movements normalizing. \r\nMinimal pain at graft and donor site. \r\n\r\nCase Plan:\r\nContinue same. Stop Yogut. \r\nPlan to d/c tomorrow after dressing.\nseen by dr anish\r\nno fresh complaints , vitals good\nS/b Dr. Tom and team\r\n\r\nCase plan:\r\nTab. Zempred 4mg OD\r\nPlan to d/c today after one more dressing by Dr. Bhat.\nSeen by DRA.K.Bhat.\r\nDressings changed.Donor thigh healed.SSG leg settling.\r\nAdviced:Emollient to rt thigh thrice a day-for 1 month.Splint at night.Review wednesday 28th."}, {'role': 'model', 'content': '\nIP Number: 1638\n\nPatient Number: 11490\n\nAdmission Date: 31-07-2013\n\nDischarge Date: 26-08-2013\n\nDiagnosis: Large Non healing ulcer on the Rt heel. s/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 presented with a large non healing ulcer just above the Rt heel x 1 month., pt was admitted initially with infected ulcer which progressively improved with bed rest , I.V antibiotics, inj LMWH.\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 Venous Doppler Rt Lower Limb (14/08/13) - No e/o thrombosis of deep veins of Rt lower limb is seen. Poor deep venous flow noted below the Rt knee, possibly due to soft tissue edema. \r\n\\par Pus C/S (11/08/13) - Scanty growth of Pseudomonas. \r\n\\par \r\n\\par \r\n\\par }\r\n\n\nXray findings: nan\n\nDiscussion: {\\rtf1\\ansi\\ansicpg1252\\deff0\\deflang1033{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\f0\\fs24 68 yr old with H/o HTN admitted with non healing ulcer just above the Rt heel. Pt was initially started on i.v antibiotics, later admitted now for skin grafting. He was taken up for the procedure on 15th August 2013 under GA with strict aseptic precautions. Graft tissue harvested from the Rt thigh was used to cover the raw area on the heel. Fasciotomy was also done. The post op was uneventful. He continued on IV antibiotics and alternate day dressings were done by the surgeon. A small dose of steroids was continued and progress was monitored. The SSG is taken up well and the donor site is also healing well. He is hence discharged in a stable condition and advised to review as outpt.\r\n\\par }\r\n\n\nDiet: nan\n\nRemarks: nan'}] |
1,811 | [{'role': 'user', 'content': '\nIP Number: 1811\n\nPatient Number: 12166\n\nPatient Name: ABDU SAMAD\n\nGender: M\n\nDate of Birth: 24-07-1960\n\nAddress: MORAYUR P O\n\nPincode: nan\n\nPhNo: 9746707590\n\nAdmission Date: 27-09-2013\n\nDischarge Date: 12-10-2013\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC NEPHROPATHY WITH CRONIC RENAL FAILURE\nTYPE 1 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: A k/c/o Type 1 DM with associated CRF, presented with gangrene and Rt mid foot amputation was done. Now readmitted for SSG.\n\nXray information: ECHO (01/10/13) - Normal chamber dimensions. Ant. wall akinesia. Impaired LV function. No valvar pathology. (EF - 46%). \r\nPus C/S (03/10/13) - Scanty growth of Pseudomonas sensitive to quinolones.\n\nClinical examination: Temperature :98.6 °F\r\npulse :74 /min\r\nRespiration :22 /min\r\nBP :140 / 80 mm Hg\r\nLocal Examination :Foot ulcer granulated well.\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by Dr. Tom and team\r\n\r\nCASE PLAN:\r\nTab. Cilacar 10mg 1-0-1\r\nInj. Basalog 6 units\r\nInj. Dynalix .4 OD\r\nStop platloc.\nSeen by DrA.K.Bhat.\r\nLeg elevation.Daily oxum dressings.Plan fr SSG under SA on tuesday 1st oct.Arrange 1 pint packed cells fr operation.\r\n\r\nseen by dr anish \r\nno fresh complaints, gc good\r\n\nSeen by Dr. Tom and team\r\n\r\nCASE PLAN:\r\nTab. Cilacar 10mg 1-0-1\r\nInj. Basalog 6 units\r\nInj. Dynalix .4 OD\r\nStop platloc.\r\n\r\n\r\n29/09/13\r\ns/b dr.manoj\r\npatient had hypoglycemia yesterday night at 1.55am\r\ncorrected with biscuits\r\nAC-196\r\nBP-140/90mmhg\r\ncase plan;\r\nto reduce insulin\r\ninsulin according to the food intake.\r\nSeen by DrA.K.Bhat.\r\nContinue trt.\nSeen by DrA.K.Bhat.\r\nLeg elevation.Daily oxum dressings.Plan fr SSG under SA on tuesday 1st oct.Arrange 1 pint packed cells fr operation.\r\n\r\nseen by dr anish \r\nno fresh complaints, gc good\r\n\r\n29/9\r\nPT GC SAME NO FRESH COMPLAINTS , VITALS GOOD\r\n\r\n\nPosted for SSG under SA on 1st oct..\r\nPreoperative Instructions:\r\nGet consent.\r\nNil oral as per Anesthetist advice.\r\nClean&dress area on morning of operation.\r\nBetadine scrub of thigh morning of operation.\r\nIV antibiotics-Inj.Monoscot 1gm IV HS and CM.\r\nMedical &Anesthetic fitness for the procedure.\r\n\r\n\r\nS/B Dr Anees\r\nPre op instructions to be followed.\r\nConsent taken.\r\nNil oral as per Anesthetist advice.\r\nClean&dress area on morning of operation.\r\nBetadine scrub of thigh morning of operation.\nSeen by Dr. Tom and team\r\nAC-205mg%\r\n\r\nCASE PLAN:\r\nIns. Actrapid 10-6-3\r\nIns. Basalog 10 units at bed time \r\nTo do her post dinner RBS\r\nCardiac consult tomorrow\r\nSSG tomorrow\nCase seen by Dr. Robert, \r\n\r\nPatient doing well, no fresh complaints. \r\nPatient afebrile.\r\n\r\nAdvice: Continue same medication\nSeen by DRA.K.BHat.\r\nHb-10.2 gm.Continue trt.Restart platloc tmrw.REmove foleys tmrw.\r\n\r\nS/b Dr Anees\r\nnil complaints\r\n\r\nGRBS-6pm-76mg/dl\r\nInformed Dr Lakshmi\r\n7pm-67mg/dl\r\n10pm-256mg/dl\r\n\r\nBasalog-6U\r\nChek GRBS at 2am\ns/b dr.tom\r\nBP-120/80\r\ncontinue same\nSeen by Dr. Tom amd team\r\nAC-271mg%\r\n\r\nCASE PLAN:\r\nIns. Actrapid 10-5-2\r\nIns. Basalog 6 units at bed time\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\n\r\nEvening Rounds done by Dr. Robert, \r\nNo fresh complaints, patient afebrile. \r\nAdvice: Continue same medication\n\r\n\r\nSeen by Dr. Tom and team\r\nAC-281mg%\r\nBP- 130/80 mg%\r\npus c/s-pseudomonas\r\nresistant to cephalosporins\r\nS-pipzo/cipro/levofloxacin/imipenem/meropenem/ofloxacin/netilmicin\r\n\r\nCASE PLAN:\r\nContinue same treatment.\r\nIns. Basalog 8 units at bed time.\r\n\nSeen by DRA.K.Bhat.\r\nDressings changed.SSG taken up.Clean.Continue trt.Oral antibiotics.\r\n\r\nstop monoscot sb\r\nstart oxcip 500 1-0-1\r\n\r\n\r\nS/b Dr Anees\r\n\r\nNil spl\r\nGRBS-237mg/dl at 6pm\r\nInformed Dr Lakshmi,\r\nInsugen R:2UNIT,Insugen N :10unit.\nSeen by Dr\r\nAC-131mg%\r\nBP -140/90mmHg\r\n\r\nCASE PLAN:\r\nContinue same.\nSeen by Dr Anees\r\nnil spl\r\nGC fair\r\n\r\nGRBS-186mg/dl\r\nInformed Dr Lakshmi\r\nInsugen R-2U\r\nInsugen N-10U\nCase seen by Dr. Robert, \r\nNo fresh complaints. Patient afebrile. \r\n\r\nGRBS:113mg/dl. \r\n Case informed to Dr. Lakshmi, advised Insugen R-2Units and Insugen N-10Units\nSeen by Dr Biju, Dr Robert.\r\nGC - better, AC - 151mg%.\r\nNo fresh complaints. No hypos. \r\nc/o mild pain at the donor site. \r\n\r\nCase Plan:\r\nContinue same. \r\nDressings tomorrow.\nSeen by DRA.K.BHat.\r\nC&D done.SSG settling.Continue trt.\r\n\r\nSeen by Duty Doctor,Dr Anees\r\nnil spl\r\nContinue trt.\r\nGRBS-103mg/dl at 6pm\r\nInformed Dr Lakshmi\r\nInsugen R-2U\r\nInsugen N-6U\nSeen by Dr. Radha, Dr. Lakshmi, Dr. Manoj and Dr. Biju\r\nBP- 140/70mmHg\r\n\r\nCASE PLAN:\r\nContinue same.\r\n\nSeen by DR.A.K.Bhat.\r\nContinue trt.\r\n\r\nEvening Rounds done by Dr. Robert, \r\nPatient GC same, no fresh complaints.\nSeen by Dr. Radha, Dr. Lakshmi, Dr. Manoj and Dr. Biju\r\nAC-550mg%\r\nBP-150/100mmHg\r\n\r\nCASE PLAN:\r\nContinue same.\nSEEN BY DR ANISH \r\nNO FRESH COMPLAINTS, VITALS GOOD\nSeen by DRA.K.BHat.\r\nContinue trt.\r\nDressing done yesterday.\r\n\r\nSeen by Dr. Radha and team\r\nAC - 374mg%. \r\n\r\nCASE PLAN:\r\nAll insulin injections to Abdomen only\nSeen by DRA.K.Bhat.\r\nDressings changed.SSG settling.Donor site healing.Continue trt.Plan fr DC on saturday.\r\n\r\nEvening Rounds by Dr. Robert, \r\nPatient GC same, no fresh complaints.\nSeen by Dr Tom and team.\r\nBP - 150/90. AC - 162mg%.\r\n10PM - 281mg%, 2 AM - 225mg%.\r\npredinner - 143mg%.\r\n\r\nCase Plan:\r\nWill discuss with Dr Bhat regarding further course of action. \r\nContinue same. \r\nInj Basalog 10 units at bed time s/c.\nSeen by DRA.K.Bhat.\r\nPlan fr DC tmrw.\nSeen by Dr. Radha, Dr. Lakshmi, Dr. Manoj and Dr. Biju\r\nAC-335mg%\r\nBP- 130/80mmHg\r\n\r\nCase plan:\r\nIns Insugen R 10-10-2\r\nIns Basalog 10units at bed time\nSeen by Dr. Radha, Dr. Lakshmi, Dr. Binu, Dr. Manoj and Dr. Biju\r\nAC- \r\n\r\nCase plan:\r\nIns Insugen R 10-10-2\r\nIns Basalog 10 HS\r\nPlan to discharge today.'}, {'role': 'model', 'content': "\nIP Number: 1811\n\nPatient Number: 12166\n\nAdmission Date: 27-09-2013\n\nDischarge Date: 12-10-2013\n\nDiagnosis: Impaired LV Function (EF - 46%).\r\ns/p CVA\r\nCAD- s/p ant wall MI- x 2 months ago\r\nPOVD\r\nRt mid foot amputation\n\nClinical Exam(With BP): {\\rtf1\\ansi\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 A k/c/o Type 1 DM with associated CRF, presented with gangrene and Rt mid foot amputation was done. now readmitted for SSG.\r\n\\par }\r\n\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: {\\rtf1\\ansi\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 ECHO (01/10/13) - Normal chamber dimensions. Ant. wall akinesia. Impaired LV function. No valvar pathology. (EF - 46%). \r\n\\par Pus C/S (03/10/13) - Scanty growth of Pseudomonas sensitive to quinolones.\r\n\\par }\r\n\n\nXray findings: {\\rtf1\\ansi\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Temperature :98.6 \\'b0F\r\n\\par pulse :74 /min\r\n\\par Respiration :22 /min\r\n\\par BP :140 / 80 mm Hg\r\n\\par Local Examination :Foot ulcer granulated well.\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 with H/o type 1 DM , POVD, CAD, CVA admitted for SSG.Pt had a mid foot amputation done to the RT leg x 2 1/2 month ago. Pt was started on I.V antibiotics, insulin basal bolus regimen, seen by surgeon, SSG was done to the Rt leg. pt clinically stable, not in any distress, discharged under stable condition\r\n\\par }\r\n\n\nDiet: nan\n\nRemarks: nan"}] |
1,935 | [{'role': 'user', 'content': "\nIP Number: 1935\n\nPatient Number: 13523\n\nPatient Name: N A BABU\n\nGender: M\n\nDate of Birth: 23-10-1953\n\nAddress: NADUKKUDY H\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 23-10-2013\n\nDischarge Date: 15-11-2013\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: A known diabetic, presented to us with c/o pain, swelling and warmth on the Lt leg. OP doppler showed e/p thrombosis. Hence admitted for LMWH and anti-biotics. \n\nXray information: Versa (24/10/13) - Normal Rt arterial study, Normal Lt AB index with elevated posterior tibial. Adequate toe pressure. \r\nVibro (24/10/13) - B/L Severe loss of vibratory perception.\r\nPus C/S (31/10/13) - No pathogen isolated in the culture. \n\nClinical examination: Afebrile. \r\nBP - 130/70. \r\nPR - 92/min. \r\nResp Rate - 22/min. \r\nSystems - NAD. \n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: S/B DR ANISH\r\nPT COMPLAINS OF PAIN \r\nADV T.ULTRACET STAT\nSeen by Dr. Binu and team\r\nBP -120/80mmHg\r\nGC better.\r\n\r\nCase plan:\r\nEye check +TSH\nFever last evening at 6:30PM, temp 102.5, case advised to Dr. Lakshmi, advised Inj. Pactive. \r\nPt. history of fever late last night at 2:00AM, Temp:100.6, \r\nCase informed to Dr. Biju advised Tab. Welset, \r\nTemp 100 at 6:00Am, Tab. Dolopas given.\r\n\r\n\r\nSeen by Dr. Binu and team\r\nOedema present \r\nBP- 140/90mmHg\r\nAC -77mg%\r\nPt has spikes of fever last night and today morning/.\r\nNo systemic symptoms.\r\nBowelaand bladder movements normal\r\nOn exam:\r\nPt comfortable \r\nNo Dyspnic\r\nLt leg is warmth until mid thighs.\r\nSwelling is improving with wrikling of skin\r\nNo tenderness\r\nSoft to feel\r\nErythema decresing.\r\nAn area of blistering noted over left medial thigh.\r\nLt inguinal lymph nodes palpable\r\nPulse: 90/min\r\nChest is clear\r\nSAb soft\r\nCVS: Heart sounds normal.\r\nSPO2:96% on room air\r\nSugars are controlled.\r\n\r\nCase plan:\r\nTab Acitrom 4mg 1-0-0\r\nInj Clexane to continue\r\nTab Paracetamol 650mg 1-1-1\r\nTab Pantaprazole 40mg 1-0-0\r\nInj Biopiper 4.5 IV TDS\r\nTab Linezolid 600mg 1-0-1\r\nRepeat TC and INR today and INR daily.\nSeen by DrA.K.Bhat.\r\n?Necrotising fasciitis left leg extending to thigh with multiple blisters leg and thigh.Diffuse redness,tenderness.Stretch pain at ankle.Dorsal pulsations present.\r\nAdviced:Tbact oint tds.IV Clindamycin 600mg 8th Hrly.Blood urea,.\r\n\r\nSeen by Dr Anees\r\nc/o pain\r\n\r\nTemp 100.6 F\r\nGRBS-133mg/dl\r\nInformed Dr Lakshmi\r\n\r\nT Dolopar 650mg \r\nInsugen R-2u\r\nN-4u\n7.30 PM\r\nSEEN BY DR FEBA\r\nC/O FEVER AND MILD PAIN\r\nTEMP 99F\r\nT DOLOPAR 1 GIVEN\r\n\nLesion looks status quo.\r\nThe fever has subsided. \r\nTC - 26,000. INR - 1.2.\r\nPt c/o internmittent pain in the Lt leg. \r\nPassing urine well. \r\n\r\nCase Plan: \r\nWas discussed with Dr Bhat last evening.\r\nTo w/h Acitrom in view of possible need of surgery.\r\nChange to IV Linezolid.\r\nContinue Biopiper and Dalacin.\r\nT. Dolopar 650mg 1-1-1-1.\r\nSeen by DRA.K.Bhat.\r\nSome reduction in swelling on medial side and patient says pain is less.Continue trt.\r\nChase C/S reports. \r\nCBC, S. Elect, RFT, INR tomorrow.\r\nT. Axiplex 1-0-0.\nCase seen by Dr. Anees, \r\n Pt temp-afebrile\r\nGRBS-199mg/dl\r\nInformed Dr Laxmi\r\nInsugen R-2\r\nN-4\r\n\r\nAdvice: Continue antibiotics, Pt. planned for fasciotomy tomorow.\r\nNPO after 7am\r\nT Axipan 40mg HS and CM\r\nT Emeset 8mg HS and CM\r\nT Trika 0.25mg HS and CM\r\nFollow PAC orders\nSeen by Dr.A.K.Bhat.\r\nStill painful esp. on weight bearing.Blisters around area of tendoachilles insertion.Pus filled blisters thigh-deroofed-C/S taken.\r\nProvisionally plan fr fasciotomy under SA 28th oct. 12.30 PM.\r\nPreop:Informed consent.Nil oral as per anesthetist.C&D left lower limb after betadine cleaning.Medical fitness for procedure.Arrange one pint packed cells.Rpt FBS tmrw.\r\n===========\r\nInformed consent.\r\nThere is pus filled infection of left foot,ankle and leg extending to thigh region.This pus infection is extending deep to deeper tissues like fascia.There are multiple pus filled blisters in these regions.The infection needs incision and drainage and fasciotomy under anesthesia.During operation the spreading infection will be opened up in multiple areas and pus will be drained.In necrotising fasciitis there will be infection more extensive than what is seen on the surface.Infected skin and soft tissues may need to be removed.Due to extending nature of infection, after surgery the wounds will be large and control of infection and healing will be delayed.The healing and circulatory condition of wounds will need observation.Repeat surgery may be needed.Understanding the above consent for anesthesia and operation is given.\r\n=======================\r\n\r\nCase seen by Dr. Lakshmi, \r\nPatient Counts still high, Pt temp 100, Advice: Continue antibiotics, Pt. planned for fasciotomy tommarow.\nCase seen by Dr. Robert, \r\nPatient doing well post-op, \r\nPt. afebrile\r\n\nSeen by Dr. Binu and team\r\nAC-139mg%\r\nBP-120/80mmHg\r\ngc better\r\nAfebrile\r\nPhysician fitness given\r\n\r\nCase plan;\r\nScheduled for Fasciotomy today.\nCase seen by Dr. Robert, \r\nPatient GC same. \r\nPt. afebrile\r\n\r\nAdvice: No fresh complaints\nSeen by Dr. Tom and team\r\nAC- 144mg%\r\nBP - 140/80mmHg\r\nGC better\r\nAfebrile.\r\nCheat is clear.\r\n\r\nCase plan:\r\nRestart Inj Clexane 0.4 OD\r\nRepeat counts, Serum electrolytes, SGOT, SGPT,Creat, Urea, CBC\r\nStop IV fluids.\r\nIntake 2 liters/day\r\nContinue rest\nSeen by Dr. Binu and team\r\nAC - 156mg%\r\ndoing well\r\nBP- 140/70mmHg\r\nCreat - 1.2\r\nTC -17000 (improving)\r\nUrine output: 2 liters\r\nNo fever.\r\nConstipated.\r\nSugars fair\r\n\r\nCase plan:\r\nContinue IV antibiotics.Chase tissue culture reports\r\nStop regular Paracetamol.\r\nTab Ultracet 1tab 1/2 before wound dressing.\r\nTab Dulcolax 2 tab STAT with 2 glass water.\nSeen by DrA.K.Bhat.\r\nAfebrile.C&D in OT tmrw.Continue trt.\r\n\r\nS/B Dr Anees\r\nnil spl\r\nGC fair,doing well\r\n\r\n6pm GRBS-179mg/dl\r\nInformed Dr Biju\r\nR-2\r\nN-6\r\n\r\nContinue same trt\nSeen by DR.A.K.Bhat.\r\nDressings changed.Clean ulcers lt leg and thigh.The posterior skin flapover distal tendoachilles region needs observation.Continue trt.\r\n\r\nSeen by Dr. Binu and team\r\nBP- 130/80mmHg\r\nPt better, no fever, Had pain during dressing today.\r\nClear urine.\r\nWell hydrated and cheerful.\r\n\r\n\r\nCase plan:\r\nInj Tramadol 50mg IV 1/2 an hour before next dressing.\r\nCBC,RFT tomorrow.\r\nTo keep Folley's for now.\r\nChase tissue cultures\r\n\nS/b Dr Anees\r\n\r\nnil spl,vitals stable\r\n\r\nGRBS-238mg/dl\r\nInformed Dr Laxmi\r\nR-8\r\nN-6\r\n\r\nContinue the same.\nSeen by DR.A.K.Bhat.\r\nContinue trt.C&D in OT tmrw.Oral antibiotics frm tmrw.\r\n\r\nSeen by Dr. Binu and team\r\nStable\r\nAfebrile\r\nFeels well.\r\nO/E:\r\nBP - 130/80mmHg\r\nGRBS - 188mg/dl\r\n\r\nCase plan:\r\nTo remove Catheter.\r\nChase todays blood reports and old tissue culture.\r\nIncrease Insugen N 6 units\r\n\nSeen by Dr. Tom and team\r\nBP - 120/80mmHg\r\nAC -195mg%\r\n\r\nCase plan:\r\nCap Dalacin 600mg 1-0-1. \r\nRepeat TC and Creat on monday. \r\nInj Insugen N 10 units at bed time s/c.\r\nInj Insugen R 8-8-8 units.\r\n\r\nSeen by DRA.K.Bhat.\r\nDressings changed.Clean.Continue trt.\nSeen by Dr Biju and Dr Robert.\r\nGC - better. \r\nAfebrile. AC - 155mg%. \r\n\r\nCase Plan:\r\nDressings tomorrow. \r\nRFT, TC tomorrow. \r\nInj Supridol 50mg IV 1/2 hr before dressings. \r\nChase tissue culture report.\nSeen by DrA.K.Bhat.\r\nContinue trt.Plan fr discharge on wednesday after dressings.\nSeen by Dr Binu and team.\r\nGC - better. BP - 110/80.\r\nAC - 164mg%, Afebrile. \r\nWound dressing today. \r\n\r\nCase Plan: \r\nInj Insugen R 8-10-8 units. \r\nInj Insugen N 12 units at bed time s/c.\r\nT. Metadoze 500mg 0-0-1.\nSeen by DrA.K.Bhat.\r\nDressings changed.Clean.\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\n\r\nSeen by Dr. Binu and team\r\nGC better\r\nPt is doing well. No new issues.\r\nAfebrile\r\nAC - 137mg%\r\n\r\nCase plan:\r\nReady to discharge but Pt wants to stay longer. Awaited tissue cultures. CBC tomorrow.\nSeen by Dr. Binu and team\r\nAC - 128mg%\r\nBP - 140/80mmHg\r\nCBC normal\r\n\r\nCase plan:\r\nContinue Dalacin 600mg 1-0-1\r\nTab Linazolid 600mg 1-0-1 \r\nPow Glucerna SR 3 tsp at night.\r\nInj Human mixtard 30/70 22-0-18units 1/2 an hr before food.\r\nAdvised alternate dressing.\r\nPlan to discharge today after consultation with Dr. Bhat.\r\nMetadoze IPR 500 1-0-1\r\nDiabetic educator to consult\r\nPhysio consult today.\r\nPantaprazole 40mg 1-0-0\nSeen by DrA.K.Bhat.\r\nC&D done.Clean ulcers leg.Adviced:Change of dressings once in 2 days jelonet/oxum gauze,pad,crepe bandage.Antibiotics 1 week.Review OP next friday 15th nov.\nSeen by Dr. Binu and team\r\nAC - 120mg%\r\n130/80mmHg\r\nPt wants to stay back for the sake for dressing.\r\n\r\nCase plan:\r\nContinue same\nSeen by DRA.K.Bhat.\r\nDressings changed.Clean ulcers.Continue trt.\nSeen by Dr. Binu\r\nBP - 130/80mmHg\r\nGC better\r\nAfebrile.\r\n\r\nCase plan:\r\nStop Tab Entavar\r\nContinue dalacin\r\nH.mixtard 18-0-16\r\nDressing today.\nSeen by Dr. Binu and team\r\nAC- 106mg%\r\nBP - 130/80mmHg\r\nGC better\r\n\r\nCase plan:\r\nAntibiotics -to ask Dr. Bhat.\r\nSeen by Dr.A.K.Bhat.\r\nContinue trt.Oral Antibiotics for 2 days.\nCase seen by Dr. Robert, \r\nPatient GC same, no fresh complaints\r\ntemp: afebrile\r\n\r\nAdv: Continue same medication\ns/B dRS.BINU AND rOBERT:\r\n\r\nNil active issues. Doing well. Stable\r\nBlood glucose stable.\r\n\r\nPlan:\r\nStop Dalacin\r\nContinue rest\r\n\nSeen by Dr. Binu and team\r\nGC better\r\n\r\nCase plan:\r\nContinue same\nSeen by Dr.A.K.Bhat.\r\nClean ulcers.Continue trt.\nSeen by Dr. Tom and team\r\nAC - 104mg%\r\nBP - 113/80mmHg\r\nDoing good, sugars well controlled.\r\nDressing done yesterday.\r\n\r\nCase plan:\r\nContinue same.\r\n\nSeen by Dr Tom and team. \r\nAC - 107mg%. \r\nNo fresh complaints. \r\nAfebrile. BP - 110/70. \r\n\r\nCase Plan:\r\nTo discuss with Dr Bhat regarding discharge and dressing. \r\nStop LMWH.\r\nPlan to discharge on friday. \r\n\nSeen by DrA.K.Bhat.\r\n16 days after fasciotomy.C&D done.Clean.Plan fr DC on friday.Then may need SSG later.\r\n\r\nEvening Rounds by Dr. Robert, \r\nPatient GC same, nil special\nSeen by Dr. Tom and team\r\nAC - 113mg%\r\nBP -130/80mmHg\r\nAfebrile \r\nGC better.\r\n\r\nCase plan:\r\nPhysio to supervise ambulating patient with the help of walker.\r\nPlan to discharge tomorrow.\nPlan to discharge today.\nSeen by DrA.K.Bhat.\r\nClean raw areas.Adviced:Change of dressings once in 2 days-jelonet,oxum gauze,pad,bandage.Review after 2 weeks in OP."}, {'role': 'model', 'content': '\nIP Number: 1935\n\nPatient Number: 13523\n\nAdmission Date: 23-10-2013\n\nDischarge Date: 15-11-2013\n\nDiagnosis: Necrotizing Fascitis Lt Leg.\r\nS/p Fasciotomy\n\nClinical Exam(With BP): {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 A known diabetic, presented to us with c/o pain, swelling and warmth on the Lt leg. OP doppler showed e/p thrombosis. Hence admitted for LMWH and anti-biotics. \r\n\\par }\r\n\n\nSystolic BP: 110.0\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 (24/10/13) - Normal Rt arterial study, Normal Lt AB index with elevated posterior tibial. Adequate toe pressure. \r\n\\par Vibro (24/10/13) - B/L Severe loss of vibratory perception.\r\n\\par Pus C/S (31/10/13) - No pathogen isolated in the culture. \r\n\\par Tissue Biopsy (29/10/13) - Suggestive of a Necrotizing Fascitis. \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 Afebrile. \r\n\\par BP - 130/70. \r\n\\par PR - 92/min. \r\n\\par Resp Rate - 22/min. \r\n\\par Systems - NAD. \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 year old male was admitted with lt lower limb edema with redness . He is a k/c T2DM . He was started on i/v antibiotics and LMWH . but the symptoms persisted and he developed blister over the left thigh too. Dr bhat opnion was taken and He advised fasciotomy with I& D of the blister. Inj. antibiotics including Inj. Linezolid, Dalacin , Biopiper were continued,Basal bolus insulin was also continued. As wound was better and there was sufficient control of infection, patient could be discharged on oral antibiotics.\r\n\\par }\r\n\n\nDiet: nan\n\nRemarks: If You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.'}] |
2,058 | [{'role': 'user', 'content': '\nIP Number: 2058\n\nPatient Number: 12346\n\nPatient Name: VALSALA M K \n\nGender: F\n\nDate of Birth: 06-08-1959\n\nAddress: MADAPPILLY H,\n\nPincode: nan\n\nPhNo: 8086066956\n\nAdmission Date: 22-11-2013\n\nDischarge Date: 09-12-2013\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nEssential (primary) hypertension\nDIABETIC NEPHROPATHY WITH MICROALBUMINUREA\nDIABETIC PERIPHERAL NEUROPATHY\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: Patient came with non-healing ulcer on the right foot.\n\nXray information: Pus C/S (24/11/13) - No pathogenic organism isolated in the culture. \n\nClinical examination: Temperature :98.6 °F\r\npulse :82 /min\r\nRespiration :22 /min\r\nBP :140 / 80 mm Hg\r\nL/E:\r\nLarge ulcer rt foot dorsum.Granulating well,except some areas of slough\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by DRA.K.Bhat.\r\nLarge ulcer rt foot dorsum.Granulating well,except some areas of slough.Edema present-needs observation.c/S taken.Adviced:Daily cuticell/oxum gauze dressing.IV monoscot.Leg elevation.\nSeen by DRA.K.Bhat.\r\nRaw area rt foot dorsum is clean and granulating.Option of SSG has been given.Adviced:Leg elvation.Daily cuticell,oxum dressing.\nSeen by Dr Binu and team. \r\nAC - 131mg%. \r\nURE, CBC, Creat report awaited. \r\nPus C/S sent, report awaited.\r\n\r\nCase Plan:\r\nT. Shelcal 1-0-0. \r\nfree T4 and TSH with morning reports. \r\nT. Macraberin P 0-0-1. \r\n\r\n\nSeen by DRA.K.Bhat.\r\nContinue trt.OPtion of SSG under SA has been given.\r\n\r\nCase seen by Dr. Tom and Dr. Robert, \r\nPatient slept well, c/o mild pain. \r\nPassed stools. \r\nFBS:130, BP:110/90mmhg\r\nCase Plan: Cleaning and Dressing\ns.b dr anish\r\npt gc better \r\nno fresh complaints\nSeen by DRA.K.Bhat.\r\nDRessings changed.Ulcer rt foot dorsum granulating.Plan fr SSG under SA on Thursday 28th nov..Preop:Daily dressing.Leg elevation.Medical fitness for proposed procedure.BT,CT,PT,LFT,ECG,CXR PA,Screening tests.\nSeen by Dr. Binu and team\r\nBP - 110/70mmHg\r\n\r\nCase plan:\r\nT. Metadoze IPR 850mg 1-0-1\r\nT. Amaryl 1 mg 1-0-0\r\nT. X-tor 10mg 0-0-1\r\nMay plan for SSG, by Dr. Bhat\nSeen by DRA.K.BHat.\r\nDaily dressing cuticell,oxum.\nseen bydr anish\r\npt complaints of pain \r\nadv: t. ultracet after food\nSEEN BY DR FEBA \r\nC/O MILD PAIN IN THE WOUND\r\nPATIENT OTHERWICE STABLE\r\nGC GOOD\nSeen by DR.A.K.Bhat.\r\nFor SSG under SA on 28th nov.Preop:Nil oral as per anesthetist advice.Consent.IV antibiotics.C&D.BEtadine scrub both thighs HS&CM.Medical fitness.\r\n\r\nGC fair\r\nAfebrile\r\n\r\nCase plan:\r\nPlan for SSG tomorrow\r\nInj Basalog 6 units at bed time.\nGC : fair\r\nBP- 110/80mmHg\r\nAC- 116mg%\r\n\r\nCase plan:\r\nTo be taken up SSG today at 3pm. And NPO from 12noon.\r\nInform GRBS pre-lunch\r\nInj. DNS with 6units insulin IV while NPO.\r\nPhycian fitness to be given by Dr. Manoj.\r\nSyp. Looz 30ml HS to be continued.\nseen by duty dr.sadique patient general condition satisfactory, vitals stable,continue same medication\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\n seen by duty dr.sadique. general condition better now, no fresh complaints, vitas stable. continue same treatment\nSeen by Dr. Binu and team\r\nBP - 110/70mm Hg\r\nAC - 89mg%\r\n\r\nCase plan:\r\nStop Ultracet.\r\nInj Clexane 0.4 s/c 1-0-0\r\nContinue rest\r\n\n7.18 PM\r\nSEEN BY Dr FEBA\r\nC/O MILD PAIN RIGHT THIGH\r\nGC GOOOD VITALS STABLE\r\nCONTINUE MEDICATIONS\nSeen by Dr Binu and team. \r\nAC - 115mg%, predinner - 182mg%.\r\nDidnot pass stools. \r\nGC - better, Afebrile. Mild pain. \r\n\r\nCase Plan:\r\nDulcolax suppository stat. \r\nContinue rest. \r\n1 pillow elevation for both legs. \r\nStop IV antibiotics. Remove cannula. \r\nT. Xpand 625mg 1-0-1.\nCase seen by Dr. Lakshmi \r\nVitals stable, c/o mild pain. Sugar controlled\r\nAdvice: Syrup. Looz 30 ml BD, \r\nContinue the same medication\nseen by dr anish\r\npt complains of pain \r\nadviced t. welcet\nSEEN BY Dr FEBA\r\nGC GOOD \r\nNIL SPECIAL\r\nCONTINUE MEDICATIONS\nSeen by Dr. Binu and team\r\nBP - 110/80mmHg\r\nAC - 97mg%\r\nNo new issues\r\n\r\nCase plan:\r\nStop Inj Basalog\r\nContinue rest\r\n1st opening today.\r\nSeen by DRA.K.Bhat.\r\nDressings changed.SSG taken up.Continue trt.\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\nSeen by Dr. Tom and team\r\nBP - 110/70mmHg\r\nAC - 104mg%\r\nVomitted once\r\n\r\nCase plan:\r\nTab Axiplex 1-0-0\r\nECG, Hb today.\nseen by dr anish\r\nno fresh complaints vitals good\r\n\nPatient seen\r\nNil special\nSeen by DRA.K.BHat.\r\nContinue trt.\r\n\r\ns/b dr.radha/manoj/biju\r\n\r\nAC-132\r\nstill feels lethargic\r\nHb-10.6\r\n\r\ncase plan\r\nGlucerna/D-Protein \r\nplan for disharge after podiatry review\r\ntab.lonazep 0.25 0-0-1\r\n\n6.30 PM\r\nSEEN BY Dr FEBA \r\nGC GOOD NIL SPECIAL\r\nCONTINUE THE MEDICATIONS\nSeen by DRA.K.Bhat.\r\n7th Postop. day,C&D done.SSG settling.Continue trt.\r\n\r\nSeen by Dr. Radha and team\r\nAC - 116mg%\r\nBP - 100/60mmHg\r\nDressing changed \r\nGC better\r\n\r\nCase plan:\r\nContinue same\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n8.20pm : Patient comfortable. no fresh complaints. GC: good. vitals stable\ns/b Dr binu\r\nnil special\r\nvitals stable\r\nslept well\r\ncase plan \r\nstop clexane\r\ncont rest\nSeen by Dr. Binu and team\r\nBP - 100/60mmHg\r\nAC - 127mg%\r\nVitals stable. \r\n\r\nCase plan;\r\nPlan to discharge on monday after dressings.\r\nSeen by DRA.K.Bhat.\r\nContinue trt,.Plan fr DC on monday.\nstool for occult blood\r\nstart Tab ferox XT 1-0-0\nPatient seen\r\nC/O pain Right heel\r\nGC good\r\nADVICE\r\nT Paracetamol 500mg SOS\nSeen by DRA.K.Bhat.\r\nContinue trt.For DC tomorrow.\r\n\r\ncase seen by Dr. Radha, \r\nno fresh complaints, \r\npatient general condition the same, slept well\r\nGRBS:107mg/dl\r\n\r\nCase Plan: Continue same medication\nS/b dr.binu and team\r\nc/o giddiness\r\nburning micturition\r\n \r\nO/E:\r\nnystagmus+ (towards right0\r\n\r\ncase plan:\r\nurine r today\r\nStop Tab Ultracet Lonazep\r\n\r\n\nSeen by DRA.K.Bhat.\r\nDressings changed.SSG taken up.Donor site healed.Adviced:Dressing rt foot once in 2 days-cuticell,pad,crepe bandage.Oil application rt thigh for 1 month.Review wednesday OP after 2 weeks.'}, {'role': 'model', 'content': "\nIP Number: 2058\n\nPatient Number: 12346\n\nAdmission Date: 22-11-2013\n\nDischarge Date: 09-12-2013\n\nDiagnosis: nan\n\nClinical Exam(With BP): {\\rtf1\\ansi\\ansicpg1252\\deff0{\\fonttbl{\\f0\\fnil\\fcharset0 Times New Roman;}}\r\n\\viewkind4\\uc1\\pard\\lang1033\\f0\\fs24 Patient came with non-healing ulcer on the Right foot \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 (24/11/13) - No pathogen isolated 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 :98.6 \\'b0F\r\n\\par pulse :82 /min\r\n\\par Respiration :22 /min\r\n\\par BP :140 / 80 mm Hg\r\n\\par \r\n\\par Large ulcer rt foot dorsum.Granulating well,except some areas of slough\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 54 year old female patient and k/c/o DM and HTN was admitted with non-healing ulcer on the dorsum on the right foot. Split Skin Graft was done under spinal anaesthesia on 28/11/13. The graft is taken up well and the donor site is healing. Dressings were given periodically and BSL were monitored and kept under tight control. She is discharged in a stable condition and advised to review as outpt.\r\n\\par }\r\n\n\nDiet: nan\n\nRemarks: If You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor."}] |
2,443 | [{'role': 'user', 'content': '\nIP Number: 2443\n\nPatient Number: 10434\n\nPatient Name: MARY CHAKKAPPAN\n\nGender: F\n\nDate of Birth: 03-04-1956\n\nAddress: CHITTILAPPILLY HOUSE\n\nPincode: nan\n\nPhNo: 0484 2786978\n\nAdmission Date: 07-03-2014\n\nDischarge Date: 21-03-2014\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC PERIPHERAL NEUROPATHY\nMixed hyperlipidaemia\nEssential (primary) hypertension\nUrinary tract infection, site not specified\nTYPE 2 DIABETES MELLITUS\nPeripheral vascular disease, unspecified\nDIABETIC NEPHROPATHY WITH CRONIC RENAL FAILURE\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: 57 yr old lady c/o redness, swelling and pain over the right foot since 5 days.\r\n\r\nImpression:\r\nDM type 2\r\ncellulitis rt foot\r\n\r\nCare plan:\r\nAdmission\r\nIV antibiotics\r\nSurgery consultation.\n\nXray information: ECG (12/03/14) - Normal Axis, Sinus Rhythm, No ST- T changes. \r\nPus C/S (12/03/14) - Scanty growth of Staph Aureus. \r\nVersa (10/03/14) - B/L arterial ds, Mild Lt arterial ds. Moderate Rt arterial ds. \r\nVibro (10/03/14) - B/L Severe loss of vibratory perception. \r\nPBF (11/03/14) - Normocytic, Normochromic anemia (Hb 8.5gm%) with neutrophil leukocytosis. \n\nClinical examination: BP: 120/70mmHg\r\nPR: 78/min\r\nChest: clear\r\nCVS:S1S2 heard.\r\nLocal examination of right leg:\r\nEdema and redness of dorsum of foot exteding above the ankle.Local rise of temp +,tenderness+.\r\nLeft leg: normal.\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by DrA.K,.Bhat.\r\nIntertrigo rt 2nd and 3 rd web spaces of foot.??deeper necrosis.Cellulitis of foot present.Distal pulsations present.Adviced:Tbact between toes tds.IV antibiotics.leg elevation.\r\nT. ULTRACET SOS\r\n\r\nseen by dr anish\r\npt had fever temp 101\r\nadv t. welset stat\nSeen by Dr. Radha, Dr. Lakshmi, Dr. Manoj and Dr. Biju\r\nSugars well controlled\r\nGC better\r\n\r\nBP: 110/70mmHg\r\nAC:113mg%\r\n\r\nCase plan:\r\nTC, Creat tomorrow.\r\nSeen by DRAKBhat.\r\nBlister 2nd and 3rd web spaces of rt foot, deroofed.Aspiration only serosanguinous fluid-C/S taken.?Deeper necrosis.May need I&d under LA.Will decide tmrw.Continue trt.\r\n\r\nStool for occult blood and PBF (As per Dr.Lakshmis orders)\nseen by Dr. Divya \r\nPatient has no specific complaints \r\nVitals - stable\nSeen by DR..AK.Bhat.\r\nFor Rt foot I&D and slough excision under LA ,OT ,10 th march 1 pm.Xray rt foot AP&OBL.Versalab.Vibro.Consent.IV antibiotics.C&D.\r\n\r\nCase seen by Dr.Lakshmi \r\nSpiked fever yesterday night.\r\nCreat 1.7\r\nCounts same \r\nRedness,swelling +\r\n3rd and 4th toe infected.\r\nCase plan\r\nRepeat creat,stool occult blood.\r\nHold Clopivas.\r\nStopInj. Monoscot,T.Vogli\r\nT.Glyciphage 500mg BD\r\nINj Dalacin TID\r\nInj.Biopiper 1-0-1\r\nInsugen R 10-10-10\r\nInsugen N 18Units\r\nSyp LooZ 15ml\nSeen by Dr. Divya\r\nPassed stools.\r\nNo specific complaints\r\n\r\n( 9/3/14) \r\n TC - 18,400\r\nStool occult blood - POSITIVE\r\n S. Creat - 1.7\nNO SPECIFIC COMPLAINTS\r\nPATIENT FEELS BETTER\nSeen by Dr Tom and team. \r\nGC - status Quo. \r\nScheduled for I & D with slough excision today under LA. \r\nVersa done - B/L arterial disease. \r\nVibro - B/L Severe neuropathy. \r\nStool OB +ve. \r\nPain : 4/5. BP - 160/80. \r\n\r\nCase Plan:\r\nPBF report awaited. \r\nI & D with slough excision under LA today. \r\nInj Insugen N 14 units at bed time s/c.\r\nArrange for 2 PRC, transfuse 1 PRC today. \r\nStop Clopivas. \r\nT. Nebilong 5mg 1-0-0. \r\nContinue rest.\nS/B Dr.Rebecca\r\nc/o of increased sweating.fatigue+\r\nvomiting+.\r\nECG taken -WNL\r\nGRBS-100mg/dl\r\nspeech-mildly slurred \r\ns.electrolytes sent\nSeen by DRA.K.BHat.\r\nPain.No soakage.Swelling decreased.Continue trt,.\r\n\r\nSeen by Dr Ajish and team. \r\nI & D done yesterday. \r\nAC - 98mg%. 1 unit of PRC given. \r\nNo more vomiting. \r\n\r\nCase Plan:\r\nChase Pus C/s reports. \r\n1 units of PRC today. \r\nPlan to discharge after one more dressing. \r\nT. Axipan 40mg 1-0-1\r\nWill shift to twice daily premixed insulins by discharge, \r\nInj Insugen R 8-8-8 units 1/2 hr before meals s/c.\r\nInj Insugen N 14 units to continue.\n3 15 pm\r\nStart Inj lineZolid 600mg BD (verbal orders from Dr.Laksmi\r\nno specific complaints\nCase seen by Dr.Radha and Dr.Manoj.\r\nPain score 4/5.\r\nVomiting and nausea yesterday midnight.\r\nAC 109mg%\r\no/e\r\ndehydration\r\n\r\nAdvice\r\nT.Revera D OD\r\nT.Nitrest HS\r\nCap.Tramadol 50mg 1-0-1\r\nSyp.Sucralfil 15ml TDS\r\ninj pactiv SOS\r\nInj.Clexane 0.4 s/c od\r\nIVF- 500ml NS @75ML/HR\r\n plan to add alainezolid after c/s\r\nstop Metformin.\r\nSeen by DRA.K.Bhat.\r\nC&D done.Ulcer viability needs observation.Pus and swelling decreased.Continue trt.\nS/B Dr AKHIL \r\nGC FAIR \r\nVITALS STABLE \r\nTEMP:\r\nPR:\r\nBP:\r\nRS:CHEST CLEAR\r\nCVS:S1 S2 HEARD NO MURMUR\r\nNO FRESH COMPLAINTS\r\n\r\nrepeat serum electrolyte at 9pm \r\n\r\nURINE ROUTINE\r\nalbumin +\r\nPUS CELL 20-25hpf \r\ninformed Dr lakshmi \r\nadvised \r\ntab nitrofurantoin 100mg 1 stat\nSeen by DrA.K.Bhat.\r\nPain is less.No soakage.Continue trt.\r\n\r\nSeen by Dr. Ajish and team\r\nGC better\r\n\r\nPain score: 1/5\r\n\r\nAC-189 mg/dl\r\nBP-170/100 mmHg\r\n\r\nCase plan:\r\nHold Inj Clexane\r\nTab Tramadol SOS\r\nRepeat Creatinne/tc/electrolytes/Hb today\r\nstrict I/O chart\r\n\nSeen by Dr. Tom and team\r\nGC better\r\nAfebrile\r\n\r\nPain score: 0/5\r\n\r\nAC: 105mg%\r\nBP: 190/90 mmHg\r\nCreatinine: 3.2 mg/dl\r\n\r\nCase plan:\r\nURE, CBC tomorrow\r\nContinue antibiotics\r\nTab Cranpac 300mg 1-0-1\r\n200ml 3% NS @ 20ml/hr.\r\nPhysio for mobilization of left limb\r\nRestart Clexane 0.4 s/c OD\r\nNephro consult\nSeen by DrA.K.Bhat.\r\nDressings changed.Ulcer slough present.Swelling dorsum of foot.Plan fr slough excision under SA with risks of PVD/nonhealing explained.Continue trt.\r\nnephrology consultation sought( s.creat 3.1 mg/dl)\r\nNO specific complaints\nPt seen. no fresh complaints.\nThanks for the referral:\r\nS/B Dr Sooraj\r\n-----------------\r\nProblems:\r\nDM, Hypertension, DR, DN\r\nAcute on CKD \r\nprobably secondary to infection\r\n\r\nhas dropping HB levels, worsening hyponatremia\r\nurine output fair\r\nno volume overload\r\n\r\nno back pain.\r\nSuggest:\r\n1. USG abdomen+PVRU(Dr Amita)\r\n2. Tab Sobisis 1-1-1\r\n3. May convert from Razo D to Pantoprazole 40 mg 1-0-1\r\n4. treatment of infection\r\n5. Correctkion of hyponatremia. Tab Natrise 15 mg 1-0-0\r\n3% saline in addition\r\nSyp Sucrafil 10 ml tds before food\r\n\r\nDaily urea creat, repeat urine routine \r\nserum iron profile, peripheral smear to be sent.\r\n------------\r\nSeen by DRA.K.Bhat.\r\nDressings changed.Betadine oint,cuticell.\r\nSlough filled ulcer.Needs slough excision under SA.\r\n------------------------------------------------------------------\r\nSeen by Dr. Radha/Dr. Manoj/Dr. Biju\r\nGC better\r\nCellulitis decreased, but wound is slough filled\r\n\r\nPain score: 1/5\r\n\r\nCreat: 2.7 mg/dl\r\nAC: 117 mg/dl\r\nBP: 180/80mmHg\r\n\r\nCase plan:\r\nStop Dalacin\r\nUSG Abdomen on tuesday\nSeen by DrA.K.Bhat.\r\nAfebrile.Pain.Stomatitis.T.Yoghut.Cap.Cardioplus.Continue trt.\r\n\r\nSeen by Dr Biju. \r\nAC - 106mg%. Feels very weak. \r\nBP - 160/90. Afebrile. \r\nDisturbed sleep. seen by Dr Bhat in the morning. \r\nAphthous ulcers. loss of appetite. \r\nPain Score - 2/5.\r\n\r\nCase Plan:\r\nHb, TC coming morning. \r\nWill review the wound tomorrow and plan on slough exicision/debridement. \r\nC. Yogut 1-0-1. \r\nC. Cardioplus 1-0-0. \r\nBP monitoring 4th hrly. \r\nContinue rest.\nSeen by Dr Tom and team. \r\nAC - 80mg%. GC - Status Quo. \r\nBP - 160/90. \r\nChest - clear, TC - 15.400, Creat - 2.4mg%. Urea - 19mg%. \r\nPain Score - 2/5, episodic. \r\n\r\nCase Plan:\r\nRepeat S. Elect. \r\nT. Cilacar 10mg 1-0-0\r\nSaline Gargles. \r\nInsulin doses adjusted. \r\nInj Insugen R 6-6-6, Inj Insugen N 12 units at bed time s/c.\r\nSyp Digiplex.\nSeen by DrA.K.Bhat.\r\nDressings changed.Slough present,.Swelling &redness decreased.Conservative chemical debridement versus surgical debridement in the background of ischemia and time for healing has been discussed.Adviced:Arterial doppler.\\\r\n\r\nSEEN BY DR ANISH\r\nPT COMPLAINS OF PAIN \r\nTAB ULTRACET STAT\r\n\nseen by dr anish\r\nbt complains of pain \r\nt tramadol given stat.\r\n\r\nSeen by DRA.K.Bhat.\r\nDressings changed.Ulcer slough needs observation.Arterial doppler normal.?Oral antibiotics.\r\n\r\nSeen by Dr. Radha/ Dr. Lakshmi/Dr. Manoj/Dr. Biju/Dr. Deba\r\nGC better\r\n\r\nPain score: 2/5\r\n\r\nCreat: 2.2 mg/dl\r\nAC: 81 mg/dl\r\nBP: 170/90mmHg\r\nUSG Abdomen: Significant PVRU\r\n\r\nCase plan:\r\nHb, TC, electrolytes, Creat\nseen by dr anish\r\npt complains of pain a\r\n\r\nadv t ultracet at night\nSeen by Dr. Radha and Dr. Debasweta\r\nGC better\r\nHard palate moniliasis/candidiasis\r\nNo vertigo\r\nElectrolytes better\r\nTC come down\r\n\r\nPain score: 0/5\r\n\r\nBP:160/80 mmHg\r\nAC: 87 mg%\r\n\r\nCase plan:\r\nDietician to visit\r\nDr. Anuradha to see\r\nCandid mouth paint and dentogel to continue\r\n\r\n\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\npatient has no fresh complaints\nSeen by DR.A.K.Bhat.\r\nDRessings changed.Ulcer progress needs observation.Adviced:Change of dressing once in 2 days-tbact,intrasite gel,cuticell.Offloading of forefoot.Oral antibiotics 2 weeks.Review OP 1 week.-FRiday 28th friday.\r\n\r\nPatient had itching in both thigh folds.\r\nDr.Radha adviced Candid B cream for L/A.\nSeen by Dr Ajish and team. \r\nAC - 98mg%. GC - better. \r\nCreat - 2.2mg%. Afebrile. \r\nS. Iron - 37. \r\n\r\nCase Plan:\r\nS. Calcium tomorrow. \r\nINS.Novomix Flex pen (30/70) 15-0-10\r\nTab.Gemcal 500 0-0-1\r\n\nSeen by Dr. Radha/ Dr. Lakshmi/Dr. Manoj/Dr. Biju\r\nGC better\r\n\r\nPain score: 0/5\r\n\r\nAC: 157 mg%\r\nBP: 170/90mmHg\r\n\r\nCase plan:\r\nPlan to discharge today\r\nSaline Gargles\r\nNa, Urea, Creat, TC on review'}, {'role': 'model', 'content': '\nIP Number: 2443\n\nPatient Number: 10434\n\nAdmission Date: 07-03-2014\n\nDischarge Date: 21-03-2014\n\nDiagnosis: Old CVA.\r\nRight Foot Cellulitis with Non Healing Ulcer.\n\nClinical Exam(With BP): 57 yr old lady c/o redness, swelling and pain over the right foot since 5 days.\r\n\r\nImpression:\r\nDM type 2\r\ncellulitis rt foot\r\n\r\nCare plan:\r\nAdmission\r\nIV antibiotics\r\nSurgery consultation.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: ECG (12/03/14) - Normal Axis, Sinus Rhythm, No ST- T changes. \r\nPus C/S (12/03/14) - Scanty growth of Staph Aureus. \r\nVersa (10/03/14) - B/L arterial ds, Mild Lt arterial ds. Moderate Rt arterial ds. \r\nVibro (10/03/14) - B/L Severe loss of vibratory perception. \r\nPBF (11/03/14) - Normocytic, Normochromic anemia (Hb 8.5gm%) with \r\nneutrophil leukocytosis.\r\nFerritin (18/03/14) - 275.1ng/ml. \r\nTIBC - 190 ug/dl\r\nArterial Doppler Rt Leg (18/03/14) - Subcutaneous soft tissue edema noted in the Rt lower leg. Multiple Rt inguinal Lymph Nodes of 11-15 mm. Right anterior tibial and dorsalis pedis show normal flow with spectral widening. \r\nUSG Abd & Pelvis (18/03/14) - Fatty change liver, Significant post void residue (40cc).\n\nXray findings: BP: 120/70mmHg\r\nPR: 78/min\r\nChest: clear\r\nCVS:S1S2 heard.\r\nLocal examination of right leg:\r\nEdema and redness of dorsum of foot exteding above the ankle.Local rise of temp +,tenderness+.\r\nLeft leg: normal.\n\nDiscussion: 57 year old diabetic female with history of CVA was admitted with redness,pain and swelling of right foot for 5 days.Suspecting cellulitis with ?necrotisin facitis IV antibiotics were started.Podiatry surgeon examined the patient and suggested debridement.I&D was done and the the surgeon told the infection is extending into deeper layers.Pus culture came and the antibiotics were changed accordingly.2 units of PRBC was transfused and anaemia was corrected.Initially the wound was not improving significantly,hence surgeon planned re-exploration.Renal parameters were not good initially.Nephrology consultation was done.After changing the antibiotic signs and symptoms improved.Wound became healthy and the plan for re-exploration was dropped.Patient had malena and oral anti-platelets were stopped.Prophylactic dose of Low molecular weight heparin was given in view of risk of DVT nad old CVA.Before discharge stool OB was repeated and the stool OB became trace. She improved symptomatically and she is discharged in a stable condition and advised to review as outpt.\n\nDiet: nan\n\nRemarks: If You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\n'}] |
2,589 | [{'role': 'user', 'content': '\nIP Number: 2589\n\nPatient Number: 16323\n\nPatient Name: THRESIA\n\nGender: F\n\nDate of Birth: 09-04-1930\n\nAddress: INCHACKAL HOUSE\n\nPincode: nan\n\nPhNo: 4842464804\n\nAdmission Date: 09-04-2014\n\nDischarge Date: 28-04-2014\n\nDiagnosis determined by the doctor when the patient was admitted: Essential (primary) hypertension\nPeripheral vascular disease, unspecified\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: C/O non healing ulcer in left foot-3yrs\r\nPast CVA\r\nH/O Polycythemia Rubra Vera,HTN\r\n\r\nIMP:Non healing Ulcer\r\n\r\nCarePlan:\r\n\r\n\n\nXray information: Atherosclerotic changes B/L lower limb arteries.\r\nOcclusion in right common femoral artery.\r\nStenosis(approx 88%)in left common femoral artery\r\nComplete occlusion of B/L superficial femoral artery and left popliteal artery.\n\nClinical examination: Pallor+\r\n\r\nSystemic Exn:WNL\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by DRA.K.Bhat.\r\nLeft foot ischemic infected ulcers with previous h/o foot amputation.C/S taken.Advice:IV MOnoscot.Xray left foot AP&obl. including ankle.CXR PA.ECG.BT.CT,PT,INR,.Daily betadine,jelonet dressing.\r\n\r\nS/b Dr benji\r\nvitals stable\r\nNo fresh complaints\nSeen by Dr.Ajish,Dr.Radha and Dr.Manoj.\r\n\r\nC/O non healing ulcer-left foot-3 yrs\r\nOld CVA,Known Hypertensive\r\n\r\nCase plan:\r\nCBC,LFT<RFT,S.Electrolytes,HbA1C,Urine R/E\r\nAntibiotics after Dr.Bhatt consultation.\nSeen by DRA/K.Bhat.\r\nContinue trt.Daily dressing betadine cuticell.\r\n\r\nS/b Dr benji\r\nVitals stable\r\nNo fresh complaints\r\nCont. same\ns/b dr.radha/manoj\r\n\r\ngeneral condition better than yesterday\r\nCXR P/A-upper mediastinal widening eith trachea pushed to right side /unfolding of aorta\r\nTSH-1.10\r\n\r\ncase plan\r\nCXR lateral view\r\nplan to do CT thorax after discussion\r\nto continue same\r\n\r\n\nS/b Dr Benji\r\nVitals stable.\r\nNo fresh complaints.\r\nCont. same\nSeen byDr. Tom and team\r\nGC better\r\nPain score : 1/5\r\nPain on the wound side\r\nAC: 90 mg/dl\r\nBP: 130/80mmHg\r\n\r\nCase plan:\r\nStop Clopilet\r\nCT scan reports awaited\r\nBlood sugars to be done Pre-dinner and Fasting (Glucometer)\r\nBedside Echo today.\r\nCBC, electrolytes tomorrow. \r\nInform relatives about the need of amputation (below knee )on Wednesday\r\ncase s/b dr JIJO\r\ncase of ischemic limb Lt with infected non healing ulcer Lt foot.\r\nadv\r\ndoppler study tomorrow.\nSeen by Dr Manoj. \r\nAC - 63mg%. \r\nArterial Doppler Lt - No flow seen in Lt common femoral downwards. Multiple Lt inguinal LN. \r\nTC - 15700. K - 5mEq/L. \r\n\r\nCase Plan:\r\nHave discussed the management and gaurded prognosis with the bystanders.\r\nTo discuss with ortho surgeon regarding surgery plan.\npt seen. no fresh complaints.\nSeen by Dr Biju and Dr Deba. \r\nAfebrile. Good energy levels, \r\nCheerful. \r\nScheduled for BKA on wednesday provisionally.\r\nPus C/S - Heavy growth of Pseudomonas. \r\n\r\nCase Plan:\r\nArrange 2 units FFP, 2 units whole blood. \r\nContinue IV antibiotics. \r\nCBC, BT, CT, Blood Gp, Electrolytes, Creat.\npt seen. no fresh complaints\nS/b Dr sanjana.\r\nPreop orders for 16/04/2014:NPO 8hrs.Inj axipan & Inj emset.\r\nInv required-Hb,PT,INR,Na,K\r\nInformed consent.\r\n\r\n\r\nS/b Dr Benji\r\nVitals stable\r\nNo fresh complaints\r\nCont. same\nSeen by Dr. Manoj and Dr. Debasweta\r\nGC better\r\n\r\nPain score: 3/5\r\nBP: 120/70 mmHg\r\nO/E:\r\nNoticed small wound on the rt little toe (t-bact dressing given)\r\n\r\nCase plan:\r\nScheduled lt lower leg amputation on Wednesday.\r\nFFP and whole blood /PRBC to arrange.\nBP-140/80mmhg\r\nPallor +\r\nPosted for BKA (L) tomorrow\r\nNoticed mild hb fall from 10.1 to 8.6\r\nAll systems WNL\r\n\r\nCase Plan:\r\nStool for occult blood\r\nRepeat CBC,Hb,PT,INR,TC,Na,K,Plt count\r\nArrange 2 pints PRBC to transfuse during intra-op and post-op\r\nMonitor BP Q6H\r\nTo give T.Losar 25mg in the evening if BP> 150/90mmhg\nS/b Dr benji\r\nVitals stable\r\nNo fresh complaints\r\n\r\nStool OB:Positive\nPOSTED FOR BK Amputation under SA At 1.30 PM\r\nNPO from 5 am\r\ninj monoscot 1gm tid to continue\r\ninj amickacin 250 mg after induction.\r\ninformed high risk consent\r\ninform OT/Anesthetist\r\nINJ DNS 1pint maintainance.\r\nbetadine peparation.\r\ninform sos.\r\n\r\ns/b dr.tom/manoj\r\n\r\nposted for BKA today \r\n\r\nBP-160/80mmhg\r\nHb-8.8.4lakhs\r\nNa-143\r\nPotassium-4.7\r\n\r\nTC-15700\r\nP-80%\r\nplt-7.4\r\n\r\ncase plan\r\nTab.Cilacar 10 1 stat\r\n\r\n\ncase s/b Dr Jijo\r\npt consious .\r\nno sockage , vials stable.\r\nsuction drain in situ and working.\r\nchest clear.\r\non transfusion\r\ngood output\r\nadv\r\ninj monoscot to continue\r\ninj amickacin 250 mg bid\r\ninj dns maintainance\r\ninj midazolam 1 mg slow IV SOS.\r\nTAB VOLTAFLAM 50 MG 1-1-1\r\nTAB AXIPAN 40 MG 1-0-0\r\nTAB THRIZE 1-1-1\nS/b Dr Benji\r\nHb-10.7\r\nUrine output-2300ml\r\npatient was agitated.Neomol IV infusion was given\r\n\r\nS/b DrManoj/Dr.Radha\r\nBP-150/90mmhg\r\nVitals stable\r\n\r\nCare plan:\r\ninj.PanZac IV BD\r\nStop Clopilet\r\nShift to room after consultation with Dr.Jijo\nS/b Dr Benji\r\nNo fresh complaints\r\nVitals stable\r\nCont. same\r\ncase s/b Dr Jijo\r\nAdv\r\ncontinue same\r\ntab acuvin 1 sos.\r\ninj ketrol im sos.\r\ninj midazolam 1 mg slow IV\nS/b Dr.Shahin\r\nPatient c/o pain over amputated stump\r\nUrine output - 200ml\r\nBP-140/80mmhg\r\n\r\nInj.neomol slow IV stat\r\nInj.lasix 10mg IV stat\r\nMonitor BP\r\nRpt urea,creatinine\r\n\r\npt seen by Dr.Farook. C/O pain\ns/b Dr Radha\r\nc/o pain over the amputated stump\r\nurine output- 750ml\r\nBP 150/80mmHg\r\ncase plan \r\nTab yogut 1-0-1\r\nct same treatment\r\ncase s/b Dr Jijo\r\nwound inspection done\r\nwound clean\r\ndrain removed.\r\npt drowsy.\r\nINJ NEOMOL SLOW IV SOS. \r\nadv\r\ncontinue same\r\ninj DNS 2 PINT DAILY.\nSeen by Dr. Radha/Dr. Manoj/Dr. Shahin\r\nGC better\r\nWell hydrated\r\n\r\nPain score: 1/5\r\nBP: 150/70mmHg\r\nCase plan:\r\nRepeat electrolytes\r\nStrict I/O chart\r\nCase seen by Dr Jijo\r\npt oriented\r\nGC better.Gaseous distension +\r\nADV\r\ntab zinetac 150 mg 1-0-1\r\nplenty of oral fluids.\nSeen by Dr.Shahin\r\nC/O itching and rash in the genital area\r\nAdvised to keep area clean and dry\r\nCandid powder for LA\r\n\r\n7:00pm\r\nPatient febrile\r\nTemp: 99.6\r\nTab.Welset stat\r\nCASE S/B Dr Jijo\r\npt cosious drowsy.\r\nDehydration +\r\noutput- 650 ml since morning.\r\nADV\r\nINJ DNS 2 PINT DAILY MAINTAINANCE.\nC/o Fever,mild pain\r\n\r\nT.Acuvin 1 stat\nseen by dr farook\r\nurine output- 750ml\r\nBP 140/80mmHg\r\nAfebrile\r\nNo fresh complaints\r\ns/b Dr radha \r\ni/o-2300ml/1400ml\r\nBP 140/70mmHg\r\nPain 1/5\r\ncomfortable\r\ni/v fluids sos\nSeen by DRA.K.Bhat.\r\nLeft leg BKA stump suture line is clean.Continue dressings and symptomatic treatment.\r\n\r\nS/b Dr benji\r\nVitals stable\r\nNo fresh complaints\r\nCont. same\nSeen by Dr Tom and team. \r\nAC - 89mg%. \r\nTemp - 99.5F. No fresh complaints. \r\nChest - mild crepts. \r\nHb - 10.2gm%, TC - 12700.\r\n\r\nCase Plan:\r\nInj Levoflox 500mg IV OD.\r\nDr Bhat consultation.\nSeen by Dr.Ajish and team\r\n\r\nCase Plan:\r\nCBC, S. Elect\r\nCase s/b Dr Jijo\r\nPt drowsy.\r\nADV\r\ncont same\r\ntab ecospirin 75 mg 0-1-0\r\n\nSeen by Dr.Deba\r\n\r\nPatient is conscious and well oriented.GC good.Vitals stable.\r\nCASE S/B Dr JIJO\r\nCONSIOUS AND ORIENTED\r\nmild dehydration + drowsy\r\nhad oral feeds.\r\nADV\r\ncontinue same.\r\ndressing tomorrow.\nSeen by Dr.Shahin\r\nPatient comfortable\r\nNo fresh complaints\ns/b dr.tom/team\r\n\r\npain-0/5\r\nNa-129\r\n\r\ncase plan\r\n\r\n[Planning for discharge today\r\nTab.Hyponat 1-0-1 \r\nsalt added diet\r\nRemove catheter after getting bladder sensation\r\nTab.Levofloxacin 500 1-0-0 x 7 days\r\n\r\n\nSeen by Dr Ajish and team. \r\nGC - better, conscious, oriented. \r\nBP - 130/80. Afebrile. \r\n\r\nCase Plan:\r\nT. Hyponat 30 1-0-0. \r\nT. Levostra 500mg 1-0-0. \r\nT. Axipan 40mg 1-0-0. \r\nContinue same treatment. \r\n\nS/b Dr Benji\r\nVitals stable\r\nNo fresh complaints\r\nCont. same\nSeen by Dr Tom and team. \r\nDoing well, Mild pain. \r\nPain score - 1/5. Afenrile. \r\nPassed stools. \r\nGC - stable. BP - 150/80\r\n\r\nCase Plan:\r\nC & D as advised. \r\nPhysiotherapy daily. \r\nContinue same. \r\nPlan for discharge on monday.\nS/b Dr Benji\r\nVitals stable\r\nNo fresh complaints\r\nCont same\nSeen by Dr Radha. \r\nGC - fine. Afebrile. \r\nNo pain. Dry dressings. \r\n\r\nCase Plan:\r\nContinue same. \r\nPlan to discharge on monday.\nS/b DR Tom & Dr Benji\r\nSlept well\r\nPassed stools\r\nPain score 1/5\r\nNo fresh complaints\r\nVitals stable\r\nCont. same\r\nPlan for discharge tomorrow\nSeen by Dr Tom and team. \r\nAC - 82mg%. GC - better. \r\nAfebrile. Chest - clear. \r\n\r\nCase Plan:\r\nPlan to discharge today after dressings. \r\nCBC, S. Elect today. \r\nUpper body exercises by Physio.'}, {'role': 'model', 'content': '\nIP Number: 2589\n\nPatient Number: 16323\n\nAdmission Date: 09-04-2014\n\nDischarge Date: 28-04-2014\n\nDiagnosis: Non-healing ulcer Left lower limb- Post BKA.\n\nClinical Exam(With BP): C/O non healing ulcer in left foot-3yrs\r\nPast CVA\r\nH/O Polycythemia Rubra Vera,HTN\r\n\r\nIMP:Non healing Ulcer\r\n\r\nCarePlan:\r\n\r\n\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: Atherosclerotic changes B/L lower limb arteries.\r\nOcclusion in right common femoral artery.\r\nStenosis(approx 88%)in left common femoral artery\r\nComplete occlusion of B/L superficial femoral artery and left popliteal artery.\r\nECHO (11/04/14) - Normal chamber dimensions, No RWMA, Normal LV function, No Valvar pathology. EF - 59%. \r\nUrine C/S (23/04/14) - No significant bacteriuria. \r\nPus C/S (11/04/14) - Moderate growth of Pseudomonas. \r\nCT Thorax (11/04/14) - Areas of cystic bronchientasis with partial opacification and surrounding consolidation involving superior segment, posterior basal and medial basal segments of Rt lower lobe. \r\nFibrotic lesions with adjacent pleural thickening involving apical segment of Rt upper lobe.\n\nXray findings: Pallor+\r\n\r\nSystemic Exn:WNL\n\nDiscussion: An elderly female patient presented to us with c/o non healing ulcer of left foot of 3 years duration.At the time of admission her Total Counts were raised and she was started on IV antibiotics after consultation with the plastic surgeon.She was also seen by the orthopedic surgeon following which a Below Knee Amputation was planned in view of ischaemic left limb with infected non healing ulcer.She underwent BKA under Spinal Anaesthesia and recieved 1 pint each of FFP and PRBC Intra operatively.Post op period was uneventful and she is being discharged in a stable condition with oral antibiotics,and has been adviced regular dressing and physiotherapy.\n\nDiet: nan\n\nRemarks: nan'}] |
3,195 | [{'role': 'user', 'content': '\nIP Number: 3195\n\nPatient Number: 6618\n\nPatient Name: ROSILY\n\nGender: F\n\nDate of Birth: 27-06-1944\n\nAddress: ALUNKAL HOUSE\n\nPincode: 682024.0\n\nPhNo: nan\n\nAdmission Date: 21-08-2014\n\nDischarge Date: 05-09-2014\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC NEPHROPATHY WITH CRONIC RENAL FAILURE\nEssential (primary) hypertension\nTYPE 2 DIABETES MELLITUS\nDIABETIC NEPHROPATHY WITH MICROALBUMINUREA\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: K/c/o type 2 Diabetes Mellitus,Primary Hypertension,POVD,Necrotising fascitis s/p fasciotomy\r\n\r\nProvisional Diagnosis:HTN,Anemia of C/C disease,T2DM,acute on c/c CRF\r\nPreviously admitted with nonhealing ulcer and necrotising fascitis -fascitomy done then\r\n\r\nAdmiited for SSG under SA\r\n\n\nXray information: nan\n\nClinical examination: Vitals stable\r\nGC good\r\nAll systems wnl\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by DRA.K.Bhat.\r\nPlan for SSG under SA on saturday 23rd august.Preop:Medical review.Leg elevation.Oxum dressing.\r\n\r\n\r\nseen by dr.abhilash\r\ngc fair.vitals stable.no fresh complaints\r\ngrbs at 6pm:159.informed dr.manoj.advised to give r 4u.\r\ngrbs at 10pm:199.informed dr.manoj.advised to give n 4u.\nSeen by Dr.Ajish & team\r\n\r\nCase plan:\r\nInj.Insugen R 4-4-4U s/c\r\nInj.Insugen N 4U s/c\r\n\nSeen by DrA.K.Bhat.\r\nFor SSG under SA 23rd august.\r\nPreoperative Instructions:\r\nGet consent.\r\nNil oral as per Anesthetist advice.\r\nClean&dress area on morning of operation.\r\nBetadine scrub of thighs HS&CM.\r\nIV antibiotics Inj.Clindamycin 600 mg IV HS&CM.\r\nMedical &Anesthetic fitness for the procedure.\r\n\r\n\r\nC/S/B Duty Doctor: Dr. Joseph @ : 7:15 PM\r\n\r\nGeneral condition: fair.\r\nVitals: stable.\r\n\r\nGRBS @ 6:00 PM: 160mg/dL (Informed Dr.Manoj)\r\n\r\nAdv:\r\nContinue the same Rx\r\nInj. Insugen R 4u s/c 30 mins before food.\r\nInj. Insugen N 6u s/c at bedtime.\r\n\r\n\nseen by dr.abhilash\r\nno fresh complaints\r\ngc fair.vitals stable\r\ngrbs at 6am:165.informed dr.manoj.advised to give r 4u.\r\n\r\nSeen by Dr.Radha & team\r\nFBS-165,Crt-1.3\r\nK-2.4\r\n\r\nCase plan:\r\nT.Yogut 1-0-1\r\nInj.Insugen R 4-4-4U s/c\r\nInj.Insugen N 6U s/c at b/t\r\nSyp.Potklor 15ml TID\r\nFLP,S.electrolytes tomo\nC/S/B Duty Doctor: Dr. Joseph @ : 7:15 AM\r\n\r\nGeneral condition: fair.\r\nVitals: stable.\r\nIMA Blood requisition given.\r\nGRBS @ 6:00 AM: 226mg/dL (Informed Dr.Manoj)\r\n\r\nAdv:\r\nContinue the same Rx\r\nInj. Insugen R 4u s/c 30 mins before food.\r\n\r\nSeen by Dr Tom and team. \r\nAC - 226mg%. \r\nHR - 102/min. \r\nGC - better. \r\n\r\nCase Plan:\r\nScheduled for SSG today under SA. \r\n1 unit PRC arranged. \r\nS. Elect, Creat tomorrow.\nSeen by DRA.K.BHat.\r\nSSG rescheduled for monday 1.30 pm.\r\n\r\nSeen by Dr.Shahin\r\npatient comfortable,Vitals stable\r\nContinue same\nSeen by Dr.Shahin\r\nFBS-190 Inj.Insugen R 4U given\r\nPatient comfortable\r\nContinue same\r\n\r\nSeen by Dr.Radha\r\nBP-140/80mmhg\r\nNa-140 K-3.6\r\nWithhold Potklor\r\n\nSeen by Dr.Shahin\r\nPatient comfortable\r\nGRBS 255-Informed Dr.Radha\r\nAdvised Inj.Insugen R 8U\r\nInform GRBS at 10.00pm\r\n\r\n10.00pm GRBS-224,BP-160/100mmhg\r\nInformed Dr.Radha\r\nAdv:Inj.Insugen N 8U\r\nT.Trika 0.25mg HS/CM\r\n\nSeen by Dr.Shahin\r\nPatient comfortable\r\nGRBS at 6 am - 154 , Insugen R 4U given\r\nBP-150/90mmhg\r\nContinue same\r\n\r\nSeen by Dr.;lakshmi/tEam\r\nPosted for SSG today\r\nBP : 130/90mmHg\r\nNo fresh complaints\r\n\r\nCase plan :\r\nSSG today under SA\r\nContinue same.\r\n\ns/b Dr Radha \r\n\r\ninj. clexane 0.4 ml s/c OD from c/m\r\n\r\nBP- 170/90. GRBS- 134 at 6pm\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\n\r\nC/S/B Duty Doctor: Dr. Joseph @ 8:15 PM\r\n\r\nGeneral condition: fair.\r\nVitals: stable.\r\n\r\nGRBS @ 6:00 PM: 261mg/dL (Informed Dr.Radha)\r\n\r\nAdv:\r\nContinue the same Rx\r\nInj. Insugen R 8u s/c 30 mins before food.\r\nRepeat GRBS @ 10:00 PM\r\n\r\n\r\nC/S/B Duty Doctor: Dr. Joseph @ 10:15 PM\r\n\r\nGRBS @ 10:00 PM: 251mg/dL (Informed Dr.Radha)\r\n\r\nAdv:\r\nInj. Insugen N 12u s/c at bedtime\r\n\ncase seen by duty docter Dr. Arvind\r\n\r\nGRBS at 6 am- 160\r\n\r\nSeen by Dr Ajish and team. \r\nAC - 160mg%. \r\nGC - better. \r\n\r\nCase Plan:\r\nWill plan for PA/PRA ratio after 2-3 days -? cause fro hypokalemia\r\nT. Nebilong 5mg 1-0-0.\nC/S/B Duty Doctor: Dr. Joseph @ 6:45 AM\r\nGeneral condition: fair.\r\nVitals: stable.\r\nGRBS @ 6:00 AM: 153mg/dL (Informed Dr.Radha)\r\nAdv:\r\nContinue the same Rx\r\nInj. Insugen R 10u s/c 30 mins before food.\r\n\r\nSeen by Dr.Ajish & team\r\nBP-130/80mmhg\r\n\r\nCase plan:\r\nNa,K,Crt C/M\r\nInj.Insugen R 8-8-6U s/c\r\nInj.InsugenN 12U s/c at b/t\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\nS/b dr Benji\r\nVitals stable\r\nNo fresh complaints\r\nGRBS:188\r\nAdvise:Inj insugen R 6u\r\nInj Insugen N 12u\r\n\nGrbs:155\r\nInformed Dr ajish\r\nAdvise:Inj insugen R 8u\r\nCont. same trt\r\n\r\ns/b dr.ajish/team\r\nAC-155\r\ncreat-1.2\r\nurea-21\r\nNa-135\r\npotassium-3.9\r\n\r\nno complaints to report\r\n\r\ncase plan\r\nto continue same Rx\r\n\r\n\nSeen by DRA.K.Bhat.\r\nContinue trt.Oral dalacin 300 mg 1-1-1.C&D in ICU tomorrow.\r\n\r\nS/b Dr Benji\r\nVitals stable\r\nNo fresh complaints\r\nGrbs:199\r\nInformed Dr manoj\r\nAdvise:Inj insugen R 6u\r\nInj insugen N 12u\r\n\nS/b dr Benji\r\nFBS:152\r\ninformed Dr manoj\r\nAdvise:Inj insugen R 8 u\r\nreddish haze urine.sediments present.\r\n\r\nSeen by Dr Lakshmi and team. \r\nGC - better. \r\nAC - 152mg%\r\nUrine - high coloured. \r\n\r\nCase Plan:\r\nChange of dressings today in the OT.\r\nBladder wash today. \r\nStop Clexaine. \r\nCheck GRBS only SOS. \r\nInj.Insugen R 6-8-6\r\nInj.Insugen N 12\r\nK+, URE and Hb tomorrow.\nSeen by Dr Bhat. \r\nDRessings changed.SSG taken up.Continue trt.\r\n\r\nS/b Dr Benji\r\nVitals stable\r\nno fresh complaints\r\nGrbs:167\r\ninformed Dr biju\r\nAdvise:Inj insugen R 6u\r\nInj insugen N 12u\nS/b Dr benji\r\nFBS:148\r\ninformed Dr Biju\r\nAdvise:Inj insugen R\r\n\r\nS/B Dr Manoj , Dr Farook:-\r\ndoing fine\r\nfirst dressing done yesterday\r\nSSG taken p well\r\n BP120/80 \r\n\r\ncase plan\r\ncontinue same\nSeen by DrA.K.Bhat,.\r\nContinue trt.\r\n\r\nS/B Dr farook No fresh complaints. All vitals stable\nSeen by Dr.Lakshmi & Dr.Shahin\r\nPatient comfortable\r\n\r\nCase plan:\r\nWithhold calpol & yogut\ncase seen by dr.renji\r\nno fresh complaints\r\ngeneral condition fair\r\nvitals stable\r\nsystems nad\r\n\nfbs 148mg/dl.\r\nSeen by DrA.K.BHat.\r\n?Plan fr D/C tomorrow after dressing.\r\n\r\nSEEN BY DR.MANOJ/TEAM\r\nPATIENTS GENERAL CONDITIONS BETTER\r\nSUGARS UNDERCONTROL\r\nPAIN SCORE: 0/5\r\n\r\nCASE PLAN :\r\n.....................\r\nPLAN FOR DISCHARGE TOMORROW AFTER DRESSING.\r\ncONTINUE TREATMENT.\r\n\r\n\nSeen by DRA.K.BHat.\r\nDRessings changed.SSG settling.Donor site healing.Next dressing on friday and then D/C.\r\n\r\nSEEN BY DR.\r\nPATIENTS GENERAL CONDITION BETTER\r\n\r\n\r\nCASE PLAN :\r\n.....................\r\nINJ.NOVOMIX 20-0-15UNITS\r\n\r\n\nSEEN BY DR.AJISH/TEAM\r\nPATIENTS GENERAL CONDITION BETTER.\r\nPAIN SCORE: 0/5\r\nURINE CULTURE AWAITING\r\n\r\nCASE PLAN :\r\n.....................\r\nCONTINUE TREATMENT \r\nTAB.LEVO 500MG 1-0-0\r\n\r\n\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\nS/b Dr Benji\r\nVitals stable\r\nNo fresh complaints\r\nInformed Dr ajish\r\nAdvise:Inj novomix 15u\nFBS:167\r\nInformed dr ajish\r\nadvise:Inj novomix 20u\r\n\r\nSeen by Dr Radha. \r\nAC - 167mg%. \r\nGC - better, Afebrile. \r\n\r\nCase Plan:\r\nContinue same. \r\nURE tomorrow. \r\nInj Novomix 20-0-18 units just before meals s/c.\r\nPlan to discharge tomorrow after one more dressings.\nSeen by DrA.K.Bhat.\r\nContinue trt.Plan fr D/C tomorrow after dressing.\nSEEN BY DR.TOM/TEAM\r\nPATIENTS GENERAL CONDITION GOOD.\r\nNO FRESH COMPLAINTS\r\nDRESSING DONE.\r\n\r\nCASE PLAN :\r\n.....................\r\nDISCHARGE TODAY AFTER DR.BHAT CONSULTATION.\r\nDR.BHAT TO ADVISE ON WEIGHT BEARING ONCE SHE GOES HOME.\r\nCHASE URINE CULTURE.\r\nINJ.NOVOMIX 18-0-16UNITS\r\n\r\n\r\n\r\n\nSeen by DrA.K.Bhat.\r\nDressing changed.SSG taken up.Donor site healing.Adviced:DRessing once in 3 days-cuticell,pad,crepe bandage.Prtial weight bearing.Review OP after 2 weeks.'}, {'role': 'model', 'content': '\nIP Number: 3195\n\nPatient Number: 6618\n\nAdmission Date: 21-08-2014\n\nDischarge Date: 05-09-2014\n\nDiagnosis: Neccrotising fascitis s/p fasciotomy\r\nPost SSG.\r\nHypokalemia-Cause unknown\n\nClinical Exam(With BP): K/c/o type 2 Diabetes Mellitus,Primary Hypertension,POVD,Necrotising fascitis s/p fasciotomy\r\n\r\nProvisional Diagnosis:HTN,Anemia of C/C disease,T2DM,acute on c/c CRF\r\nPreviously admitted with nonhealing ulcer and necrotising fascitis -fascitomy done then\r\n\r\nAdmiited for SSG under SA\r\n\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: Chest X-Ray :\r\n\r\n\n\nXray findings: Vitals stable\r\nGC good\r\nAll systems wnl\n\nDiscussion: 70yr old female with H/o DM admitted for SSG.. Surgery consultation done, SSG done on 25th Aug 2014. post op was uneventful.Patients insulin dose adjusted and her sugars are well controlled on pre-mixed insulin. .Patient symptomatically better .Discharging under stable condition.\n\nDiet: nan\n\nRemarks: If You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\n'}] |
3,230 | [{'role': 'user', 'content': "\nIP Number: 3230\n\nPatient Number: 18989\n\nPatient Name: SASI SUBHASH\n\nGender: F\n\nDate of Birth: 09-09-1954\n\nAddress: 33/2629 B P C CROSS ROAD\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 29-08-2014\n\nDischarge Date: 15-09-2014\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: Pt presented to our podiatric surgeon with gangrene of the 4th and 5th toes on right foot. \r\n\r\nAdmitted for I&D under SA\r\n\r\nCare plan:\r\nAdmission\r\nI&D under SA\r\n\n\nXray information: nan\n\nClinical examination: General examination:WNL\r\nsystemic examination:WNL\r\n\r\nLocal Examination :Extensive foot infection extending from bluish discoloured 4th and 5th toes to proximal areas of foot with tissue gangrene and subcutaneous pus extending proximally with crepitus suggesting anerobic infection.Cellulitis upto lower leg.\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Assessed by Dr Benji @\r\n\r\nAdvise:Blood RE,RFT,LFT,GRBS,BT,CT,PT,Na,K,Screening tests.CXR PA,ECG.\r\n\r\nS/b Dr Benji\r\nVitals stable\r\nno fresh complaints\r\nGrbs:156\r\ninformed Dr biju\r\nAdvise:Inj novorapid 20\r\nInj lantus 16u\nS/b Dr benji\r\nFBS:233\r\nbp:200/100\r\ninformed Dr Biju\r\nAdvise:Inj novorapid 20u\r\nT. calcheck 2.5mg\r\n\r\nS/B Dr Manoj , Dr Farook:-\r\n BP110/80 \r\npain score:- 4/5\r\nGRBS 251\r\ncase plan: \r\nposted for I&D under spinal anesth @ 1pm\r\nmedical fitness given\r\n\nFBS informed to Dr Tom fbs 210 novarapid 24u\r\n\r\nSeen by Dr.Lakshmi & Dr.Shahin\r\nc/o constipation\r\n\r\nCase plan:\r\nTC tomorrow\r\nInj.Lantus 22U at b/t\r\nInj.Novorapid 24-24-20U s/c\r\nT.Dulcolax suppository 2 stat\ncase seen by dr.renji\r\nno fresh complaints\r\ngeneral condition fair\r\nvitals stable\r\nsystems nad\r\ngrbs 247 mg/dl\r\ninformed dr.lakshmi\r\nadvice:inj novorapid 24U sc stat\r\n inj lantus 22U sc stat\nfbs 193mg/dl.\r\nSeen by DrA.K.BHat.\r\nAfebrile.FOr C&D in ICU tomorrow.\r\n\r\n\r\nSEEN BY DR.MANOJ/TEAM\r\nPATIENTS GENERAL CONDITION BETTER\r\nPAIN SCORE:0/5\r\n\r\n\r\nCASE PLAN :\r\n.....................\r\nT.AXIPAN 40MG OD\r\nINJ.LANTUS 24UNITS BEDTIME\r\nINJ.NOVORAPID 24-24-24UNITS.\r\nNANOFAST GEL \r\n\r\n\nSeen by DRA.K.BHat.\r\nDressings changed.The 3rd,4th&5th toes look nonviable.2nd toe is dusky.Slough between the metatarsal spaces.Proximal foot raw area granulation present.Discussed with the husband about the condition of the foot.Plan:Wound debridement,amputation of 3rd,4th,5th toes under GA 3rd september,2pm,OT.\r\nPreop:Nil oral as per anesthetist.Informed consent.IV antibiotics.ARterial doppler to rule out PVD.\r\n========================\r\nInformed consent:\r\nThis in continuation of the consent already obtained on 30th august 2014.\r\nThere is residual infective gangrene of right foot with gangrene of 3rd&4th&5th toes & pus extending to foot.There is also decreased circulation of the 2nd toe as well,this looks dusky.There is diabetes and neuropathy.This requires wound cleaning under general Anesthesia.The gangrene of the toes needs amputation of the toes.The 3rd &4th&5th toes of right foot will be amputated at their bases in the region of the foot at a healthy level.During surgery, depending on the findings,extending pus of foot will also be drained.Maximum attempt will be made to preserve the 2nd toe but during surgery if found infected and unsaveable,then 2nd toe may also need to be amputated.The wound after surgery will be larger in size, due to the fact that in diabetes,the extent of infection in the deeper tissues will be more than what is seen in the skin surface.Due to diabetes ,wound healing will be delayed.After the operation,depending on healing further operations 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\n\r\nSEEN BY DR.AJISH/TEAM\r\nPATIENTS GENERAL CONDITION BETTER\r\nNO FRESH COMPLAINTS\r\n\r\n\r\nCASE PLAN :\r\n.....................\r\nURE\r\nINJ.TRAMADOL 50MG SOS\r\nINJ.EMESET 4MG STAT.\r\nT. becozyme C forte 1-0-0\r\nInj novarapid 24-24-22\r\nInj lantus 24u B/T\r\n\r\n\r\n\r\n\r\n\r\n\nFBS-144 Informed Dr.Radha\r\nAdvised Novorapid 14U s/c\r\n\r\nSEEN BY DR.AJISH/TEAM\r\nPATIENTS GENERAL CONDITION FAIR\r\n\r\nCASE PLAN :\r\n.....................\r\n\r\n10MEq KCL IN IV FLUID INTRA OP\r\n\nFBS:172\r\nInformed dr ajish\r\nadvise:Inj novorapid 24u\nSEEN BY DR.TOM/TEAM\r\nPATIENTS GENERAL CONDITION FAIR\r\nNO FRESH COMPLAINTS\r\nPAIN SCORE : 3/5\r\n\r\n\r\nCASE PLAN :\r\n.....................\r\nSYP.LOOZ 15ML HS\r\nELECTROLYTES AND TC TOMORROW.\r\nPHYSIOTHERAPY FOR UPPER BODY EXERCISES\r\nINJ.NOVORAPID 20-20-16UNITS\r\nINJ.LANTUS 18UNITS \r\nINJ.cLEXANE 0.4MG 1-0-0\r\nDIETICIAN TO INCREASE DIETARY POTASSIUM.\r\n\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\n\r\nC/S/B Duty Doctor: Dr. Joseph @ : 7:45 PM\r\n\r\nGeneral condition: fair.\r\nVitals: stable.\r\n\r\nGRBS @ 6:00 PM: 139mg/dL (Informed Dr.Biju)\r\n\r\nAdv:\r\nInj. Novorapid 16u s/c 30 mins before food.\r\nInj. Lantus 18u s/c bedtime.\r\nFollow orders.\r\n\nC/S/B Duty Doctor: Dr. Joseph @ : 7:00 AM\r\n\r\nGeneral condition: fair.\r\nVitals: stable.\r\n\r\nGRBS @ 6:00 AM: 94mg/dL (Informed Dr.Biju)\r\n\r\nAdv:\r\nInj. Novorapid 20u s/c 30 mins before food.\r\nFollow orders.\r\n\r\nSeen by Dr.Manoj and Biju\r\nFeeling better\r\ncase plan : \r\nInj.Novorapid 16-16-14\r\nInj.Lantus 16units\r\nDressing \r\nTo change to oral antibiotic after discussion with Dr.Bhat \r\n\nSeen by DRA.K.Bhat.\r\nDRessings changed.Large raw area-greenish discolouration.Wound needs further observation regarding viability.Inj.Ciprofloxacin 400 mg IV bd.Continue trt.\r\n\r\ncase seen by dr.renji\r\nno fresh complaints\r\ngeneral condition fair\r\nvitals stable\r\nsystems nad\r\ngrbs 134mg/dl\r\ninformed dr.biju\r\nadvice:inj novorapid 16U sc stat\r\n inj lantus 16U sc stat\nThanks for referral. Case seen by Dr Aswin Krishnan Ajit\r\nHistory noted from patient. H/s/o Adjustment disorder with brief depressive reaction, to r/o mild depressive episode of 7 months duration ( ongoing stressor- grandson's illness), now aggravated by current stressor. K/c/o HTN, DM (? poor self control since 7 months). \r\nO/E: Occassional depressive cognitions+\r\nAdv:\r\n1) Tab NEXITO 10 mg 0-0-1\r\n2) Tab LONAZEP 0.5 mg 1/2-0-1 ( Skip morning dose if excessive daytime somnolence)\r\n3) Supportive Psychotherapy given\r\nShall review on Tuesday.\r\n\r\ncase seen by dr.renji\r\nno fresh complaints\r\ngeneral condition fair\r\nvitals stable\r\nsystems nad\r\ngrbs 160mg/dl\r\ninformed dr.biju\r\nadvice:inj novorapid 16U sc stat\r\n inj lantus 16U sc stat\nfbs 142 mg/dl\r\ninformed dr.manoj\r\navice:inj novorapid 16U sc stat\r\n\r\nSeen by Dr.Manoj & Dr.Shahin\r\nFBS-142\r\nBP-130/80mmhg\r\nPatient anxious\r\nBlood clot seen in catheter\r\nRash on lower back, c/o itching\r\n\r\ncase plan:\r\nBladder wash\r\nWithhold clexane if anymore clots found\r\nT.Trika 0.5mg 0-0-1\r\nCalamine lotion for LA\r\nTFT,TC,Urea,Crt C/M.\r\n----------\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\nStop Inj.Biopiper.\r\nREmove foleys catheter.\nSeen by DR.AK.BHat.\r\nDRessings changed.Slough around dorsum and lateral aspect big toe partly excised.Guarded prognosis of wound healing explained.Tab.Movon(Aceclofenac) 100mg 1SOS.Continue trt.Physiotherapy mobilisation of limbs.\r\n\r\ncase seen by dr.renji\r\nno fresh complaints\r\ngeneral condition is fair\r\nvitals stable\r\nsystems nad\r\ngrbs 156 mg/dl\r\ninformed dr.biju\r\nadvice:inj novorapid 6U SC STAT\r\n inj lantus 16U SC STAT\nfbs 158 mb/dl\r\ninformed dr.manoj\r\nadvice:inj novorapid 16U sc stat\r\n\r\nSeen by Dr.Manoj/biju\r\nFeeling better.\r\nClamper catheter.\r\nCase plan :\r\nContinue treatment.\r\n\r\n\nCase reviewed by Dr Aswin Krishnan Ajit\r\nBetter. No undue apprehensions reported.\r\nBiological functions adequate.\r\nO/E: Cheerful affect\r\nAdv:\r\n1) Tab NEXITO 10 mg 0-0-1\r\n2) Tab LONAZEP 0.5 mg 1/2-0-1\r\n\r\nShall review on Thursday\r\n\r\ncase seen by dr.renji\r\nhistory noted\r\nno fresh complaints\r\ngeneral condition satisfactory\r\nsystems nad\r\nhistory of intake of 1400ml of water(7 glasses)\r\nbladder sensation since 6.45pm\r\ninformed dr.matthew mangat\r\nclamp released at 7.45pm\r\nurine output 800ml after clamp release\r\ngrbs 142 mg/dl\r\ninformed dr.radha\r\nadvice:inj novorapid 14U sc stat\r\n inj lantus 16u sc stat\nfbs 217mg/dl\r\ninformed dr.biju\r\nadvice:inj novorapid 18U SC STAT\r\n\r\nSeen byDr.Manoj/team\r\nNo fresh complaints\r\ncatheter removal after discussion with urologist\r\nurine clear.\r\nDressing done yesterday.\r\n\r\ncase plan :\r\nConsultation with Dr.Aswin ( psychologist)\r\n\r\ns/b Dr.Matthew M.\r\nThanks for referral.\r\nc/o lack of sensation at 200ml.> cath. clamp.x2.,yesterday.\r\ncath'n at time of toes amputn. < 6days.\r\no/e : pt. made to actively move B.legs.\r\nhad pain n stopped > 2mins.\r\nAdv.\r\nclamp cath. n remove only when pt.s bladder reg.\r\nhaving severe pain/ bladder maybe seen/felt .\r\npl. show cas. doctor to confirm.\r\nif cath removed ,get ur-c/s of MSU.\r\n\r\n\nSeen by DrA.K.Bhat.\r\nDressings changed.Raw areas mostly clean.Residual slough partly excised.Some slough remains in base of big toe-needs observation.Suggested oral ciprofloxacin.\r\n\r\nSeen by Dr.Radha\r\nc/o haematuria\r\nAdv:Withhold Clexane\r\n\r\n\r\ncase seen by dr.renji\r\nno fresh complaints\r\ngeneral condition is fair \r\nvitals stable\r\nsystems nad\r\ngrbs 231 mg/dl\r\ninformed dr.biju\r\nadvice: inj novorapid 12 u sc stat\r\n inj lantus 20 u sc stat\nfbs 197mg/dl\r\ninformed dr. radha\r\nadvice:inj novorapid 16u sc stat\r\n\r\nSeen by Dr Ajish and team. \r\nPatient comfortable\r\n\r\nCase plan:\r\nInj.Novorapid s/c 16-16-12U s/c\r\nInj.lantus 20U s/c at b/t\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\nCase reviewed by Dr Aswin Krishnan Ajit\r\nNo complaints reported \r\nBiological functions adequate\r\nTo ensure strict diabetic monitoring/control after discharge\r\nAdv:\r\n1) Tab NEXITO 10 mg 0-0-1\r\n2) Tab LONAZEP 0.5 mg 1/2-0-1 ( Skip morning dose in case of daytime somnolence)\r\n\r\nReview in Psychiatry OPD after 2 weeks\r\n\r\nS/B DR IMMANUEL, AT 8.30 PM\r\n\r\nC/O MILD ABD DISCOMFORT pain on rectum,\r\nno othere complaint, vitals stable, afebrile, oriented\r\n\r\n6pm 197mg/dl inj NOVO 14 u through phone order dr manoj.\r\n\nSeen by Dr.Ajish/team\r\nNo fresh complaints\r\nGC fair\r\nCase plan :\r\nPlan for catheter removal on saturday\r\nDr.Mangat review\r\n TC,creatinine and Electrolytes\r\nPhysio to ambulate ( after Dr Bhat concurrence)\r\nInj.Novorapid 16-16-14units\r\nInj.Lantus 24units\r\n\r\nDiscussed with Dr.Mangat and advised to stop Inj and tab.Hemisyl\r\n\r\ns/b Dr.Matthew M.\r\n\r\npt. passsing clear urine. no s/o neurogenic/atonic bladder.\r\nplan to remove cath.by day of discharge.\r\nactive physio adv.before discharge.-to ct. at home.\r\nadv. may stop Inj.n T.Hemsyl.\r\nT.Urivoid 10 mg bd.\r\nT.Terol4mg/Cap.Urotel 4mg hs.\r\nreview on Sat.-13.9.14.\nSeen by DRA.K.Bhat.\r\nC&D done.Granulation present.Some slough partly excised.Continue trt.\nSeen by Dr Tom and team. \r\nAC - 146mg%.\r\nPain Score - 3/5. \r\n\r\nCase Plan: \r\nRemove foleys tomorrow morning. \r\nPlan to discharge tomorrow. \r\nT. Ecosprin 75mg 0-1-0. \r\nShe is advised not to ambulate.\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\npt has not passed urine since morning \r\nNo bladder sensation\r\nbladder not palpable\r\nintake 1 litre now\r\nBP 120.80mmHg\r\n informed Dr Mathew\r\nAdvised \r\nInj Lasix 10mg stat \r\nw/f output- measure\r\n repeat S creat\r\nCatherterise sos \r\n\r\n\r\nS/b Dr benji\r\nVitals stable\r\nNo fresh complaints\r\nGRBS:177\r\nInformed Dr Tom\r\nAdvise:Inj novorapid 12u\r\nInj lantus 24u\r\n\nSeen by Dr.Tom/team\r\nC/o Mild Pain\r\nPain score : 2/5\r\nDressing done\r\nCatheter removed.\r\n\r\nCase plan :\r\n--------------\r\nInj.Novorapid 18-18-14 units\r\nInj.Lantus 24units\r\nPhysiotherapy consultation\r\nDischarge today.\r\n\r\ns/b Dr.Matthew M.\r\npt. not passd urine after intake of 500ml.fluids.\r\nadv. to wait till pt. intake increases.\r\nT.Urivoid 25 mg b.dx15days.\r\nCap. Urotel XL 4mg h.s.x15days.\r\ncatheterise s.o.s. -only if retention develops.\r\nreview in Uro.O.P.D. after 15days.\nFBS:253\r\nInformed Dr Tom\r\nAdvise:Inj novorapid 20u\r\n\r\nS/b Dr Tom & Dr Benji\r\nvitals stable\r\nNo fresh complaints\r\nFBS:253\r\nAdvise:Inj lantus 28u.\r\n------------\r\nSeen by DRA.K.Bhat.\r\nDressings changed.\r\nSome residual slough excised.Slough around big toe,EHL tendon is exposed bare-needs observation.Granulation present.\nS/b Dr Benji\r\nVitals stable\r\nNo fresh complaints\r\nGRBS:273\r\nInformed Dr Tom\r\nAdvise:cont. same trt\nFBS:238\r\nInformed Dr Tom\r\nAdvise:Inj novorapid 22\r\n\r\nSeen by Dr.Tom/team\r\nNo fresh complaints\r\nCase plan :\r\nDischarge today.\r\nInj.Novorapid 22-20-16units\r\nInj.lantus 30units\nSeen by Dr.Bhat."}, {'role': 'model', 'content': '\nIP Number: 3230\n\nPatient Number: 18989\n\nAdmission Date: 29-08-2014\n\nDischarge Date: 15-09-2014\n\nDiagnosis: Necrotising infection with gangrene of the RT foot except the big toe, s/p amputation of the 2,3,4,5th digits.\n\nClinical Exam(With BP): Pt presented to our podiatric surgeon with gangrene of the 4th and 5th toes on right foot. \r\n\r\nAdmitted for I&D under SA\r\n\r\nCare plan:\r\nAdmission\r\nI&D under SA\r\n\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: Rt Arterial Doppler (02/09/14) - Poorly or moderately diminished flow arterial blood flow in the Rt femoral, popliteal aretries. Poor flow with severe dampening of flow in Rt anterior tibial and peroneal arteries. \r\nPus C/S (01/09/14) - Heavy growth of Proteus Mirabilis.\n\nXray findings: General examination:WNL\r\nsystemic examination:WNL\r\n\r\nLocal Examination :Extensive foot infection extending from bluish discoloured 4th and 5th toes to proximal areas of foot with tissue gangrene and subcutaneous pus extending proximally with crepitus suggesting anerobic infection.Cellulitis upto lower leg.\n\nDiscussion: 59 yr old female known case of Type II Diabetes Mellitus presented with gangrene of the 4th and 5th digit with full thickess infection of the 2nd and 3rd digit also. She was started on I.V antibiotics, seen by surgeon, initial dedridement of the wound was done on 30/8/14 and due to the extend of the infection, Wound debridement and amputation of 2nd, 3rd, 4th and 5th toes under GA on 3/9/14. Regular dressings were done post operatively. The wound is healing well and she is being discharged in a stable condition and advised to review as outpt for dressings. \r\n\n\nDiet: Low Calorie Low Fat High Fiber Diabetic Diet (1400 - 1500 KCal)\r\nTo follow a small frequent meal pattern; To increase fiber in the diet; To have a wheat based dinner; To have small healthy snacks in between; Any 1 Low Calorie fruit / day allowed ONLY if Blood Sugars are under control. \r\nGlucerna-SR - 3 scoops in 100 ml of water @ 6 p.m. and bedtime and with oats (1 / 2 scoops) @ 10 a.m. \r\n\n\nRemarks: If You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\n'}] |
3,282 | [{'role': 'user', 'content': '\nIP Number: 3282\n\nPatient Number: 12957\n\nPatient Name: SUKESINI SHANKAR(V)\n\nGender: F\n\nDate of Birth: 21-09-1932\n\nAddress: 9/122, SUVARNA NAGAR, EROOR WEST\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 15-09-2014\n\nDischarge Date: 07-10-2014\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: K/C/O Essential (primary) hypertension,Chronic ischaemic heart disease,T2DM,Diabetiic neuropathy,OA rt hip\r\n\r\nH/O fall\r\n\r\nImp:Intertrochanteric fracture Lt LL\n\nXray information: nan\n\nClinical examination: o/e\r\nLt LL ext rotated and shortened\r\nROM painful and restricted\r\nno distal NV deficits\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: case s/b Dr Jijo\r\ninj amickacin 500 mg IV stat\r\ncatheterise the patient.\r\ninj tramadol 1 amp IM sos.\ncase seen by dr. renji\r\nno fresh complaints\r\ngeneral condition is fair\r\nvitals stable\r\nsystems nad\r\ngrbs 146 mg/dl\r\ninformed dr.lakshmi\r\nadvice:continue oral medications\r\nCASE S/B dR jIJO\r\nPT COMFORTABLE\r\nno rest pain\r\nADV\r\ncontinue same\ncases/b Dr Jijo\r\nc/o gaseous distension of abdomen\r\nADV\r\nINJ PANSEC IV ST\r\nSYP GELUSIL 1 TSP TID\r\nFFP TRANSFUSION TOMORROW\r\nhb pcv tomorrow\r\n\r\nGRBS@ 10 pm:124\nfbs 105mg/dl\r\ninformed dr.lakshmi\r\nadvice:continue OHA\r\n\r\n\r\nSeen by Dr.Tom/Team\r\nC/O Pain\r\nPain csore : 4/5\r\n\r\nCase plan :\r\nCardiology fitness.\r\nSchedule for ORIF\r\nContinue tretament.\nC/S/B Duty Doctor: Dr. Joseph @ 6:15AM\r\nNo fresh c/o\r\nGRBS@6:00AM : 71mg/dL (Informed Dr. Radha)\r\nHb: 8.8 gm%\r\nPCV: 26%(Informed Dr. Jijo, Dr. Sanjana)\r\n\r\nAdv:\r\nInj. Insugen R 4u\r\nFollow daily orders.\r\n1 pint Packed cell.\r\n1 pint FFP\r\nArrange 2 pint whole blood.\r\n\r\nSeen by Dr.Manoj & team\r\nT.Galvus 50 BD (from tonight)\r\nStop Glycomet GP2\r\nTo start on Glucerna powder as per dietician advice\r\nUSG abdomen today\ncase seen by dr.renji\r\nno fresh complaints\r\nvitals stable\r\nsystems nad\r\ngrbs 115mg/dl\r\ninformed dr.radha\r\nadvice:OHA\r\n continue other medications\r\n npo after 12.00am\r\n\r\nposted for PFN/HEMIARTHROPLASTY under sa/ga at 8.30 AM\r\nNPO from midnight\r\nhigh risk consent\r\ninj wakcef 1.5 gm bid\r\ninj amickacin 500 mg bid\r\narrange 2 pints of grouped and cross matched blood\r\ninform OT/Anesthetist\r\nFBS,HB,PCV, CREATININE in the morning\r\n\r\ninvestigation reports obtained at 9.49pm\r\ninformed dr.radha and dr.manoj\r\nSURGERY POSTPONED FROM TOMORROW\r\nLFT showed rise in bilirubin total\r\nand a decrease in pottasium level\r\nexplained to the bystanders\r\nadvice:syp potklor 10ml TID\r\n investigations to be repeated tomorrow\r\n\ncase seen by dr renji\r\nno fresh complaints\r\nvitals stable\r\nsystems nad\r\ngrbs 147mg/dl\r\ninformed dr.manoj\r\nadvice:\nfbs 81mg/dl\r\ninformed dr.radha\r\nadvice:withhold OHA\r\n to decide with repeated LFT reports\r\n\r\n\r\nSeen by Dr.Tom/Team\r\nPassed stool\r\nOB positive.\r\n\r\nCase plan :\r\nWithhold OHAs and Insulin.\r\nHold wakcef and amikacin.\r\nBilirubin tomorrow\nSeen By Dr.Manoj/team\r\n\r\nFeeling better.\r\n\r\ncase plan : \r\nContinue same.\r\ncase s/b Dr Jijo\r\ndiscussed with Dr Lakshmi\r\nposted for PFN/ HEMIARTHROPLASTY tomorrow at 8.30 am\ncase seen by dr.renji \r\n no fresh complsints \r\ngeneral condition fair\r\nvitals stable\r\nsystems nad\r\ngrbs 173mg/dl\r\ninformed r.biju\r\nadvice:OHA\r\n\r\n\r\ncase s/b Dr Jijo\r\nposted for PFN/Hemiarthroplasty under GA/ SA\r\nnpo from midnight\r\nhigh risk consent\r\ninj wakcef 1.5 gm IV at 6 am\r\ninj amickacin 500 mg IV at 6 am\r\nARRANGE 1 PINT BLOOD\r\n\r\n\nC/S/B DR IMMANUEL, CASUALTY MO\r\n\r\nC/O URIN OUT PUT LESS\r\n INPUT-3000ML\r\n OUTPUT- 300ML\r\n\r\nO/E PT AFEBRILE CONSCIOUS ORIENTED IRRELAVENT SPEACH,\r\n\r\nCVS-S1S2 HEARD\r\nRS- B/L CREPS +\r\nP/A SOFT, NO TENDERNESS, BLADER +.\r\n\r\n\r\n11.10 PM, HB 9.6, PCV 29, SODIUM-136,K 4.4, UREA-49, CREAT-0.9, BIL TOTAL-1.2, DIR-0.6.\r\n\r\nINFORMED RESULT TO DR TOM.\r\n\r\n\r\n\r\nINFORMED DR LAKSHMI AND DR JIJO,\r\n\r\nSTOP INJ AMIKACIN.\r\nINJ LASIX 20MG IV SOS.\r\nCASE S/B Dr JIJO\r\nPULSE -88 BP - 124/64\r\nCONSIUOS AND ORIENTED\r\nCHEST CLEAR\r\nP/A soft bs +\r\nI/O 3000/500\r\nmade patient sit\r\nADV\r\nINJ KLEXANE 40 1U S/C 2hrs after removal of epidural (8 AP)\r\nHB PCV in the morning\r\ninform SOS.\nNPO\r\nfbs 155mg/dl\r\ninformed dr biju\r\n\r\n\r\n\r\n\r\n\nC/S/B DR IMMANUEL, CASUALTY MO\r\n\r\nC/O URIN OUT PUT LESS\r\n INPUT-3000ML\r\n OUTPUT- 300ML\r\n\r\nO/E PT AFEBRILE CONSCIOUS ORIENTED IRRELAVENT SPEACH,\r\n\r\nCVS-S1S2 HEARD\r\nRS- B/L CREPS +\r\nP/A SOFT, NO TENDERNESS, BLADER +.\r\n\r\n\r\n11.10 PM, HB 9.6, PCV 29, SODIUM-136,K 4.4, UREA-49, CREAT-0.9, BIL TOTAL-1.2, DIR-0.6.\r\n\r\nINFORMED RESULT TO DR TOM.\r\n\r\n\r\n\r\nINFORMED DR LAKSHMI AND DR JIJO,\r\n\r\nSTOP INJ AMIKACIN.\r\nINJ LASIX 20MG IV SOS.\r\n\r\n\r\nCASE S/B Dr JIJO\r\nPULSE -88 BP - 124/64\r\nCONSIUOS AND ORIENTED\r\nCHEST CLEAR\r\nP/A soft bs +\r\nI/O 3000/500\r\nmade patient sit\r\nADV\r\nINJ CLEXANE 40 1U S/C 2hrs after removal of epidural (8 AP)\r\nHB PCV in the morning\r\ninform SOS.\nNPO\r\nfbs 155mg/dl\r\ninformed dr biju\r\n\r\n21/9/14.6.30pm c/s/b drimmanuel\r\n \r\nNO COMPLAINTS AT THE TIME\r\nGC BETTER\r\nVITALS STABLE\r\nCVS/RS/-NAD\r\n \r\nEPI CATH REMOVED\r\nORAL INTAKE TAKEN \r\nHB-9.3\r\nPCV-28\r\nURINE OUTPUT TOTAL 6PM TO 6 AM- 950ML\r\nINTAKE 900ML\r\n\r\n\r\npatient seen by dr.luke\r\nc/o mild cough,\r\no/e chest clear,no added sounds,s1 and s2 heard,\r\npatient is consious and oriented\r\nvitals stable,\r\n\r\nCASE S/B Dr JIJO\r\nPT COMFORTABLE\r\nVITALS STABLE\r\nADV\r\nTAB THRIZE 1-1-1\r\nTAB ACUVIN 1-1-1\r\nPHYSIO- CHEST PHYSIO. ANKLE PUMPS. PELVIC BRIDGE, \r\nANKLE PASSIVE MOBILISATION\r\nHEEL SLIDES ONLY\r\nNO SLR .\r\n\r\n\r\nSeen by Dr Biju. \r\nPt comfortable. \r\nDoes not complain of pain. \r\nBP - 125/70 mmHg. \r\nHR - 90mg%. \r\nSpO2 - 88% in room air (pt is refusing O2 delivery by nasal prongs or mask). \r\nChest - clear. \r\nOutput - Just adequate. \r\n\r\nCase Plan:\r\nIVF maintainence at 75ml/hr. \r\nInj Lasix 5mg IV stat. \r\nCBC, S. Creat, S. Elect tomorrow. \r\nStop Potklor. \r\nContinue remaining medications. \r\nWill keep in recovery for 1 more day. \r\nWIll shift out tomorrow. \r\nChest physio.\r\nInj Clexaine 0.4ml s/c OD.\r\n\r\ncase seen by dr.renji\r\npost op day 2\r\nno fresh complaints \r\ngeneral condition fair \r\nsystems nad\r\nvitals stable\r\ngrbs 174mg/dl\r\ninformed dr.biju\r\nadvice:OHA\r\n continue other medication\nfbs 103mg/dl\r\ninformed dr.biju\r\nadvice:OHA\r\n continue other medications\nSeen by Dr.Ajish/team\r\nC/O pain\r\nPain score : 2/5\r\nIntake less\r\n\r\nCase plan :\r\nI /O Chart\r\nContinue same.\r\nStop OHA\r\nInj.Pactiv 6th hrly.\r\ncase s/b Dr Jijo\r\nGC better Strict I/O chart\r\npain reduced\r\nmade to sit \r\nchest clear\r\nADV\r\nCONTINUE SAME\r\nPHYSIO TO CONTINUE.\r\n\r\n\r\n\r\n\ncase seen by dr.renji\r\nno fresh complaints\r\nvitals stable\r\ngeneral condition fair\r\nsystems nad\r\ngrbs 147mg/dl\r\ninformed dr.radha\r\nadvice:no OHA\r\n10.00pm grbs 238mg/dl\r\ninfromed dr.radha\r\nadvice:inj insugen N 8u sc B/T\nC/S/B Duty Doctor: Dr. Joseph @ 7:10 PM\r\n\r\nGRBS@ 6:00 PM : 157 mg/dL (informed Dr. Ajish) \r\n\r\nAdv:\r\nInj. Insugen R 4 units 1/2 hr before food s/c.\r\nInj. Lantus 6 units at bed time s/c. \r\nFollow other orders.\r\ncase s/b Dr Jijo\r\nno pain\r\nmobilised\r\nADV\r\ncontinue same.\nfbs 212mg/dl\r\ninformed dr.radha\r\nadvice:t galvus 1-0-1\r\n continue other medications\r\n\r\nSeen by Dr.Tom/team\r\nc/o chest discomfort\r\nchest-clear\r\nTotal intake 740ml Output-1100ml\r\nMaintaining negative balance\r\n\r\nCase plan:\r\nECG to be taken\r\nChange to basal bolus\r\nIVF NS 500ml - maintanence\r\nInj.Lantus 6U s/c at b/t\r\nInj.Actrapid 4-4-4U s/c \r\nStop T.Accuvin\r\nInj.Pactive IV infusion SOS\r\n\nC/S/B Duty Doctor: Dr. Joseph @ 7:00 AM\r\n\r\nGRBS@ 6:00 AM : 79mg/dL (informed Dr. Ajish) \r\n\r\nAdv:\r\nwithhold inj. \r\nFollow same orders.\r\n\r\nSeen by Dr.Tom & team\r\nc/o nasal block\r\nPain score-2/5 over surgical site\r\n\r\nCase plan:\r\nSteam inhalation BD\r\nCBC,Crt,S.electrolytes\r\nTo discuss with Dr.Jijo regarding blood transfusion\r\n\r\n\ncase s/b DR JIJO\r\nMADE TO SIT FOR SOME TIME\r\nSTARTED TAKING MORE FOOD\r\nGC BETTER\r\nNO much of pain\r\nadv\r\ncontinue same\r\nplan\r\ninj teriparitide from day after tomorrow.\r\nno need of blood transfusion as HB improved and no active bleeding\r\ndressing tomorrow.\nC/s/b Dr Jijo\r\nPt comfortable\r\nstable \r\nactive movements +\r\nno sockage\r\nADV\r\nContinue same\nSeen by Dr Ajish and team. \r\nAC - 125mg%.\r\n\r\nCase Plan:\r\nContinue same. \r\nT. Nitrest 5mg 0-0-1. \r\nS. Elect tomorrow. \r\nInj Insugen R 4-4-4. \r\nStop Lantus.\r\n\r\nSeen by Dr.Jijo Jose\r\nnot much pain\r\nMade to sit\r\nDressing changed\r\nGreenish discolouration +\r\n\r\nCase plan ;\r\nInj.Ciplox 500mg 1-0-1\r\n\nSeen by Dr Tom and team. \r\nAC - 170mg%. \r\nHb - 8.4gm%. TC - 12000. \r\nGC - mildly dyspneic. \r\nO2 on flow. SpO2 - 97%. \r\nto chase LFT report. \r\n\r\nCase Plan:\r\nStop Potklor and Nitrest. \r\nT. Resperidone 0.5mg 1/2-0-1/2.\r\nT. Quitipin 25mg 0-0-1.\r\nBRE, RFT, Trop T.\r\n\r\nSeen by Dr.Jijo jose\r\nPt has no pain\r\nDisorientation +\r\nCase plan :\r\nPsychiatric consultation\r\nMonday onwards stop clexane.\r\nT.Clopilet A 0-0-1 ( start today )\ns/b Dr benji\r\nVitals stable\r\nno fresh complaints\r\ngrbs @ 6 pm:214\r\ninformed Dr Tom\r\nAdvise:Inj insugen R 4u\r\ncase s/b Dr JIJO\r\nPT BETTER, NO DISORIENTATION\r\nadv\r\ncontinue same.\nS/b Dr Benji\r\nVitals stable\r\nNo fresh complaints\r\nGRBS @ 6pm:189\r\nInformed Dr Radha\r\nAdvise:inj insugen 4u\nSeen by Dr.Radha & Dr.Shahin\r\nFBS-154\r\n\r\nCase plan:\r\nContinue same\nFBS:185\r\nInformed Dr Radha\r\nAdvise:Inj insugen R 6u\r\n\r\n\r\nSeen by Dr.Tom/Radha\r\nFeeling better.\r\nGC fair.\r\nHad food.\r\n\r\nCase plan :\r\nPhysiotherapy\r\nStop Clexane\r\nInj insugen R 6-6-6\r\nVit D 25Hydroxy,cxalcium,phosphorus and Albumin\r\n\r\n\r\n\r\nSeen by Dr.Jijo Jose\r\nDressing done\r\nPseudomonas infection present,informed Dr.Lakshmi\r\nDisorientation may be due to quinolones\r\nHence stop wakcef and ciplox\r\nInj.Biopiper 2.25gm 1-0-1\nS/B DR IMMANUEL, INFORMED TO DR LAKSHMI,\r\n6PM GRBS 126MG/DL- GIVEN INJ INSUGEN R-2U\nSeen by Dr.Ajish/Team\r\nFeeling better.\r\nPseudomonas infection.\r\nPus sent for culture.\r\nConstipation +++\r\n\r\nCase plan :\r\nT.Galvusmet 1-0-1\r\nInj.Lantus 4units at bedtime.\r\nDulcolax Suppository after commode.\nThanks for referral\r\nCase seen by Dr Aswin Krishnan Ajit\r\nH/s/o Delirium, now resolved\r\no/e: dehydration +\r\nAdv:\r\n1) Tab QUTIPIN 25 mg 0-0-1/2\r\n2) Tab SIZODON MD 0.5 mg 1/2-0-0\r\n3) Ensure adequate hydration.\r\n\r\nSeen by Dr.Shahin\r\nPatient comfortable\r\n6pm GRBS-166 Informed Dr.Radha\r\nInj.Lantus 4U at b/t\nSeen by Dr.Shahin\r\n6am GRBS 156 Informed Dr.Radha\r\nT.Galvus met given\r\nseen by DR Ajish& team\r\nlantus 6 unit other continue the same\r\n\r\nS/B Dr. Tom and Team\r\nDoing well\r\nSleep disturbed\r\nAppetite better\r\nLabs\r\nAC- 156 mg/dl\r\nCase Plan\r\nContinue same\r\nCatheter out tomorrow\ncase s/b Dr Jijo\r\nmade to stand on unaffected leg\r\nhigh chair sitting \r\nadv\r\ncontinue same\nSeen by Dr.Shahin\r\n6am GRBS 129\r\nInformed Dr.Ajish\r\ncase s/b Dr Jijo\r\nGC good\r\nsat by hersef with support\r\nADV\r\ncont same\npt s/b Dr Farook. GC GOOD. All vitals stable\nSeen by Dr Tom and team. \r\nGC - better. \r\nAC - 104mg%. Afebrile. \r\nChest - clear. \r\n\r\nCase Plan:\r\nDressings today by Dr Jijo Sir.\r\nCASE S/B Dr Jijo\r\nwound inspection done\r\nwound clean, alternate sutures removed.\r\nADV\r\nContinue same.\nCase seen by Dr.Luke \r\npatients gc good with stable vitals and no fresh complaints\r\nGRBS-112\r\ninformed to Dr.Manoj\r\nadvised lantus 6\nSeen by Dr Tom and team. \r\nGC - better. Afebrile. \r\nAC - 166mg%.\r\nTC - 7200. Creat - 0.9mg%. \r\nMildly restricted ROM. \r\n\r\nCase Plan:\r\nContinue same.\r\ncse s/b Dr JIJO\r\nGC fair,\r\ntaking adequate food\r\nadv\r\ncontinue same\nSeen by Dr Tom and team. \r\nAC - 94mg%. \r\nNo fresh complaints. \r\nGC - stable. \r\n\r\nCase PLan:\r\nPhysiotherapy review. \r\nPlan to discharge tomorrow.\r\ncase s/b Dr JIJO\r\nPatient made to get up from bed and side sitting with minimal support .\r\nadv\r\nphysio- non wt bearing walker stance\r\ncommode transfer.\nSeen by Dr.Ajish & team\r\n\r\nCase plan:\r\nT.Xpand 625 1-0-1 x 5 days \r\nT.Yogut 1-0-1 x 5 days\r\nStop Lantus\r\nHarold consultation\r\nCASE S/B dR jijo\r\nsuture removal done\r\nmay be discharged.'}, {'role': 'model', 'content': '\nIP Number: 3282\n\nPatient Number: 12957\n\nAdmission Date: 15-09-2014\n\nDischarge Date: 07-10-2014\n\nDiagnosis: Intertrochantric fracture Lt.\n\nClinical Exam(With BP): K/C/O Essential (primary) hypertension,Chronic ischaemic heart disease,T2DM,Diabetiic neuropathy,OA rt hip\r\n\r\nH/O fall\r\n\r\nImp:Intertrochanteric fracture Lt LL\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: Chest X-Ray :\r\n\r\n\n\nXray findings: o/e\r\nLt LL ext rotated and shortened\r\nROM painful and restricted\r\nno distal NV deficits\n\nDiscussion: 81 yr old lady admitted with h/o fall, was diagnosed to have comminuted IT fracture with subtrochantric extension. Was treated with PFN. She is discharged in a stable condition and advised not to bear wt on Lt LL as the fracture is unstable. she is also advised to continue physio at home and to moblise at a slow pace.\n\nDiet: nan\n\nRemarks: nan'}] |
3,291 | [{'role': 'user', 'content': '\nIP Number: 3291\n\nPatient Number: 18462\n\nPatient Name: A VASU (V)\n\nGender: M\n\nDate of Birth: 01-08-1940\n\nAddress: MADAPPATTU PARAMBIL\n\nPincode: nan\n\nPhNo: 2808582\n\nAdmission Date: 17-09-2014\n\nDischarge Date: 03-10-2014\n\nDiagnosis determined by the doctor when the patient was admitted: Essential (primary) hypertension\nTYPE 2 DIABETES MELLITUS\nDIABETES MELLITUS WITH PERIPHERAL NEUROPATHY\nDIABETIC FOOT\nDIABETIC NEPHROPATHY WITH CRONIC RENAL FAILURE\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: K/C/O DIABETES MELLITUS WITH PERIPHERAL NEUROPATHY,Essential (primary) hypertension,Chronic ischaemic heart disease,DIABETIC NEPHROPATHY WITH CRONIC RENAL FAILURE,TYPE 2 DIABETES MELLITUS,DIABETIC FOOT\r\n\r\nC/O recurrent episodes of fever\n\nXray information: nan\n\nClinical examination: General Examn: No pallor,No icterus\r\nSystemic Examn: Chest-RVBS heard\r\nCVS-S1 S2 heard\r\n\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: case seen by dr.renji\r\nk/c/o T2DM/DN/HTN/CRF with chronic ulcer right foot\r\nno fresh complaints\r\ngc fair \r\nvitals stable\r\nsystems nad\r\ngrbs 84 mg/dl\r\ninformed dr.radha\r\nadvice:inj actrapid 8u sc stat\r\n continue other medications\nSeen by DRA.K.Bhat.\r\nDressing changed.Pus from deep layers of sole is decreased-however probes to bone.Xray shows e/o OM of tarsal bones esp.lateral aspect-Charcots.\r\n?PLan:Foot conserving procedure versus BKA.\r\nAdvice:IV antibiotics.Packed cell transfusion.\r\n\r\ncase seen by dr renji\r\nno fresh complaints\r\nvitals stable\r\nsystems nad\r\ngrbs 147mg/dl\r\ninformed dr.manoj\r\nadvice:inj human mixtard 12u sc stat\nfbs 187mg/dl\r\ninformed dr.radha\r\nadvice:inj actrapid 18u sc stat\r\n\r\nSeen by Dr.tom/team\r\n\r\ncase plan :\r\nstop Niftas\r\n\r\ns/b Dr.Matthew M.\r\nThanks for referral.\r\nc/o diff. in prepuce retraction.\r\no/e : Phimosis.\r\nadv. Dorsal slit under LA.0n 20.9.14.\r\nfbs/s.cr.on 20.9.14. \r\n\r\n\nSeen by DRA.K.Bhat.\r\nPus discharge present.Discussion had with son regarding bone nibbling of midfoot versus midfoot amputation versus BKA.Patient and bystanders prefer only bone nibbling and control of present infection.Plan:Bone nibbling/slough excision rt foot under SA along with circumcision.Preop:Nil oral.Informed Consent.C&D.IV antibiotics.Medical fitness.Arrange one pint packed cells.\nfbs 141mg/dl\r\ninformed dr.manoj\r\nadvice:inj actrapid 18u sc stat\r\n\r\nSeen By Dr.Tom and Biju\r\nFeeling better.\r\n\r\ncase plan :\r\nSyp .Looz 15ml stat and HS\r\nInj.Lasix 10mg Midway of blood transfusion.\nfbs 150 mg/dl\r\ninformed dr.manoj\r\nadvice:inj actrapid 8u sc stat\r\n\r\nSeen by Dr.Tom/team\r\nC/O shivering\r\nBP:150/90mmhg\r\nInj.Pactiv 10mg/ml Stat given\r\n\r\ncase plan :\r\nInj.Actrapid 14-14-6units\r\nInj.Basalog 8units\r\n\nSeen by Dr Biju and Dr Luke. \r\nAC - 199mg%. \r\nHad a spike of temp in the morning. \r\nPRC on flow. \r\nHb - 9.3gm%, PCV - 28, Urea - 32mg%, Creat - 1.9mg%.\r\n\r\nCase Plan:\r\nHb, PC, TC, S. Elect, Creat tomorrow. \r\nBhat Sir to decide on catheter removal.\r\nContinue same. \r\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\n\r\n\r\n\r\n\r\n\r\n\r\n21/9/14 evening rounds\r\ncase seen by dr renji\r\nno fresh complaints \r\nvitals stable\r\nsystems nad\r\ngrbs 132 mg/dl\r\ninformed dr.biju\r\nadvice:inj actrapid 6 u sc stat\r\n inj basalog 10u sc stat\r\n continue other medication\nc/sb dr immanuel 20/9/14 at 7.30pm\r\n\r\nO/E GC BETTER, CONSCIOUS,ORIENTED,\r\n\r\nGRBS-6PM-194MG/DL INJ H.ACTRAPID 6U\r\n INJ BUSALOG 8U GIVEN\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\nSeen by Dr.Shahin\r\nc/o cough\r\nSyp.Sufrecof 1tsp BD\r\nT.Allegra 120mg HS\r\nSteam inhalation BD\r\n22/9/14,7:30 am\r\nNIL SPECIAL,INFORMED DR LAKSHMI.\r\nADV:H,ACTRAPID 4U,BUSALOG 8 UNITS\nfbs 133mg/dl\r\ninformed dr.biju\r\nadvice:inj actrapid 14 u sc stat\r\n continue other medications\r\n\r\nSeen by Dr.Manoj and team\r\nBP: 150/80mmhg\r\nTC : 16000cells/cumm\r\ncase plan ;\r\nTab.Cilacar 10mg 1-0-1\r\nInj.Clexane 0.4ml 1-0-0\r\nTo be seen by Dr.Mangat\r\n\r\ns/b Dr.Matthew M. \r\nreview. pt.fine.\r\nadv. remove dressing. Neosporin eye ointment locally.b.d.\nSeen by DRA.K.Bhat.\r\nDRessings changed.Suggested InJ.Cefoperazone,sulbactum.\r\n\r\nSeen by Dr.Ajish/team\r\nFeeling better.\r\n\r\nCase plan :\r\nChange Antibiotic to Cegava\r\nInj.Actrapid 14-14-14unitys\r\nInj.\ncase seen by dr.renji\r\n6.00pm\r\nc/o dizziness\r\ngrbs 147mg/dl\r\nglucose and juice given\r\n7.30pm\r\ncase seen by dr.renji\r\nno fresh complaints\r\nvitals stable\r\ngeneral condition fair\r\nsystems nad\r\ngrbs 147mg/dl\r\ninformed dr.radha\r\nadvice:OHA\r\n10.00pm grbs 124mg/dl\r\ninfromed dr.radha\r\nadvice:withhold actrapid\r\ninformed dr.radha\r\nadvice::inj basalog 12u sc B/T\r\n10.00pm grbs 124mg/dl\r\ninfromed dr.radha\r\nadvice:inj insugen N 6u sc B/T\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\nC/S/B Duty Doctor: Dr. Joseph @ 7:10 PM\r\n\r\nGRBS@ 6:00 PM :178 mg/dL (informed Dr. Ajish) \r\n\r\nAdv:\r\nInj. Actrapid 6 units 1/2 hr before food s/c.\r\nInj. Basalog 14 units at bed time s/c. \r\nFollow other orders.\r\n\nfbs 153mg/dl\r\ninformed dr.radha\r\nadvice:inj human actrapid 10u sc stat\r\n continue other medications\r\nHad an episode of hypo at 6pm yesterday \r\nwas symptomatic\r\ncorrected with hypotab and biscuits?\r\nw/h night dose of rapid insulin \r\ngave inj insugen-N at bedtime \r\nFBS 153mg%(put in by Dr Radha)\r\n\r\nSeen by Dr.Ajish/team\r\n\r\nCase plan:\r\nInj.Actrapid 10-10-6U s/c\r\nInj.Basalog 14U s/c at b/t\nC/S/B Duty Doctor: Dr. Joseph @ 7:00 AM\r\n\r\nGRBS@ 6:00 AM :139 mg/dL (informed Dr. Ajish) \r\n\r\nAdv:\r\nInj. Actrapid 10 units 1/2 hr before food s/c.\r\nFollow same orders.\r\n\r\nSeen by Dr.Tom & team\r\nPatient comfortable\r\n\r\nCase plan:\r\nContinue same\r\n\r\n\r\n\nSeen by DR.A.K.Bhat.\r\nDressings changed.Clean cavity.Minimal residual slough-partly excised.Continue trt.\r\n\r\nseen by dr.abhilash\r\nno fresh complaints.pain decreased\r\nafebrile\r\ngrbs at 6pm:234\r\ninformed dr biju.advised to continue the same treatment\nSeen by DR.A.K.Bhat.\r\nDressings changed.Clean,but deep defect rt heel.Allevyn dressing done.Continue trt,.Suggested oral antibiotics.\r\n\r\nPt s/b Dr farook. all vitals stable. No fresh complaints\nseen by dr.abhilash\r\nno fresh complaints\r\ngrbs at 6am:128.informed dr.biju.advised to continue the same treatment.\r\n\r\nSeen by Dr.Ajish/team\r\nFeeling better\r\n\r\ncase plan ;\r\nBRE,Creatinine\r\ncandid mouth paint\r\nDulcolax HS\nS/b Dr Benji\r\nNo fresh complaints\r\nVitals stable\r\nGRBS @ 6:141\r\nInformed Dr tom\r\nAdvise:Inj actrapid 4 u\r\nInj basalog 12u\r\nStop IV antibiotics\r\nStart T. levoflox OD\nSeen by DrA.K.Bhat.\r\nContinue trt.Suggested oral antibiotics.\nFBS:150\r\nInformed Dr Tom\r\nAdvise:Inj actrapid 10u.\r\nSeen by DrA.K.Bhat.\r\nDressings changed.Large deep cavity rt foot exposing deep tarsal bones.Granulation present.Pus decreased.Continue trt.\r\n\r\nSeen by Dr.Radha & Dr.Shahin\r\nPatient comfortable\r\n\r\ncase plan:\r\nT.Welset 1 sos\r\nStop Allegra\r\nStop Sufrecof\r\nStop Clexane\r\nTo restart on T.Clopilet after discussing with Dr.Bhatt\r\n\r\nAdvised to restart clopilet\nS/b Dr Benji\r\nVitals stable\r\nNo fresh complaints\r\nGRBS @ 6pm:97\r\nInformed Dr Radha\r\nAdvise:Inj actrapid 2u\r\nGRBS @ 10:203\r\nInj basalog-14u\nFBS:79\r\nInformed Dr Radha\r\nAdvise:Inj actrapid 6\r\n\r\nSeen by Dr.Tom/Radha\r\nFeeling better.\r\n\r\ncase plan :\r\nXray right foot AP/Lat.\r\n\r\nBasalog 12units.\nSeen by DRA.K.Bhat.\r\nC&D done.Rt foot deep ulcer.Plan:Discussed with DR.Tom&DR.Jijo:Stage one:Tibialis posterior release.Stage two:Arthrodesis.\r\n\r\nS/B Dr immanuel, informed to dr lakshmi,\r\n\r\n6pm GRBS-172mg/dl- ACT 2U,& BASA 10U,\nSeen by DRA.K.Bhat.\r\nContinue trt.C&D tomorrow before surgery.\r\n\r\nSeen by Dr.Tom/Team\r\nFeeling better.\r\nAfebrile.\r\n\r\ncase plan :\r\nInj.Actrapid 6-6-2units\r\nInj.babsalog 10units.\r\n\nSeen by Dr.Shahin\r\nPatient comfortable\r\n6pm GRBS-106 Informed Dr.Radha\r\nInj.Basalog 10U at b/t\nCASE S/B Dr Jijo\r\noccl pain\r\nADV\r\nTHIOSPAS 8 MG 0-0-1\r\nCONTINUE ORAL ANTIBIOTICS\nSeen by Dr.Shahin\r\n6am GRBS 117 Informed Dr.Radha\r\nInj.Actrapid 6U given\r\ncase s/b Dr jijo\r\nADV\r\nPOSTED FOR posteriomedial release under LA at 12 noon\r\ninj cegava 1.5 mg IV just before shifting\r\nconsent\r\ninform sos.\r\n\r\ns/b DR Ajish and team\r\n case plan\r\n-------------\r\nfasting 117 \r\nc/o constipation\r\nposted for posteriomedial release under LA\r\n\n2.30am\r\nSeen by Dr.Shahin\r\nC/O pain,cannot sleep\r\nAdv:Inj.Tramadol IV stat,Inj.Emeset IV stat\r\nPatient had an episode of hypoglycemia around 3am,had a biscuit himself.\r\nGRBS 6am 200\r\nInformed Dr.Ajish,Adv Actrapid 4U\r\n\r\nS/B Dr Jijo \r\nc/o pain\r\nAdv Inj tramadol sos\r\n\r\nSeen by Dr.Tom & Dr Farook\r\n6am GRBS 200\r\n\r\nAdv 2am GRBS tomorrow\r\nCase plan \r\nDischarge after discussing with Dr bhatt.\r\nSeen by DrA.K.Bhat.\r\nC&D tomorrow.\nS/B Dr Farook. \r\nAll vitals stable\r\nGC good No fresh complaints.\r\n\r\nGRBS @ 6pm 133. Informed Dr.Tom\r\ncont same\nSeen by Dr Bhat. \r\nDressings changed.Adviced:Dressing change once in 2 days-cuticell,pad,bandage.Antibiotics 2 weeks,.REview 2 weeks OP.\nSeen by Dr Tom and team. \r\nGC stable. \r\nAfebrile. \r\n\r\nDressings by Dr Bhat. \r\nPlan to discharge today.'}, {'role': 'model', 'content': '\nIP Number: 3291\n\nPatient Number: 18462\n\nAdmission Date: 17-09-2014\n\nDischarge Date: 03-10-2014\n\nDiagnosis: Chronic Non Healing Ulcer Lt foot. \r\nOM Tarsal bones. \r\nPost Circumcision.\n\nClinical Exam(With BP): K/C/O DIABETES MELLITUS WITH PERIPHERAL NEUROPATHY,Essential (primary) hypertension,Chronic ischaemic heart disease,DIABETIC NEPHROPATHY WITH CRONIC RENAL FAILURE,TYPE 2 DIABETES MELLITUS,DIABETIC FOOT\r\n\r\nC/O recurrent episodes of fever\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: Pus C/S (19/09/14) - Moderate growth of E coli. \r\n\n\nXray findings: General Examn: No pallor,No icterus\r\nSystemic Examn: Chest-RVBS heard\r\nCVS-S1 S2 heard\r\n\n\nDiscussion: 74 yr old, Mr Vasu, a known diabetic with associated nephropathy, neuropathy and retinopathy, presented to us with fever with chills. The ulcer on the Rt foot was infected with extensive pus and OM. He was admitted and started on empirical antibiotics. He was seen by our podiatric surgeon who debrided the ulcer as there was excessive necrotizing infection over the sole of the foot. Circumcision was also done during the same time by our urologist as he had phimosis. Regular dressings were given. Since the evertors were infected, the feet became inverted, which was seen by our ortho surgeon and tenson fractional lengthening was done. The wound was monitored and regular dressings were done. The wound is clean and healing with granulation tissue. His sugars are also under control. Hence discharged in a stable condition and advised to review as outpt.\n\nDiet: nan\n\nRemarks: If You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\n'}] |
3,566 | [{'role': 'user', 'content': "\nIP Number: 3566\n\nPatient Number: 20307\n\nPatient Name: RAFEEKA BEEVI\n\nGender: F\n\nDate of Birth: 04-11-1936\n\nAddress: PUTHENVEEDU\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 17-11-2014\n\nDischarge Date: 06-12-2014\n\nDiagnosis determined by the doctor when the patient was admitted: Essential (primary) hypertension\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: Provisional Diagnosis:B/L severe OA Knee,CIPA,Essential Hypertension\r\n\r\nAdmitted for total knee replacement\n\nXray information: nan\n\nClinical examination: Conscious & Oriented\r\nVitals stable\r\nBP-130/80mmhg\r\nChest-NVBS heard\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: 12.30pm,seen by Dr.Shahin\r\nTemp-100.4F\r\nT.Dolo 650stat\r\ncase s/b Dr Jijo\r\nprovisionally posted for b/l TKR on thursday\r\nc/o pain and effusion of both knees and wrist.\r\nAdv\r\ntab Naprosyn 500 1-0-1\r\nthrize 1-1-1\ncase s/b Dr Jijo\r\nOn urinary catheter as adviced by urologist\r\nADV\r\nInj amickacin 500 mg IV st and bid\r\n\r\n\ncase s/b Dr Jijo\r\npain reduced\r\nable to move the limbs\r\nedema reduced\r\nadv\r\narrange 5 pints of packed cell \r\nplan to transfuse 1 pint preop\r\n\nseen by physio\r\nKnee scoring 80/100 by knee society scoring system\ncase s/b DR Jijo\r\nPt comfortable\r\nconsious and oriented\r\nvitals stable\r\nno sockage\r\nno distal NV deficits\r\nchest clear\r\nS1S2 N\r\nP/A SOFT \r\nBS +\r\nadv\r\ninj pansec 40 mg IV Stat\r\ncontinue rest of medications.\npost op orders\r\nNPO X 4 HRS\r\nIVF DNS 3 PINTS IV 100 ML /HR FOR NEXT 24 HRS\r\nINJ WAKCEF 1.5 GM IV BID\r\nINJ AMICKACIN 500 MG 1V BID\r\nANALGESIC THROUGH EPIDURAL AS INSTRUCTED BY ANESTHETIST\r\nI/O CHART\r\nWATCH FOR BLEEDING/SOCKAGE/ DRAIN\r\nINJ KLEXANE 40 MG S/C FROM TOMORROW MORNING 6 AM.\r\nPHYSIO- CHEST PHYSIO\r\nSLR\ns/b Dr Benji\r\ntemp:103F\r\npulse:130/min,BP:130/80\r\nAdvise:Inj neomol infusion\r\nsend Hb,PCV,electrolytes tomorrow morning\r\nCase s/b Dr Jijo\r\npt comfortable\r\nminimal pain\r\nurine output reduced\r\nno ongoing bleed\r\nadv\r\ninj amickacin 250 mg bid from tomorrow\r\ninj paracetamol iv sos.\ns/b Dr Benji\r\ntemp:103F @ 1am\r\npulse:130/min,BP:130/80\r\nAdvise:Inj neomol infusion\r\nsend Hb,PCV,electrolytes in morning\r\n\r\n\r\nS/b Dr Benji\r\nblood stained epidural catheter on aspiration\r\nInformed Dr Sajana\r\nAdvise:stop epidural injections\r\nInj tramadol 50mg BD\r\nInj emset 4mg BD\r\n\r\nHb:7.7,PCV:23,Creat:0.8,Na:139,K:2.6\r\nInformed Dr jijo\r\nAdvise:Transfuse 1 pint packed cell\r\ncase s/b Dr JIJO\r\nRt side sockage +drain not functioning\r\nLt side minimal drainage\r\n\r\nRT HAND EDEMA +\r\nMILD B/L FOOT EDEMA +\r\nI/O- 2700/ 1200\r\nDRAIN ABOUT 300 ML\r\nCHEST clear\r\nP/A soft bs +\r\nADV\r\nPHYSIO- CHEST PHYSIO\r\nANKLE PUMPS\r\nSLR WITH BRACE\r\nGENTLE KNEE MOBILISATION 15 TIMES BID\r\nCONTINUE ALL MEDICATIONS\r\nCENTRAL VENOUS CATHETERISATION\r\ntab THRIZE 1-1-1\r\n\ns/b Dr Benji\r\ntemp:103F\r\npulse:130/min,BP:130/80\r\nAdvise:Inj neomol infusion\r\nsend Hb,PCV,electrolytes tomorrow morning\r\nCase s/b Dr Jijo\r\npt comfortable\r\nminimal pain\r\nurine output reduced\r\nno ongoing bleed\r\nadv\r\ninj amickacin 250 mg bid from tomorrow\r\ninj paracetamol iv sos.\r\ncase s/b Dr JIJO\r\nMINIMAL PAIN \r\nACTIVE SLR +\r\nKNEE BENDING 15-20 DEG \r\nNO SOCKAGE\r\nADV\r\n\r\nCONTINUE SAME\r\nICE PACK APPLICATION 15 MIN EVERY 2 HRS\r\nTO REMOVE EPIDURAL CATHETER TOMORROW MORNING AFTER GIVING MORNING DOSE\r\nWITHHOLD INJ CLEXANE TILL REMOVAL OF EPIDURAL CATHETER.\r\nTRANSFUSE I PINT OF PACKED CELL TOMORROW MORNING AND SHIFT TO WARD.\ns/b Dr Benji\r\ntemp:103F @ 1am\r\npulse:130/min,BP:130/80\r\nAdvise:Inj neomol infusion\r\nsend Hb,PCV,electrolytes in morning\r\n\r\n\r\nS/b Dr Benji\r\nblood stained epidural catheter on aspiration\r\nInformed Dr Sajana\r\nAdvise:stop epidural injections\r\nInj tramadol 50mg BD\r\nInj emset 4mg BD\r\n\r\nHb:7.7,PCV:23,Creat:0.8,Na:139,K:2.6\r\nInformed Dr jijo\r\nAdvise:Transfuse 1 pint packed cell\r\ncase s/b Dr JIJO\r\nRt side sockage +drain not functioning\r\nLt side minimal drainage\r\n\r\nRT HAND EDEMA +\r\nMILD B/L FOOT EDEMA +\r\nI/O- 2700/ 1200\r\nDRAIN ABOUT 300 ML\r\nCHEST clear\r\nP/A soft bs +\r\nADV\r\nPHYSIO- CHEST PHYSIO\r\nANKLE PUMPS\r\nSLR WITH BRACE\r\nGENTLE KNEE MOBILISATION 15 TIMES BID\r\nCONTINUE ALL MEDICATIONS\r\nCENTRAL VENOUS CATHETERISATION\r\ntab THRIZE 1-1-1\r\ncase s/b dr Jijo\r\nwound inspection done \r\nwound clean\r\ndrains removed\r\ndressing done\r\nadv\r\ntab acuvin 1-1-1\r\ntab axipan 1-0-0\r\nice pack 15 min x every 2 hrs\r\ntransfuse 1 pint of blood.\r\n\nEpidural Injection given at 06:00am\r\nEpidural Catheter removed at 06:30am\r\n\r\n\r\nS/b Dr. Mercy\r\nTemp - 101F\r\nBP - 143/92mmHg\r\nPR - 105bpm\r\nAdvised Neomol Infusion stat\r\n\r\nSeen by Dr.Lakshmi & Dr.Shahin\r\nTemp-100.1F\r\nI/O-1050/1600\r\nB.P- 140/88\r\nPulse- 104/min\r\nPulse OX- 94-95 On 2 L nasal cannula\r\n\r\nPt states that the pain is less.\r\nepidural catheter removed. only on tramadol twice daily\r\nMild increase in temp. WBC normal\r\nCheck urine Re\r\nHb- 8.3, K- 3.3\r\n\r\nPlan- transfuse 1 units of PRBC,\r\nInj neomol + 1 am Avil prior to transfusion, lasix 20 mg in between\r\nDNS with KCl 40 meq on flow\r\ncase s/b Dr jijo\r\nPT Comfortable\r\nblood on flow\r\ngc fair\r\nno rest pain\r\nstarted knee flexion upto 30 degree\r\nslr and static quads started\r\nno sockage\r\nADV\r\nMay be shifted to ward after blood transfusion\r\ncheck x-ray while shifting\r\ninj neomol 100 mg IV TID \r\n\r\n\nDr. JIJO advised\r\nInj. Dextrose 25% 100ml TID\r\n\r\n\r\nInformed Dr. Lakshmi\r\nGRBS at 06:00pm - 138mg/dl\r\nCASE S/B DR Jijo\r\nGC better\r\nADV\r\nCONTINUE SAME.\nS/b Dr.Tom and Team\r\nGC slighlty drowsy but arousable\r\n?pain +\r\nPR - 90/min\r\nHb - 9.5\r\nPottassium - 3.7\r\nI/O - 1600/2270\r\n\r\nCase Plan\r\nRFT,Electrolytes daily\r\nDaily Creatinine\r\nIVF NS with 20 mmol Kcl , iv 80ml/hr\r\nInj.Pansec 40mg iv BD\r\nInj. Emeset SOS\r\ncase s/b Dr JIJO\r\nPt drowsy\r\n30 flexion of both knees+\r\nadv\r\ninj dextrose 25 % slow IV tid\r\nstop acuvin.\r\n\nCASE S/B DR JIJO\r\nPt comfortable\r\nminimal pain \r\nADV\r\nCONTINUE SAME\r\nOSTOSPRAY 1 PUFF DAILY FROM TOMORROW.\nInformed Dr. Lakshmi\r\nGRBS at 06:00am - 132mg/dl\r\n\r\nSeen by Dr.Ajish & team\r\nPatient better\r\nBP-130/80mmhg\r\nContinue same\r\ncase s/b Dr Jijo\r\nGC IMPROVED\r\nMade to sit on the side\r\nknee flexion upto 30 deg\r\nextension full\r\nADV\r\nPHYSIO- increase knee flexion upto 60 deg\r\ndo all exercises\r\nquads strengthening\r\nheel slides.\r\ncontinue same medications.\nS/b Dr. Ajish and Team\r\n\r\nCase Plan\r\nCASE S/B Dr Jijo\r\nwound inspection done\r\nwound clean\r\nbulky dressing changed to thin dressing\r\nGC good\r\nADV\r\nPhysio bid\ncase s/b Dr Jijo\r\npain +\r\nconstipation +\r\nADV\r\nTab LORNASAFE (lornoxicam) 8 MG 1-0-1\r\ntab dulcolax 2 hs\r\n\nS/B Dr Ajish/Dr Radha/Dr Lakshmi\r\n\r\nAll vitals stable.\r\nCase plan\r\n\r\nContinue physiotherapy \r\nSyp looz 20ml BD.\r\nCASE S/B Dr jijo\r\nmade to stand\r\nadv\r\ncontinue physio\r\ntab yogut 1-0-1\r\nsyp bevon 1 tsp bid\r\ncandid mouth paint.\nDr. Lakshmi advised\r\nHb, Creatinine tomorrow\r\n\nS/b Dr Tom and Team\r\npain-3/5\r\nnot passed stools\r\n\r\no/e\r\nBP-130/80mmhg\r\n\r\n\r\nCase Plan\r\nSyp.Looz 20 bd\r\n\r\n\nSeen by Dr Tom and team. \r\nWalked yday with help. \r\nHas loose stools. \r\n\r\nCase Plan:\r\nContinue same.\r\nCASE S/B DR JIJO\r\nRemove catheter,\r\ncommod transfer today\r\ntab lopramide stat\r\nto continue physio\r\ndressing change today\r\nIVF 2 PINT DNS IV ST\ncase s/b Dr Jijo\r\nRt knee effusion\r\nADV\r\nICE PACK APPLICATION HOURLY FOR 15 MIN RT SIDE\r\nLt side 2 hrly 15 min.\r\ninj clexane to be stopped tomorrow\r\nsyp Shelcal 10 ml hs\r\ntab ecosprin 75 mg 0-1-0\nSeen by Dr Tom and team. \r\nGC - better. \r\nSlept well. Edema less. \r\nMild loss of appetite. \r\nLoose stools better. \r\n\r\nCase Plan:\r\nPhysiotherapy(mobilization and supported ambulation) to continue.\r\nCASE S/B Dr Jijo\r\npain and swelling reduced\r\nadv\r\nstop injectable antibiotics\r\ntab wakcef 500 mg 1-0-1\r\ninj arachitol 6L iu IM ST\r\nCONTINUE ICE AND PHYSIO.\[email protected] am c/o shivering\r\nO/E afebrile, All vitals stable\r\nInj avil 1amp im stat\r\n\r\n\r\nS/b Dr. Ajish and Team\r\nGC - stable, better. \r\nWalked with a walker under supervision of physiotherapist. \r\n\r\nCase Plan\r\nS. Elect, Calcium profile, Urea.\r\n\r\nS/B Dr.Matthew M.\r\ncath. removed <2 days.\r\nincont'ce.-wets full diaper n bedsheets n floor by morng.\r\nur-c/s sent after cath removal. -report awaited.\r\nadv.\r\nCap.UrotelXL4mg bd.\r\nshall review after ur.-c/s report.\r\n\r\n\ncase s/b Dr Jijo\r\nPt comfortable\r\nfatigue +\r\nGood rom Rt 90 Lt 100\r\nADV\r\nhb pcv tomorrow\r\nx-ray both knee ap &lat\r\ninj aminodrip once daily.\nSeen by Dr.Ajish & team\r\nContinue same\r\ncase s/b Dr Jijo\r\nx-ray good align\r\nrom Rt 70 Lt 90 active\r\nno ext lag\r\nslr +\r\nhb 9.5\r\nADV\r\nSUTURE REMOVAL DONE\r\ninj amino drip slow IV OD\r\n \r\n\ncase s/b Dr Jijo\r\nadv\r\nstop Tab WAKCEF\r\ncontinue exercises\r\n\r\nS/b Dr Benji\r\nVitals stable\r\nNo fresh complaints\r\ncont. same trt\nS/b Dr. Ajish and team\r\nGC Stable\r\n\r\nCase Plan\r\nContinue same\ncase s/b Dr Jijo\r\nh/o blood in stool\r\nGC good \r\ndoing exercises well\r\nadv\r\nfor discharge tomorrow.\r\ndr bhat consult for proctoscopy\r\nhb, esr, protien tomorrow.\r\n\r\nS/B Dr Tom & Team\ncase s/b Dr Jijo\r\nhb-9.6 ESR- 75\r\nTP- 6.3 ALB 3.1, GLB 3.2\r\ngc improved\r\nwalks independently on crutches.\r\nADV\r\nCONTINUE SAME\r\nMAY BE DISCHARGED ."}, {'role': 'model', 'content': '\nIP Number: 3566\n\nPatient Number: 20307\n\nAdmission Date: 17-11-2014\n\nDischarge Date: 06-12-2014\n\nDiagnosis: CIPA - RA\r\nB/L severe OA Knee\n\nClinical Exam(With BP): Provisional Diagnosis:B/L severe OA Knee,CIPA,Essential Hypertension\r\n\r\nAdmitted for total knee replacement\n\nSystolic BP: 130.0\n\nDiastolic BP: 80.0\n\nPhysical examination: nan\n\nXray findings: Conscious & Oriented\r\nVitals stable\r\nBP-130/80mmhg\r\nChest-NVBS heard\r\n\n\nDiscussion: 78 YR old lady admitted with severe pain and swelling of both knees and unable to walk was diagnosed to have Rheumatoid arthritis with severe distruction of both knee joints Rt>Lt.She had 30 degree of FFD on both sides and further passive flexion of upto 60 degree on Rt and 80 degree on Lt. B/L TKR was done and has achieved about 110 degree of knee flexion \r\nof Lt knee and 90 Degree on Rt And is ambulating with walker support with minimal pain. she is advised Home exercise programme at home and healthy diet to improve her physical condition. urology consult given for urinary incontinance and rheumatology consult for RA\r\nActive RA treatment is deffered as the disease is burnt out with no other joint involvement. \r\nProtien supplimentation should be given for at least 3 months.\r\ninj zolendronate and inj Arachitol 6L IU was given for osteoporosis and is advised to repeat Inj zolendronic acid every year for 3 consecutive years. She has to be on calcium supplimentation for 5 yrs.\n\nDiet: nan\n\nRemarks: nan'}] |
3,651 | [{'role': 'user', 'content': '\nIP Number: 3651\n\nPatient Number: 20978\n\nPatient Name: JOBY JOHN\n\nGender: M\n\nDate of Birth: 06-12-1982\n\nAddress: MADUKKAKUZHY\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 06-12-2014\n\nDischarge Date: 22-12-2014\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: Admitted with h/o RTA\n\nXray information: nan\n\nClinical examination: Vitals stable\r\nGC fair\r\nSystemic examn:WNL\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: case s/b Dr Jijo\r\nrisk of AVN to femoral head explained to patients brother\r\nposted for Recon nailing under EPIDURAL under c-arm AT 9.30 AM\r\ninj wakcef 1.5 gm bid\r\ninj amickacin 500 mg bid\r\ninj forwin 30 mg + inj phenergan 12.5 gm im ST\r\nCONSENT\r\nINFORM OT/ANESTHETIST.\r\nPHYSICIAN CONSENT .\ncase s/b dr jijo\r\nminimalpain otherwise comfortable\r\nfebrile\r\nvitals stable\r\nADV\r\nINJ WAKCEF 1.5 GM BID\r\nINJ AMICKACIN 500 MG BID\r\nINJ PACTIV TID\r\nINJ IVF 2 PINT DNS 100 ML /HR\r\n\r\nhb pcv tomorrow.\ncase s/b DR Jijo\r\nvitals stable\r\nminimal pain \r\nsockage+\r\nswelling reduced\r\nadv\r\nover pad\r\n1 pint of blood to be transfused today\r\narrange 2 pints of blood for tomorrow\r\nposted for clavicle fixation and nail locking on 10 /12/14 at 3.30 PM\r\nnpo from 9 AM\r\nINFORM OT/ANESTHETIST\r\nCONSENT\r\nInform sos\r\ncontinue iv antibiotics .\ncase s/b Dr Jijo\r\npain reduced \r\nGC IMPROVED\r\nADV\r\nCONTINUE SAME\r\nTO transfuse 1 pint of blood tomorrow.\nPOST OP ORDERS\r\nNPO FOR 4 HRS\r\nINJ AMICKACIN 500 MG iv stat and bid thereafter\r\ninj WAKCEF 1.5 GM IV STAT AND BID thereafter\r\ninj neomol IV tid\r\ninj IVF as per anesthetic advice\r\ninj clexane 40 mg S/C AT 9 AM \r\nInform sos.\r\n-------------------------------------\r\nS/B Dr.Jijo\r\nvitals stable \r\nFebrile\r\nGood Urine output\r\nChest clear\r\nPain +\r\nNo Fresh complaints\r\nAdv Stop Inj Wakcef\r\nInj Tazowak 4.5 g IV BD(10am 10pm)\r\nRest of Inj Cont\r\nURE, Culture after clamping\r\nTab.Thrice 1-1-1\r\nTab Yogut 1-0-1\nc/o pain \r\nInformed Dr. Lakshmi\r\nAdvised Inj. Tramadol 50mg iv stat\r\nPatient still c/o pain\r\nInj. Epidural stat\r\n\r\ns/b Dr.Lakshmi/Manoj\r\n Thanks for the referral\r\n\r\npost op\r\n\r\nc/o pain\r\nmild throat irritation\r\nfever\r\n\r\no/e\r\npulse-100/min\r\nBP-120/80mmhg\r\nSPO2-90% (room air)--98% with O2\r\nno calf muscle tenderness\r\nChest-clear\r\nabd-soft\r\ncvs s1s2+\r\n\r\ncase plan\r\nCBC/RFT/Urine R/Electrolytes\r\nchest physio--spirometry\r\n\r\ncase reviewd (2.15pm)\r\ntachycardia 116/min\r\nHb-8.3\r\nTC-6100\r\nPOLY-87\r\n\r\nSPO2 91%--room air\r\n\r\nplan-to correct anaemia--blood transfusion\r\nto add Linezolid if the fever persists\nS/B Dr Farook\r\nInformed Dr Jijo/Dr Manoj\r\nU alb 4+\r\nIVF 1 pint ns\r\nCKMB Electolytes creat\r\ncase s/b Dr Jijo\r\nPT COMFORTBLE\r\nMINIMAL PAIN\r\nadv\r\ncontinue same\ncase s/b Dr Jijo\r\npain much better\r\ntachycardia rate reduced to 98\r\nBP 120-/70 \r\nGOOD OUTPUT\r\nCHEST CLEAR\r\nP/A soft\r\nADV\r\nfor dressing tomorrow\r\nto remove epidural catheter tomorrow before giving inj clexane after consulting with anesthetist.\r\nto shift to ward tomorrow\r\nphysio bid\r\nx-ray - Rt femur with hip AP/LAT AND LT CLAVICLE AP while shifting.\r\n\r\nS/b Dr. Mercy\r\nGC - stable\r\nBP - 118/60mmHg\r\nPR - 93 bpm\r\nSPO2 - 94\ncase s/b Dr JIJO\r\nminimal pain\r\nswelling +\r\nstarted sitting on the side\r\nfoot edema +\r\nADV\r\ninj polybion 1 amp in iv fluid od\r\n\ncase s/b Dr Jijo\r\nwound inspection done\r\nwound clean\r\nvitals stable\r\nADV\r\nInj IVF NS 100 ML/HR to continue\r\ninj tazowak 4.5 gm IV BID\r\nINJ AMICKACIN 500 MG BID\r\nINJ PACTIV 1000 MG IV TID\r\nINJ FORTWIN 30 IM AND INJ PHENERGAN 12.5 GM IM HS SOS\r\nTAB THRIZE 1-1-1\r\nTAB YOGUT 1-0-1\r\nINJ CLEXANE 40 MG S/C AT 9 AM\r\nTAB AXIPAN 4O MG 1-0-0\r\nTAB ECOSPRIN 75 MG 0-1-0\r\nMAY BE SHIFTED TO WARD\r\nICE PACK APPLICATION TO RT THIGH EVERY 2 HRS FOR 10 MIN\r\nPROTIEN RICH DIET.\nSeen by Dr.Jijo\r\nPt comfortable\r\nMade to sit\r\nNo soakage\r\nOdema of Rt thigh +\r\nAdv:To stop clexane after tomorrows dose\r\nContinue IV antibiotics\r\nAdv:\r\nSyp.Dexorange 1tsp BD\ncase s/b Dr JIJO\r\nPAIN +\r\nnot pased motion\r\nabd distension+\r\nADV\r\nCONTINUE SAME\r\nDRESSING TOMORROW.\ncase s/b Dr Jijo\r\npt comfortable, afebrile\r\nminimal pain \r\nADV\r\ncontinue same\ncase s/b Dr Jijo\r\nwound inspection done\r\nwound clean\r\nADV\r\nTo continue medications\r\nstop inj pactive, amikacin, IV fluids and thrize.\r\ntab ciplox 500 mg 1-0-1\r\ntab alanz d 1-1-1\nCASE S/B Dr Jijo\r\npt comfortable\r\ndone exercises \r\nadv\r\ncontinue same\r\nstop inj tazowak from tomorrow morning.\r\ntab wakcef 500 mg 1-0-1 from tomorrow evening\r\nremove canula tomorrow\r\ntab becozinc 0-1 -0\r\n\nCASE S/B DR Jijo\r\nPt comfortable\r\nadv\r\nclavicle dressing today evening.\ncase s/b Dr Jijo\r\nwound dressing done\r\nwound clean\r\nalternate sutures removed\r\nADV\r\ncont same\r\nwound dressing of leg tomorrow\r\n\nC/o pain\r\nInformed Dr. Jijo\r\nAdvised\r\nInj. Tramadol 50mg IM stat\r\nInj. Phenergan 12.5mg IM stat\ncase s/b Dr Jijo\r\npain + at fracture site\r\nadv\r\nx-ray- Rt femur with hip AP With hip in internal rotation.\r\nhb .s.bilirubin today\r\ninj ketrol 1 amp im sos\r\nstop alanz d\r\ntab zixmr od 0-0-1\r\n\r\n\nS/b Dr. Lakshmi\r\ndoing fine \r\n\r\nCase Plan \r\nCt same\ncase s/b Dr Jijo\r\nwound dressing done\r\nsutures removed\r\nADV\r\nmay be discharged'}, {'role': 'model', 'content': '\nIP Number: 3651\n\nPatient Number: 20978\n\nAdmission Date: 06-12-2014\n\nDischarge Date: 22-12-2014\n\nDiagnosis: fracture neck and shaft of Rt femur\r\nfracture distal end clavicle Lt\r\nfracture 3 rd and 4th MT Rt hand\r\nmultiple abrasions and contusions - Rt side of face , both LL, Lt shoulder , abdomen RT , AND Hands.\n\nClinical Exam(With BP): Admitted with h/o RTA\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: nan\n\nXray findings: Vitals stable\r\nGC fair\r\nSystemic examn:WNL\n\nDiscussion: patient was admitted with fracture of neck and shaft of femur, treated with recon nailing. Owing to the initial displacement of neck fracture, patient and bystander was informed regarding chance of AVN of head of femur. closed reduction and nailing was done. post operative period was complicated by myoglobinuria which was treated with IV fluids and a close watch was made on kidney function. urine became clear by 3 days .\r\nLt clavicle fracture was treated by ORIF AND 3nd and 4th MC fractures of Rt hand treated conservativally \r\nhe is adviced to continue bed rest as both upper limbs were unable to use for crutch walking\n\nDiet: nan\n\nRemarks: nan'}] |
4,258 | [{'role': 'user', 'content': '\nIP Number: 4258\n\nPatient Number: 8599\n\nPatient Name: JANAKI K\n\nGender: F\n\nDate of Birth: 10-12-1943\n\nAddress: C/O SREE SARADA MADAM, M. G. ROAD\n\nPincode: 682016.0\n\nPhNo: nan\n\nAdmission Date: 11-05-2015\n\nDischarge Date: 28-05-2015\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: c/o pain RT Hip. dhs fixation done elsewhere.\r\nunable to bear weight on Rt hip\r\nBL OA knee, Rt knee MMI\r\nRt hip healed fracture\n\nXray information: nan\n\nClinical examination: CNS Conscious oriented\r\nCVS s1 s2 heard\r\nResp B/L NVBS\r\nP/A soft non tender\r\n\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: @11.30 AM S/B Dr Farook \r\nHistory collected\nCASE S/B Dr Jijo\r\nRt hippain post surgically\r\nx-ray showed derotation screw into the hip jt\r\nADV\r\nrpt lat x-ray\r\ncontinue same.\r\ntab corallium d3 (coral calcium)HS\nSEEN BY DR. TOM AND TEAM\r\nC/O: \r\n\r\nO/E: \r\n\r\nPULSE:\r\nBP:\r\nCVS:\r\nCNS:\r\nRS:\r\nSUGAR PROFILE: PREDINNER:\tFBS:\tPPBS:\r\n\r\nINVESTIGATION FINDINGS:\r\nX-RAY: \r\nECG: \r\nUSG ABDOMEN:\r\n\r\nCASE PLAN:\r\nCHANGE OF MEDICATION:\r\nCONSULTATIONS PLANNED:\r\nINVESTIGATION TO BE DONE: \r\nhba1c\r\nrft\r\n\r\ncases/b Dr Jijo\r\nc/opain+\r\nflexor tightness +\r\n20 deg ffd +\r\nADV\r\nContinue same.\ncase s/b Dr Jijo\r\npain reduced\r\nFFD -20 DEG\r\nADV\r\nCONTINUE SAME\r\nPHYSIO BID\r\nSTOP ZIX MR OD\r\nTAB THIOSPAS 8 MG 1-0-1\r\nTAB LORSAID SD 1-0-1\ncases/b Dr JIJO\r\nADV\r\nCONTINUE THE SAME.\ncases/b Dr Jijo\r\npain reduced \r\nmade to walk\r\nsymptomatically better\r\nADV\r\nCONTINUE SAME\ncase s/b Dr JIJO\r\nPAIN REDUCED\r\nADV\r\nTAB THIOSPAS 8MG 0-0-1\nSEEN BY DR. TOM AND TEAM\r\nC/O: \r\n\r\nO/E: \r\n\r\nPULSE:\r\nBP:\r\nCVS:\r\nCNS:\r\nRS:\r\nSUGAR PROFILE: PREDINNER:\tFBS:\tPPBS:\r\n\r\nINVESTIGATION FINDINGS:\r\nX-RAY: \r\nECG: \r\nUSG ABDOMEN:\r\n\r\nCASE PLAN: continue same\r\nCHANGE OF MEDICATION:\r\nCONSULTATIONS PLANNED:\r\nINVESTIGATION TO BE DONE:\r\ncases/b Dr Jijo\r\nminimal pain at night\r\nnumbness+both foot\r\nadv\r\ntab macraberiin P 0-0-1.\r\n\nc/o pain\r\nadv: t alanZD 1 stat\ncase s/b DrJIJO\r\npain reduced\r\nADV\r\nphysio-gait training\nCASE S/B Dr Jijo\r\n pain+over the Lt hip and knee\r\nADV\r\nTAB ALANZ D 1-1-1\r\nTAB REVERA D 1-0-0\r\nTAB MENABOL 1-0-1\r\n\ncase s/b dr Jijo\r\npain + on Rt hip\r\nLt leg pain reduced\r\nADV\r\nphysio bid from tomorrow\r\ncontinue same\ncase s/ b Dr JIJO\r\nADV\r\nSCREW REMOVAL ON MONDAY 1PM\r\nINFORM OT/ANESTHETIST\n4.00 PM: c/o severe pan (R) leg\r\nadv T. acyclofenac 1 stat\npost op orders\r\nnpo x 3 hrs\r\ninj pactiv iv st and sos\r\ntab wakcef 500 mg 1-0-1\r\ntab acuvin 1-0-1\nCASE S/B dR jijo\r\nWI done, wound clean \r\nADV\r\ncontinue same\r\nto be discharged tomorrow.\nSEEN BY DR. TOM AND TEAM\r\nC/O: \r\n\r\nO/E: \r\n\r\nPULSE:\r\nBP:\r\nCVS:\r\nCNS:\r\nRS:\r\nSUGAR PROFILE: PREDINNER:\tFBS:\tPPBS:\r\n\r\nINVESTIGATION FINDINGS:\r\nX-RAY: \r\nECG: \r\nUSG ABDOMEN:\r\n\r\nCASE PLAN: discharge\r\nCHANGE OF MEDICATION:\r\nCONSULTATIONS PLANNED:\r\nINVESTIGATION TO BE DONE:\r\ncase s/b Dr Jijo\r\nPt comfortable\r\nminimal pain\r\nwalking with support\r\nADV\r\nmay be discharged\r\n'}, {'role': 'model', 'content': '\nIP Number: 4258\n\nPatient Number: 8599\n\nAdmission Date: 11-05-2015\n\nDischarge Date: 28-05-2015\n\nDiagnosis: BIL OA knee, Rt knee MMI\r\nRt hip healed fracture\n\nClinical Exam(With BP): c/o pain RT Hip. dhs fixation done elsewhere.\r\nunable to bear weight on Rt hip\r\nBL OA knee, Rt knee MMI\r\nRt hip healed fracture\n\nSystolic BP: 140.0\n\nDiastolic BP: 70.0\n\nPhysical examination: nan\n\nXray findings: CNS Conscious oriented\r\nCVS s1 s2 heard\r\nResp B/L NVBS\r\nP/A soft non tender\r\n\n\nDiscussion: admitted for mobilisation and pain management. since she had a mechanical lock even after adequate physio, she is adviced removal of derotation screw which was done on 25/05/15\r\npost op period uneventful.\n\nDiet: nan\n\nRemarks: nan'}] |
4,507 | [{'role': 'user', 'content': "\nIP Number: 4507\n\nPatient Number: 25158\n\nPatient Name: S B RAMAMOORTHY\n\nGender: M\n\nDate of Birth: 08-07-2028\n\nAddress: G-141, PANAMPILLY NAGAR , KOCHI\n\nPincode: 682036.0\n\nPhNo: 9444645962\n\nAdmission Date: 08-07-2015\n\nDischarge Date: 28-07-2015\n\nDiagnosis determined by the doctor when the patient was admitted: Mixed hyperlipidaemia\nTYPE 2 DIABETES MELLITUS\nEssential (primary) hypertension\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: 87 year old male patient, k/c/o Diabetes melittus, hpertension, on medications. patient missed a step at home today morning and fell on his right side.no loc. could not move his right lower limb after the incident.\r\nXray shows fracture (R) neck of femer. posted for hemi arthoplasty.\n\nXray information: Xray pelvis: AP\r\nXray (R) hip lateral\n\nClinical examination: Local Examination :severe pain in right hip on movement.\r\nRt LL shortened and externally rotated\r\nndnvd\r\nGc patietn in pain\r\nsystems wnl\r\nvitals stable\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: c/s/b duty doctor\r\n\r\ncbc,fbs,ppbs, creatinine, blood urea, s. electrolytes, lft, hiv,hbsag, hcv, urine routine, blood grouping, bt,ct\r\nchest x-ray, ECG\r\nphysician fitness\r\ninform sos\r\narrange 1 pint of blood\r\n\ncase s/b dr jijo\r\nadv\r\ninj pactiv 1000 mg IV tid\r\ninj Amikacin 500mg iv bid\r\ncatheterise.\n7.30 pm patient c/o shivering\r\no/e severre shivering. laboured breathing. spo2: 80%\r\nBP 190/110. pulse: 80/m. chest: clear.\r\ninformed dr Manoj\r\nadv: inj avil 2 mg stat.\r\ninj hydrocortisone 100 mg stat\r\n\r\npatient had i episode vomiting right after intake of water\r\nadv inj emeset 4mg iv stat\r\ninj pantoprazole 40 mg iv stat\r\n9 30 pm: BP 160/70\r\nspo2 94% with 2 l o2\npatient had an episode of shivering after passing urine. \r\npulse - 84/m, spo2- 97% with 2 l o2, BP 160/70 mm hg, chest clear\r\nadv: inj avil 1/2 ampule\r\n\r\nSEEN BY DR TOM & TEAM\r\nGC:STABLE\r\nPRE DINNER:233 mg/dl\r\nFBS:150 mg/dl\r\nBP:160/70 mm hg\r\nspo2-88\r\nCASE PLAN:ECHO & cardio consultation done\r\ndo creatinine & tc/dc & urine c/s,spirometry\r\ndo usg abdomen pelvis\r\nstart inj levofloxacin od\r\ninj clexane 0.4 ml \r\nneb combimist tid\r\ntab pantocid bd\nCASE SEEN BY DR JIJO\r\nPt comfortable.\r\nin view of anticoagulants surgery to be postponded to monday.\r\n\r\ns/b Dr.M.M.-Uro.\r\n\r\nObst.LUTS ++.--failed cath'n attempt yesterday.(by staff).\r\nfever today morning.100.6\r\ns.cr. :2\r\nU/S : R. mild small size kidney.\r\nBPE.+\r\nPVR :not done.\r\nBPE/CRF/Phimosis.\r\nplan : dorsal slit under S.A.\r\nd/w Dr.Jijo.\r\npt. on parenteral antibiotic + Levoflox already started today\r\nadv. : rpt urea/ s.cr/Na/K/PSA.\r\n\r\n\r\no/e : Phimosis.++\ncase s/b Dr Jijo\r\nno dyspnoea / fever\r\npt comfortable \r\nminimal pain\r\nADV\r\nContinue same.\r\n\nSEEN BY DR. & TEAM\r\nGC:STABLE\r\nPRE DINNER::129\r\nFBS:177\r\nCASE PLAN:\r\n\r\n\nSEEN BY DR. & TEAM\r\nGC:STABLE\r\nPRE DINNER::129\r\nFBS:177\r\nCASE PLAN: patient better\r\nno bed sores\r\nchest clear\r\np/a nad\r\nmaintance DNS with 4 units R\r\nlooz 15 ml \r\n\r\n\r\nThanks \r\n-------\r\nS/B Dr Sooraj\r\n\r\nKnown DM and Hypertension for the past 10 years\r\n?DR no h/o pedal edema or facial puffiness \r\nwas not on regular follow up\r\nprevious renal status not known\r\n\r\nUTI + upper tract involvement likely\r\nLUTS +\r\nnot in overload\r\nappears underhydrated \r\n\r\nImp: Acute on CKD - UTI + volume depletion. CKD due to DN \r\n\r\nSuggest:\r\n1. Intake - 2.5 litres per day\r\n2. Continue antibiotics\r\n3. Tab Sobisis 1-1-1\r\n4. Tab Alfalog 1-1-1\r\n5. RFT tomorrow after adequate hydration\r\n\r\n24 hr urine protein\r\n\r\nReview USg to specify size of kidneys\r\n\r\n\r\n\ncase s/b Dr Jijo\r\npt clinically better\r\nminimal pain only\r\ncomfortable in prop up position\r\nADV\r\ncontinue same\nSEEN BY DR. & TEAM\r\nGC:STABLE\r\nPRE DINNER::286mg/dl\r\nFBS: 131mg/dl morning R 2units given\r\nCASE PLAN:bp- 184/90mmhg\r\nrepeat TC, RFT, 24 hr urine protien today \r\nusg abd after consulting with dr suraj\r\n\r\n\nSEEN BY DR. & TEAM\r\nGC:STABLE\r\nPRE DINNER::\r\nFBS:131mg/dl\r\nCASE PLAN:maintain input 2-2.5 litres\r\ni.v ns maintainance\r\nrepeat TC , urea, creatinine today and inform dr manoj\r\n\r\n\ncase s/b Dr JIJO\r\npT COMFORTABLE Creat- 3\r\nadv\r\nnephro consult and decide regarding date of surgery\r\nd/w dr manoj\r\nreports informed - advice repeat urea, creatinine , potassium,tom evening\r\ndr lakshmi advice to take CK tomorrow\nSEEN BY DR. & TEAM\r\nGC:STABLE\r\nPRE DINNER:148\r\nFBS:119\r\nCASE PLAN: craetinine 2.5\r\nsurgery tomorrow\r\n\r\n\r\n\nposted for hemiarthroplasty at 1 pm \r\nNPO from 7 am\r\nstop inj clexane today.\r\ninj antibiotics to continue\r\ninform Dr mangatt, OT, Anesthetist\r\nhigh risk consent\r\n\nS/B Dr Sooraj\r\n----------------\r\nplanned surgery today\r\nCreat stable at 2.5\r\nurine output good\r\npressures stable\r\n\r\nUSG - smaller RK. \r\n\r\nSuggest:\r\n1. May proceed with the proposed procedure with increased risk in view of associated CKD. Informed consent regarding possibility of post procedural worsening of renal function to be obtained.\r\n2. Kindly ensure adequate hydration during surgery.\r\n3. Avoid NSAIDs/aminoglycosides/nephrotoxics\r\n4. Avoid hypotension intra op\r\n5. RFTs 24 hrs post surgery\r\n\r\nWill review\r\nTo do serum protein electrophoresis, serum iron and serum PSA in the next prick\r\n\r\n\r\nSEEN BY DR. TOM & TEAM\r\nGC:STABLE\r\nPRE DINNER:231 mg/dl\r\nFBS:142 mg/dl\r\nBP:170/100 mm hg\r\nCASE PLAN:hemiarthroplasty with dorsal slit under SA to be done today afternoon at 1 pm\r\nmedical fitness given.\r\nnephro consultation done\r\n\nseen by duty dr\r\nblood transfusion started at 6:40 pm\r\ninj avil pre med given\r\ninj lasix 20 mg mid BT given\r\n\r\ncase s/b Dr JIJO\r\nPT CONSIOUS ORIENTED\r\npulse 65\r\nbp 158/88\r\nchest clear\r\np/a soft bs +\r\nMINIMAL SOCKAGE\r\nDRAIN NIL\r\nIVF 1000 ML MAINTAINANCE X 24 HRS\r\nADV\r\nCONTINUE ANTIBIOTICS AND PACTIV IV\r\nCHEST PHYSIO\r\nPROP UP POSITION\r\nSTART ORAL FLUIDS\r\n\r\n\nseen by duty dr\r\n-bp:190/110 at 12:15 am ,hence lasix 20 mg given \r\n-oozing present from surgical site at 5:45 am ,hence \r\npads applied to the site.\r\n-bp :190/90 at 7 am,tab cilacar 10 mg given.\r\n-inj clexane 0.4 ml subcutaneous given at 7\r\n \r\n\r\n\ncase s/b Dr jijo\r\npt consious and oriented\r\nvitals stable\r\nminimal oozing\r\nno dnvd\r\nknee joit mobilised\r\nADV\r\nphysio\r\nmobilise ankle, knee and hip\r\nno int rotation adduction movements\ncase s/b Dr JIJO\r\nPT STABLE\r\nCNSIOUS AND ORIENTED\r\nORALLY FED\r\nCHEST CLEAR\r\nNO OOZING\r\nMINIMAL DRAIN\r\nadv\r\nuro consult tomorrow and to decide regarding catheter removal\r\nurine r/e, urine culture tomorrow\nSEEN BY DR. & TEAM\r\nGC:STABLE\r\nPRE DINNER::\r\nFBS:233mg/dl\r\nCASE PLAN: \r\ncatheter removed \r\npt stable\r\n will be shifted out of ICU after seeing by ortho\r\ntab.prazopress XL 2.5 0-0-1 start from today\r\ninj insulin R 4-6-4\r\nINJ n 4 UNITS\r\nbp-160/80mmhg\r\ninj biopiper 8 th day- discuss with dr jijo for any change of antibiotics\r\nseen by Dr Lakshmi\r\npt had a ? vasovagal episode or postural hypotension while trying to sit the patient up\r\nPulse- 42/min, B,p 110/60, saturation to 79\r\n\r\npt assessed, conscious, put on oxygen and leg elevated, better after that\r\nPt now stable and even withoiut oxygen, saturation is good 97 on RA\r\n s/b duty doctor\r\npt catheterised since not passed urine, pt is stable and shifte to ward side\ns/b Dr.M.M.-Uro.\r\ncath. removed on request of Ortho.Dr.Jijo.\r\nre-catheterise if pt. develops retention.\r\n\r\ndressing by Dr.M.M.\nse seen by Dr JIJO\r\nWI DONE\r\nWUND CLEAN\r\nMADE TO STAND\r\nDESTURATED ONCE\r\nINFORMED DR LAKSHMI\r\nadv\r\nmay be shifted to ward if stable\r\nstop IV antibiotics\r\nTAB TAXIM O 200 MG 1-0-1\r\nPHYSIO- MOBILISATION\r\nCHECK X-RAY rT HIP AP WHILE SHIFTING\r\n\ncase s/b DR jijo\r\nno pain\r\nbp 150/90\r\npr- 82\r\nchest clear\r\nadv\r\ncontinue same\r\ntab dolo 650 1-1-1\r\nstop pactiv\r\ntramadol sos\r\nprotien diet after consulting with nephro\nSEEN BY DR.TOM & TEAM\r\nGC:STABLE\r\nPRE DINNER:274 mg/dl\r\nFBS:251 mg/dl\r\nBP:130/70 mm hg\r\ncr-2.5 mg/dl\r\nurea:88\r\nCASE PLAN:\r\nClamp catheter \r\nTo change Inj.Insugen N To Inj.Lantus\r\nInj.Lantus 8 units at bedtime\r\n\nSEEN BY DR. & TEAM\r\nGC:STABLE\r\nPRE DINNER::\r\nFBS:283mg/dl- R12units\r\nCASE PLAN:\r\ninj insugen R 12-12-10\r\ninj lantus 14units\r\n tc,hb, dc , electrolytes repeat\r\nrepeat\r\nd/w dr mathew\r\nremove the catheter clamp and \r\ninformed dr manoj\r\nS/B DUTY DOCTOR\r\n1 UNIT PC - BAG NO 7032 , START AT 2.45 PM\r\n inj lasix 1amp i.v to be given\r\nblood transfusion got over- procedure was uneventfull\r\ns/b dr manoj\r\nadd inj pansec 40mg i.v bd\r\n\nSEEN BY DR.TOM & TEAM\r\nGC:STABLE\r\nPAIN:3/5 over rt hip & over the penile region where dorsal slit was done\r\nPRE DINNER:231 mg/dl\r\nFBS:228 mg/dl\r\nBP:150/60 mm hg\r\nUREA:72\r\nCREATININE:2.3\r\nHB:8.2\r\nCASE PLAN:\r\nmake patient sit up & move his leg\r\nStop inj clexane \r\nBLOOD TRANSFUSION GIVEN\r\ninj avil IV stat \r\ninj lasix 20 mg IV mid BT\r\n\r\nseen by duty dr\r\nc/o fever\r\npatient has temp-100 degree farenheit at 2:30 pm\r\ntab dolo 650 mg given,BT Stopped\r\ntemp-101.3 degree farenheit at 4:30 pm\r\ninj pactive 100 ml iv started\r\nInj cortis 100 mg iv stat\r\ntemp-99.8 degree farenheit at 6 pm\r\nBT restarted\r\n\r\n\nCASES/B dR JIJO\r\npT clinically better\r\nminial pain\r\nno sockage\r\nADV\r\nREMOVE AIR BED\r\nCONTINUE SAME.\nSEEN BY DR. & TEAM\r\nGC:STABLE\r\nPRE DINNER::\r\nFBS:264mg/dl gave R 14 units\r\nCASE PLAN:\r\ngiven 1 units of blood- had transfusion reaction yeaterday- given hydrocortisone 1 shot\r\n2800 input/3.5 litr output\r\nhb 8.6\r\ntc- 15500\r\nbp-130/60mmhg\r\non urine catheter\r\nadvice ambulation\r\nrepeat tc today\r\ninj insulin R16-16-14\r\ninj lantus 20 units\r\n\ncase s/b Dr Jijo\r\nWI done\r\nwound clean\r\nLt LL edema+\r\nadv\r\nMOBILISE THE PT\r\nTAB THRIZE 1-1-1\r\nTAB ECOSPRIN FROM TOMORROW\nd/w dr ajish\r\ntemp 101.7\r\n advice inj pactiv 1gm i.v st\r\n\r\nd/w dr lakshmi\r\nadvice to sent urine routine now\r\nand tab niftas 100mg st\r\n\r\nSEEN BY DR. TOM & TEAM\r\nGC:STABLE\r\npain:3/5 over rt hip & over penile region\r\nPRE DINNER::217 mg/dl\r\nFBS:220 units- adviced insugen R 20 units\r\nCASE PLAN:\r\nURE sent\r\nUrology consultation planned for today\r\n give inj lantus 10 units stat\r\nstart tab entavar 600 mg 1-0-1(linezolid)\r\n\r\n\r\nseen by Dr.lakshmi\r\nstop tab dolo 650 mg & start tab acuvin 1-0-1\r\n\nS/B Dr Sooraj\r\n-----------------\r\niron levels low\r\nincreased 24 hr urine proteins - nephrotic range\r\nSPE negative\r\nHb - 8.2\r\n\r\nInj Encicarb 1 gm in 100 ml NS slow IV over 2 hrs\r\n\r\nOral iron and folic acid supplementation in addition\r\nTab Sobisis 1-1-1\r\nTab Eido 1-0-0\r\nCap Laretol/Cacitrol 0.25 mcg 1-0-0\r\nTAb Alfalog 1-0-1\r\n\r\nContinue others\r\nSEEN BY DR.TOM & TEAM\r\nGC:STABLE\r\nwas febrile at 7:30 am & inj pactiv iv was given.now pt is afebrile\r\npain:3/5 over penile area & rt hip\r\nPRE DINNER:217 mg/dl\r\nFBS:220 mg/dl\r\nHB:8.6\r\nBP:160/60 mm hg\r\nCASE PLAN:start tab entavar 600 mg 1-0-1(Linezolid)\r\n\r\n\ncase s/b Dr Jijo\r\nc/o pain over the knee and ankle \r\no/e\r\ndiffuse swelling over the knee , ankle and thigh+\r\nmild knee effusion +\r\nADV\r\nvigourous mobilisation of knee and ankle\r\n\r\n\nseen by duty dr\r\nc/o fever \r\ninj pactiv iv given at 9 pm\r\ninj dalacin 300 mg hs & c/m given as per orders by dr lakshmi \r\n\r\n\r\nSEEN BY DR. & TEAM\r\nGC:STABLE\r\npain:3/5 at rt hip & over penile region\r\nPRE DINNER:93 mg/dl\r\nFBS:112 mg/dl\r\nCASE PLAN:\r\n\r\nc/o pain in his surgical site\r\nunable to move his rt limb\r\nadd inj dalacin 300mg i.v tds\r\ninj clexane .4 mg OD\r\n\r\nvenous doppler today\nCASE S/B Dr Jijo\r\nclinically better\r\nswelling reduced\r\nmade to stand for 5 min for 2 times\r\nmade to sit \r\nADV\r\nCONTINUE SAME.\nS/B Dr Sooraj\r\n-----------------\r\nstable\r\nCSTSEEN BY DR. & TEAM\r\nGC:STABLE\r\nstill complaints of slight pain of the right lower limb on movement\r\nno fever\r\nfeels better\r\nPRE DINNER::\r\nFBS:153mg/dl\r\nCRP-70\r\nCreat-2.0\r\n\r\nCASE PLAN:\r\nContinue same\r\nphysio as advised by the ortho\r\nTo Continue IV Piperacillin for one more day and then continue Linezolid and Dalacin\r\n\r\ns/b urologist\r\ndisscused with dr jijo\r\nadvised to remove catheter\r\nurine for c/s\r\nrecatheterise sos\r\n\r\ns/b duty dr\r\non the advise of Dr.lakshmi\r\nstop inj clexane \r\nstop tab acuvin\r\nstop nebulisation with combimist\r\nstart tab welset sos\r\n\r\n\r\n\r\n\nS/B Dr.M.M.-Uro.\r\nforeskin edema reducing well. \r\npedal edema ++\r\npt. in severe pain moving sideways.\r\nunable to bend R.knee.\r\n\r\nd/w Dr.J.J.\r\nPt.afebrile.\r\nplanning discharge from ortho on 25.7.15.(SAT).\r\nremove cath. \r\nUr-c/s....of first voided urine-M.S.U.(mid-stream).\r\nre-catherise S.O.S., IF RETENTION.\r\nshall review after discharge in Uro. OPD.\r\nwith urea/s.creat./Na/K.\r\nno antibiotics reqd. from Uro. side.\r\nT.Veltam0.4mg h.s.x15days.\r\n\nseen By Dr JIJO\r\nPain shoulders after walking\r\nmild breathlessness +\r\nADV\r\ncontinue same\r\nNANOFAST GEL FOR LA\r\n\r\n\r\nS/B urologist\r\npt did not pass urine\r\nrecatheterised at 6:45 pm by urologist\r\n14 french catheter passed\r\n750 ml urine emptied\r\nno antibiotics from urologist's side\nSEEN BY DR. & TEAM\r\nGC:STABLE\r\nPRE DINNER::179 mg/dl\r\nFBS:102 mg/dl\r\nCASE PLAN:\r\non urinary catheter\r\nstop -\r\nsyp sucrafil/tazovac/yogut/acuvin/clexan/nebulizaion/pansec/dalacin/prazopress\r\nstart tab veltam 0.4 HS\r\ninj R 14-14-12\r\ninj lantus-14\r\n\r\n\r\n\r\n\nSEEN BY DR. & TEAM\r\nGC:STABLE\r\npain:moderate pain over penile area,inflammation present\r\nPRE DINNER::103 - R 6 units\r\nFBS:95mg/dl R 10 units given\r\nCr:2.2 mg/dl\r\nBP:160/60 mm hg\r\nCASE PLAN:continue same\r\n\r\n\ncase s/b Dr JIJO\r\nWI DONE\r\nWOUND CLEAN\r\nSUTURES REMOVED\r\nADV\r\nSTOP ANTIBIOTICS\r\nTAB ACUVIN SOS\r\nTAB BECASULES Z 0-1-0\r\nGLUCERNA SR 3 SCOOP BID\r\nTAB CORRALLIUM D3 0-0-1\r\nSTOP SHELCAL\r\nCANDID POWDER FOR LA\nSEEN BY DR.LAKSHMI & TEAM\r\nGC:STABLE\r\nPRE DINNER:104 mg/dl-insugen R-6 units given\r\nFBS:127 mg/dl-insugen R-12 units given\r\nCASE PLAN:\r\nplan to tapper insulin\r\nadvice tab galvus 50mg od\r\nwith hold insulin at noon\r\n\nSEEN BY DR. LAKSHMI & TEAM\r\nGC:STABLE\r\nPRE DINNER:196 mg/dl\r\nFBS:175 mg/dl\r\nCASE PLAN:\r\nstop tab eido\r\ncontinue same\r\nplan for discharge tomorrow\r\n\r\n\ncase s/b Dr Jijo\r\nno much of pain\r\nambulating well with walker\r\nADV\r\nCLAMP AND REMOVE THE CATHETER\r\nfor discharge tomorrow.\nSEEN BY DR. & TEAM\r\nGC:STABLE\r\nPRE DINNER:150mg/dl\r\nFBS:150 mg/dl-NOVOMIX 10units given\r\nCASE PLAN:plan for discharge today\r\nsugars-195mg/dl\r\ninj novomix-8-0-6\r\n\r\n\r\n\ncase seen by Dr Jijo\r\npt comfortable\r\nambulating\r\nADV\r\nTab ecosprin 75 mg 0-1-0 TO CONTINUE\r\nTAB CORALLIUM d3 0-0-1 TO CONTINUE\r\nTAB BECASULES Z 1-0-0 TO CONTINUE\r\nMAY BE DISCHARGED\r\nREVIEW AFTER 1 MONTH WITH LOCAL ORTHOPEDICIAN"}, {'role': 'model', 'content': '\nIP Number: 4507\n\nPatient Number: 25158\n\nAdmission Date: 08-07-2015\n\nDischarge Date: 28-07-2015\n\nDiagnosis: fracture neck Rt femur- S/P RT hemiarthroplasty\r\nAcute on chronic renal Failure\r\nBPH\r\nAnaemia- ? iron deficiency/anaemia of chronic disease\r\nDorsal slit and RT hip hemiarthroplasty with AMP- done\r\n\n\nClinical Exam(With BP): history of fall on right side today morning.\r\ncurrent medications:\r\nAten 50 0-1-0\r\nclopilet 0-1-0\r\nnicardia r 0-1-0\r\nglychek m forte 0-1-0\r\naztor 10mg 0-1-0\r\n\n\nSystolic BP: 180.0\n\nDiastolic BP: 80.0\n\nPhysical examination: Xray pelvis: AP\r\nXray (R) hip lateral\n\nXray findings: Local Examination :severe pain in right hip on movement.\r\nRt LL shortened and externally rotated\r\nndnvd\r\nGc patietn in pain\r\nsystems wnl\r\nvitals stable\n\nDiscussion: 87 year old male patient, k/c/o Diabetes melittus, Hypertension, on medications. He was admitted in the hospital as he missed a step at home on and slip and fell on his right side on 08/07/2015 morning . No LOC or ENT bleed.Later he could not move his right lower limb after the incident.\r\nXray shows (R) neck of femur fracture . He was noted to have a creatinine of 2.0, urea- 68 on admission and also urinary infection, was started on IV antibiotics, There was worsening of his renal parameters and was given nephrology consult. USG Abdomen was done- which showed small RT kidney and BPH. Urology consultation was given for bladder outlet obstruction and severe phimosis . Cardiology consultation was done for cardiac assesment .Once his renal and cardiac status was stable he was taken up for surgery on 14/07/15. Dorsal slit of the foreskin and RT hip hemiarthroplasty with AMP was done on the same sitting. He desaturated during surgery and was revived. Post operative period he had chest and urinary infection which was treated with IV antibiotics. Also his blood sugars came under control . Post OP there was difficulty in removing the catheter, Started on veltam and later was successfully able to remove the catheter. He was ambulated using crutches and is discharged in stable condition. \r\n\n\nDiet: nan\n\nRemarks: nan'}] |
4,744 | [{'role': 'user', 'content': "\nIP Number: 4744\n\nPatient Number: 77\n\nPatient Name: P.K.THANKAM NAIR\n\nGender: F\n\nDate of Birth: 06-08-1940\n\nAddress: DWARAKA,ELENCHERIL ROAD\n\nPincode: 682020.0\n\nPhNo: 0484-2311214\n\nAdmission Date: 12-09-2015\n\nDischarge Date: 28-09-2015\n\nDiagnosis determined by the doctor when the patient was admitted: Essential (primary) hypertension\nMixed hyperlipidaemia\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: Mrs P.K.Thankam Nair,a 75 year old female who is a k/c/o type 2 diabetes mellitus,hypertension & dyslipidaemia on insulin & medications for hypertension & dyslipidaemia came now with history of fall in the bathroom yesterday night injuring her left hip. Xrays of the hip showed subtrochanteric fracture of left femur. Hence,she got admitted for further investigations & management.\n\nXray information: Chest xray:\r\nECG:\n\nClinical examination: afebrile\r\nBP:180/`100 mm hg\r\nPulse:90 beats/min\r\nsystemic examination:\r\ncns:cocious,oriented\r\ncvs:S1 s2 heard\r\nrs:chest clear\r\np/a:soft,non tender\r\nlocal examination:\r\ndiffuse swelling Lt Thigh\r\nLt LL shortened and externally rotated\r\nnot able to move Lt LL\r\ndistal pulses felt\n\nPrecautions to be taken while treating the patient: NKA\r\nstrong family h/o DIABETES MELLITUS,HTN,DLP\n\nRemarks: seen by dr jyothi\r\nclinicl summary taken\r\nvitals stable\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:mild tenderness over the injured site\r\nconstipation present\r\nPAIN SCORE:2\r\nBLOOD SUGARS : \r\nPREDINNER: 241 MG/DL\r\nFBS: 277 MG/DL\r\n PPBS : MG/DL\r\nBP: 140/80 MM HG\r\nCASE PLAN :\r\ncardiac fitness tom\r\ninj clexaine 2 nd day\r\ndiscuss with dr jijo for constipation- for any need for enema\r\n\r\nd/w dr jijo\r\nsurgery posted on tuesday and managemnt of constipation after surgery\r\n\r\nS/B DUTY DOCTOR\r\n C/O PAIN OVER THE INJURED SITE- ADV- INJ TRAMADOL I.V WITH EMEST I.V\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 193 MG/DL\r\nFBS:196 MG/DL\r\n PPBS : MG/DL\r\nBP: 140/70 MM HG\r\nCASE PLAN :\r\nwithold: T pletoz,T. megabid, \r\n\r\n\r\n6.30 PM: patient disoriented.\r\nCNS : disorientation+.\r\nmuscle power+\r\nplantar- no response\r\npupils: sluggish\r\nsent for electrolytes\r\nECG: no changes from ECG taken on 12/9\r\n\r\nK+ 6.7\r\nNa+ 126\r\nadv: asthalin neb stat\r\ninj lasix stat\r\nNS with 6 u insulin\r\nK bind sachet\r\nURE\r\nCPK\r\n\nCASE S/B dR Jijo\r\nPOSTED FOR RECON NAILING UNDER SA+ EPI ON 15/06/15 AT 3.30 PM\r\nNPO FROM 8 AM\r\nINFORM OT/ANESTHETIST\r\nINJ WAKCEF 1.5 GM IV ATD BID FROM TOMORROW MORNING\r\nINJ AMIKACIN 500 MG 1-0-1 iv From tomorrow morning\r\nstop inj clexane\r\n\nsent for electrolytes tomorrow morning.\r\nwithhold T.Trika\r\n\r\ngive T. rantac stat\r\n T. emeset stat\nc/s/b duty doctor\r\nBP 160/70\r\nSpo2 97% on 2l o2\r\npatient is sleeping.\r\nson says occassional disorientation.\r\ninf Dr Radha\r\nadv:\r\nKBind 15 g TDS\r\nneb Asthalin Q4H\r\nrepaet Hb, TC, Creat.\r\n\r\n\r\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:3/5 over the left hip\r\nBLOOD SUGARS : \r\nPREDINNER: 146 MG/DL\r\nFBS: 212 MG/DL\r\n PPBS : MG/DL\r\nBP: 160/70 MM HG\r\nCASE PLAN :\r\n1 unit blood to be given\r\nABG to be sent\r\nmedical fitness to be given\r\nrecon nailing scheduled for today afternoon under SA\r\n3% hypertonic saline iv slowly on flow\r\n\r\nblood for transfusion counter checked by dr jyothi\r\ntransfusion started\r\ninj avil iv stat given\r\ninj lasix 20 mg mid BT \r\n\r\n\ncase s/b Dr Jijo\r\nmild disorientation +\r\nd/w dr Tom - fitness given\r\nadv\r\ncontinuesame\r\nshift to OT on call\nseen by dr jyothi\r\npt lost alot of blood intraoperatively\r\nhence,BT Given\r\ninj avil IV given before BT\r\nmid BT inj Lasix 20 mg iv given\r\nlater inj lasix 20 mg given again\r\nI/O -1500/1000 ml at 7 am\r\nBP:180/70 mm hg-tab nebibeta 5 mg given\r\nPulse:82 beats/min\r\nSPO2:95\r\nGRBS:300 MG/DL- NOVORAPID 6 UNITS GIVEN\r\nBP :160/74 mm hg-tab amlo 2.5 mg stat\r\n\r\n\r\ns/b duty doctor\r\n1 unit packed cell transfusion started at9.30am\r\nunit bag number- 9485\r\ninj lasix 1 amp st i.v\r\ninj avil 1amp st i.v\r\nif needed midway 1 amp lasix i.v\r\n\r\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: 300 MG/DL\r\n PPBS : MG/DL\r\nBP: 180/70MM HG\r\nCASE PLAN :\r\ni/o 1500/1000\r\ninj pansec 40 mg i.v od\r\nwh- tab elsartan 50mg \r\nneb asthalin / k bind stop\r\ncontinuw neb combimist \r\n\r\n\ncase s/b Dr Jijo\r\npain +\r\nno sockage\r\nno distal NV DEFICITS\r\nadv\r\nstp inj amikacin \r\ncontinue inj wakcef and pactiv\r\nprovisionally posted for DHS/DCS FIXATION ON 17/09/15\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 289 MG/DL\r\nFBS: 249 MG/DL\r\n PPBS : MG/DL\r\nBP: 160/80 MM HG\r\nCASE PLAN :\r\nHB:9.5\r\nDO sr electrolytes & creatinine\r\ngive chest physio \r\ngive spirometry exercise\r\nstart Zytee gel for LA\r\nTab axiplex 1-0-0\r\n\r\nseen by duty dr\r\nNa+:125\r\nk+:3.2\r\ncreatinine:1.3\r\nC/O weakness & drowsiness\r\ninformed Dr lakshmi\r\ninj hypertonic saline iv started\r\n\r\n\ncase s/b Dr Jijo\r\npain +\r\nmoving Rt knee and hip\r\nmade to prop up\r\nno sockage\r\nchest clear\r\nvitals stable\r\nADV\r\nCONTINUE SAME\r\nPOSTED FOR dcs PLATE FIXATION AT 1.PM\r\nNPO FROM 7 PM\r\nINFORM ANESTHETIST\r\nHIGH RISK CONSENT\r\nINJ TAZOWAK 4.5 GM IV ATD BID FROM TOMORROW\r\nSTOP INJ WAKCEF AFTER EVENING DOSE OF INJ\nseen by duty dr\r\nc/o sweating & giddiness \r\ngrbs:80 mg/dl\r\ninformed dr manoj\r\njuice & biscuits given\r\nafter that GRBS:99 mg/dl\r\n2am grbs:153 mg/dl\r\npt symptomatically better\r\n\r\n\r\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:179 MG/DL\r\nFBS: 151 MG/DL\r\n PPBS : MG/DL\r\nBP: 148/90 MM HG\r\nCASE PLAN :NPO since 7 am\r\n\r\n\r\n\r\n\nSeen by Dr. Vinod Padmanabhan\r\nHistory noted.\r\n\r\nAdvise:\r\n-> X-ray (L) Femur with Hip AP / Translateral\r\n-> Take written informed consent for surgery explaining risk of DVT, Pulmonary embolism & associated complications.\r\n-> S. LDH\r\n-> Repeat Hb, PCV, Na, K coming morning.\r\nArrange 2 units of packed cells.\noozing present.\r\ninformed dr Jijo\r\nadv to leave drain open, do overpadding\nSEEN BY DR. LAKSHMI &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 256 MG/DL\r\nFBS: 202 MG/DL\r\n PPBS : MG/DL\r\nBP: 160/70 MM HG\r\nCASE PLAN :\r\n1 unit blood transfusion today\r\nmaintain intake of 2500 ml\r\nMaintain strict I/O chart\r\ngive 1 unit NS with 1 Ampule of kcl\r\nrestart syp potklor\r\nmake inj tazowak tid'\r\nstart inj amikacin 500 mg od\r\nwithold tab lorvas sr\r\ndo RFT today\r\nrepeat sr electrolytes,RFT,Hb,PCV tomorrow\r\n\r\n\ncase s/b Dr JIJO\r\nMILD SOCKAGE +\r\nCHEST CLEAR\r\nP/A SOFT\r\nBS +\r\nNDNVD\r\nON DVT COMP PUMP\r\nadv\r\nContinue same\nSEEN BY DR. LAKSHMI &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:pain over the surgical site\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 276 MG/DL\r\nFBS: 169 MG/DL\r\n PPBS : MG/DL\r\nBP: 160/100 MM HG\r\nCASE PLAN :\r\n\r\nbp- 200/80mmhg- stop amlog, start cilacar 10mg bd with st\r\nsodium- 124- add- salt capsules.\r\ninj tramadol tds if pain +\r\nI/O- 2600/200\r\nd/w dr vinod befor giving clexane at 12pm.\r\nchange to nov- 8-8-6\r\ninj lantus- 14 units\r\n\r\ns/b duty doctor,\r\ndr jijo adv-\r\nglucerna power to be given\r\n\r\n\ncase seen by Dr Jijo\r\npt comfortable\r\npain on movements only\r\nvitals stable\r\np/a distended\r\nI/O-2600/2000\r\nminimal sockage\r\nADV\r\nMAY BE SHIFTED TO WARD\r\nCHECK X-RAY WHILE SHIFTING L femur ap/lat, Lhip ap , lat\r\nINJ CLEXANE TO CONTINUE\r\ninj pansec 40 mg IV stat\r\n\r\n\r\n\r\nD/W DR VINOD\r\nWH clexane , may be given after 6pm after d/w the consultant\r\nspo2 -90% with out o2,\r\nshifting the pt to ward will be done after his orders and xray can be taken befor shifting the pt to ward .\r\nd/w dr vinod\r\nadv- inj clexane at 6pm\r\nand shift the patient to ward after taking xray.\r\n\r\ns/b duty doctor\r\npt has been shifted to ward side after taking xrays\r\nvitals-\r\nbp-\r\npulse-\r\nspo2-\r\nRR-\r\nsugars-279- informed dr lakshmi\r\n\r\n\r\nS/B Dr Vinod Padmanabhan\r\nAfebrile, Soakage++, \r\nNo e/o DVT or PE.\r\nAdv-\r\nContinue All medication as before.\r\nCorrect electrolyte imbalance.\r\nContinue physiotherapy - Hip,Knee,ankle mobilisation.\r\nQceps strengthening ex, Pelvic lift ex, \r\nPWB walking with walker, Make the patient sit up on edge of bed, Chest physio.\r\nCare of back, Hourly change of position\r\n\nd/w dr vinod-\r\nsend- creat now\r\nmonitor vitals and I/O\r\n\r\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 279 MG/DL\r\nFBS: 146 MG/DL\r\n PPBS : MG/DL\r\nBP: 180/90 MM HG\r\npulse-60/min\r\nspo2- 92% under RA\r\nchest clear\r\nCASE PLAN :\r\nsend Na, K today.\r\ncreat today 0.8\r\npatient reluctant to eat food. give insulin after food.\r\nGlucerna powder TID\r\nadded salt\r\nsalt capsules 1-1-1\r\nhypertonic saline\r\nT. Zarco 50 mg stat\r\nspirometry every 2 hours.\r\nintermittent oxygen.\r\nchest physiotherapy.\r\nmouth paint\r\n\r\n\r\nsend for urine spot Na.\r\n\ncase s/b DR Jijo\r\nadv\r\ncontinue same\nSEEN BY DR. LAKSHMI &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 167 MG/DL\r\nFBS: 186 MG/DL\r\n PPBS : MG/DL\r\nBP: 150/80 MM HG\r\nCASE PLAN :\r\nNa+:129\r\nk+:3.6\r\ncr:0.7\r\nct same\r\n\r\nInformed dr manoj\r\npredinner:181 mg/dl-inj NOVORAPID 6 units\r\npost dinner:239 mg/dl-inj L 14 units\r\n\r\n\ncase s/b Dr JIJO\r\ncontinue same\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:181 MG/DL\r\nFBS: 179 MG/DL\r\n PPBS : MG/DL\r\nBP: 152/90 MM HG\r\nCASE PLAN :\r\nBP 138/80\r\nphysiotherapy BD\r\ncontinue same\r\n\r\n\r\nd/w Dr Vinod.\r\nadv to change Tazowak to oral antibiotic: T stafcure cv BD\r\npactive inf BD\r\n\r\npatient c/o pain.\r\nadv to give T axiplex(placebo before physiotherapy)\nCASE S/B Dr jijo\r\npt comfortable\r\nmade to stand\r\nADV\r\ncontinue same\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 175 MG/DL, given novarapid 6 units\r\n10PM: 253 given Lantus 14 units.\r\nFBS: 205 MG/DL, novarapid 12 units given\r\n PPBS : MG/DL\r\nBP: 160/90 MM HG\r\nCASE PLAN :\r\n\r\n\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 175 MG/DL, given novarapid 6 units\r\n10PM: 253 given Lantus 14 units.\r\nFBS: 205 MG/DL, novarapid 12 units given\r\n PPBS : MG/DL\r\nBP: 160/90 MM HG\r\nCASE PLAN :\r\nstop inj amikacin\r\nstart anovate ointment for L/A\r\nchange cather\r\n do URE after putting new catheter\r\n\r\nseen by duty dr\r\nc/o breathlessness\r\nspo2:84 without O2\r\ninformed dr lakshmi\r\nintermittent 02 at 2 L \r\nneb with combimist & dernide stat\r\n\r\n\r\ninformed to DR radha\r\npredinner:204mg/dl-inj novorapid 4 units given after food\r\n10 pm:210mg/dl-inj lantus 14 units\r\n\r\n\nSeen by Dr. Vinod\r\nAfebrile.\r\nNo soakage. No NVD.\r\nPt mobilised.\r\nHad constipation - enema given.\r\n\r\nAdvised:\r\nRemove foleys catheter CM.\r\nCan be discharged tomorrow.\r\nContinue Physio at home.\r\nContinue Stafcure & Esoz for 1 week.\r\nT. Dolowin plus 1-0-1 (after food) x 1 week.\r\nNewbona jelly once a week for 6 weeks.\r\nT. Bon K2 OD x 6 weeks.\r\nReview on 01.10.2015 for SR.\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:204mg/dl-inj novorapid 4 units given after food\r\nFBS:188mg/dl-inj novorapid 8 units given after food\r\n \r\n PPBS : MG/DL\r\nBP: 140/90 MM HG\r\nCASE PLAN :\r\nspo2- 92% with out o2\r\nchest b/l airentry +\r\nc/o pain on movt of the left limb\r\ncontinue the same\r\nphysio to be continued\r\n inj tramadol i.m st\r\ninform dr vinod regarding oozing from the surgical site.\r\n\r\nS/B DUTY DOCTOR\r\nsugars- 258mg/dl- informed to dr manoj- adviced- inj novorapid-4 units after food\r\n informed 10 pm sugars- dr manoj- 250 mg/dl- adv- inj lantus- 14 units.\nSeen by Dr. Vinod\r\nDressing done.\r\n\r\nPlan:\r\nStop Inj Clexane\r\nPlenty of fluids\r\nT. Ecosprin 75 0-1-0\nmorning sugras- 193 mg/dl- informed dr manoj- adv- 12units inj novorapid\r\nearly morning she had pain over the surgical site- adv- tab dolo650mg.\r\n\r\n\r\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: passing urine without feeling of bladder fullness\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 258 MG/DL- inj novorapid- 4 units givenafter food \r\nFBS: 193 MG/DL- inj novorapid 12 units given \r\n PPBS : MG/DL\r\nBP: 170/100 MM HG\r\nCASE PLAN : \r\nmay be dischged after Dr Vinod consultation\r\n\r\n\r\n"}, {'role': 'model', 'content': '\nIP Number: 4744\n\nPatient Number: 77\n\nAdmission Date: 12-09-2015\n\nDischarge Date: 26-09-2015\n\nDiagnosis: sub trochanteric fracture Lt femur\r\nS/P PFN lt femur under spinal anaesthesia\r\n\r\n\n\nClinical Exam(With BP): h/o fall in bathroom yesterday night\r\ntrauma to left hip\r\n\r\ncurrent medications:\r\nInj Novorapid 28-28-28 units before food\r\nINj lantus 30 units at bed time s/c\r\n tab pletoz 100 mg 1-0-0(occasionally)\r\nTab pregaba 75 mg 1-0-1\r\ntab betonin XT 1-0-0\r\nTab nebibeta 5mg 1-0-1\r\nTab ELSARTAN 50 1-0-1\r\nTab Isordil 5mg SOS\r\nTab Ministat 10 mg 0-0-1\r\nTab Rabekind 1-0-0\r\nTab Rantac 300mg sos\r\ntab lorvas sr 1.5 mg 1-0-0\r\ntab nikoran 10 mg 0-0-1\r\n\n\nSystolic BP: 180.0\n\nDiastolic BP: 100.0\n\nPhysical examination: Chest xray:\r\nECG:\n\nXray findings: afebrile\r\nBP:180/`100 mm hg\r\nPulse:90 beats/min\r\nsystemic examination:\r\ncns:cocious,oriented\r\ncvs:S1 s2 heard\r\nrs:chest clear\r\np/a:soft,non tender\r\nlocal examination:\r\ndiffuse swelling Lt Thigh\r\nLt LL shortened and externally rotated\r\nnot able to move Lt LL\r\ndistal pulses felt\n\nDiscussion: Mrs P.K.Thankam Nair,a 75 year old female who is a k/c/o Type 2 Diabetes Mellitus, Hypertension & Dyslipidaemia on insulin & medications for hypertension & dyslipidaemia presented with history of fall in the bathroom injuring her left hip (on 12/09/2015). Xrays of the hip showed subtrochanteric fracture of left femur.Hence she was admitted.During the hopsital stay she developed electrolyte imbalance(hyperkalemia and hyponatremia) which was corrected. she was posted for surgery(Nailing on 15/09/2015) but surgery was unsuccessful. Re exploration was done on 18/09/2015 which was uneventful. Post OP physiotherapy was done. Patient has been mobilised. During the hospital stay she had further episodes of hyponatremia that was corrected. Now patient has symptomatically improved but has pain during mobilisation.\n\nDiet: nan\n\nRemarks: review after 7 days (saturday) in ortho OP for suture removal.'}] |
4,876 | [{'role': 'user', 'content': '\nIP Number: 4876\n\nPatient Number: 27139\n\nPatient Name: P V JACOB\n\nGender: M\n\nDate of Birth: 21-10-1943\n\nAddress: VILLA 11\n\nPincode: nan\n\nPhNo: 9447067099\n\nAdmission Date: 21-10-2015\n\nDischarge Date: 07-11-2015\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: 72 year old, Mr P.V. Jacob came with complaints of pain on rt leg for the past 3 days. Pt gives h/o blunt trauma rt leg 2 weeks back. H/o fever since last night. pt is a known case of diabetes for the past 26 years and on treatment.\n\nXray information: dia eye checkup\r\nXray rt leg AP latreral\n\nClinical examination: pt is concious, oriented\r\nno pallor, ictrus, clubbing.\r\n\r\nCVS -S1S2 heard\r\nRS- chest clear.\r\nAbd- soft.\n\nPrecautions to be taken while treating the patient: F/H/O HTN, DM.\n\nRemarks: s/b Dr Radha\r\nh/o blunt injury rt leg 2 weeks bsck\r\nH/O fever since last night \r\nCellulitis rt leg with an infected eschar\r\nCase plan \r\ni/V antibiotics \r\ncontrol of sugars\r\nDr Bhat consult\r\n\r\nGBRS- 329 mg/dl\r\ninformed dr. radha\r\nadviced to give inj. novorapid 10 units.\r\nSeen by DRA.K.Bhat.\r\n?Early necrotising fasciitis rt leg.Infected eschar,.C/S taken.\r\nAdvice:Leg elevation.BBact oint qid Local application.Inj.Biopiper 4.5 gm IV bd.Continue dalacin.\ns/b Dr Radha\r\nh/o blunt injury rt leg 2 weeks bsck\r\nH/O fever since last night \r\nCellulitis rt leg with an infected eschar\r\nCase plan \r\ni/V antibiotics \r\ncontrol of sugars\r\nDr Bhat consult\r\n\r\nGBRS- 329 mg/dl\r\ninformed dr. radha\r\nadviced to give inj. novorapid 10 units.\r\nSeen by DRA.K.Bhat.\r\n?Early necrotising fasciitis rt leg.Infected eschar,.C/S taken.\r\nAdvice:Leg elevation.BBact oint qid Local application.Inj.Biopiper 4.5 gm IV bd.Continue dalacin. to stop inj. monoscot.\r\n\r\nseen by duty doctor.\r\ntime 10 pm\r\nGBRS- 300 mg/dl\r\ninformed dr. radha\r\nadviced to give inj. lantus- 15 units.\r\nto repeat GBRS at 2 am.\r\nto repeat electrolytes in the morning and to be informed.\nseen by Duty doctor\r\nGBRS- at 2 am- 267 mg/dl\r\n at 6 am- 213 mg/dl\r\nelectrolytes done in the morning.\r\nSodium-125\r\npotassium-4.8\r\nAdviced to give inj. novorapid- 14 units.\r\n\r\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:329 MG/DL\r\nFBS:213 MG/DL\r\nPPBS : 334 MG/DL\r\nBP:130/80 MM HG\r\nCASE PLAN :\r\nXRay long bones (right leg) showing cortical reaction.\r\ninj clexane 0.4 mg s/c OD\r\nNovarapid 14-14-14 & L 20 units\r\ncardiology consultation tomorrow morning.\r\n\r\nSeen by DRA.K.Bhat.\r\nREdness needs observation.Inj.Dalacin 600mg 8th hrly.Bbact oint qid.\r\n\r\nTC,RFT,Electrolytes c/m.\r\n\r\n6 PM GRBS: 224 mg/dl;Given: novarapid 18 units\r\n10 PM GRBS: 202 mg/dl; Given: L- 20 units\n6 AM GRBS: 62,patient asymptomatic. gave him tea with sugar.\r\n6.30 AM GRBS: 90 mg/dl; adv to give inj novarapid 10u before breakfast.\r\n\r\nCREATININE- 1.5\r\nPotassium- 5.2\r\nsodium- 124\r\nurea- 60\r\nuric acid- 2.0\r\nTC-11,500.\r\n\r\nSEEN BY DR.TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 224 MG/DL\r\nFBS: 62 MG/DL\r\n PPBS : MG/DL\r\nBP: 120/70 MM HG\r\nNa 124\r\nK 5.2\r\nurea 60\r\ncreat 1.5\r\nTC 11500\r\n\r\nCASE PLAN :\r\ntab. yogut bd\r\npain score 3/5 over rt lower limb\r\nsyp. looz 10 ml HS\r\nsalt added diet\r\ninj.novorapid 14- 14-12 units\r\ninj.lantus 16units\r\n\r\n\r\nSeen by DrA.K.Bhat.\r\nFor slough excision and fasciotomy under SA.24TH OCT.\r\nPreop:Nil oral.Informed consent.C&D.IV antibiotics.Medical fitness.\r\n=======\r\nInformed consent.\r\nThere is pus filled infection of right,ankle and leg extending to thigh region.This pus infection is extending deep to deeper tissues like fascia.There are multiple blisters in these regions.The infection needs incision and drainage and fasciotomy under anesthesia.During operation the spreading infection will be opened up in multiple areas and pus and infection will be drained.In necrotising fasciitis there will be infection more extensive than what is seen on the surface.Infected skin and soft tissues may need to be removed.Due to extending nature of infection, after surgery the wounds healing will be delayed.The healing and circulatory condition of wounds will need observation.Repeat surgery may sometimes be needed.Understanding the above consent for anesthesia and operation is given.\r\n======\r\n\r\nseen by duty doctor\r\ninformed dr. vivek prabhu.\r\nadviced to withhold inj. clexane 40 mg.\r\n\r\n\r\nseen by duty doctor\r\ntime 7 pm\r\nGBRS-151 mg/dl\r\nINFORMED DR. Manoj\r\nadviced to give inj. Novorapid 8u\r\nTime 10 pm\r\nGBRS- 200 mg/dl\r\nadviced to give inj.Lantus 14u\r\n\nseen by duty doctor\r\ntime 6 am\r\nGBRS-85 mg/dl\r\ninformed Dr. Manoj\r\nadviced to give IV fluid- DNS 1\r\nto inform GBRS after 1 hour\r\nGBRS at 8 am- 96 mg/dl\r\nadviced to continue iv DNS\r\n\r\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 151 MG/DL-inj novorapid 8 units\r\nFBS: 85 MG/DL- no insulin\r\n PPBS : MG/DL\r\nBP: 120/70 MM HG\r\nCASE PLAN :mode of anaesthesia to be decided after consulting anaesthesist\r\n\r\n\r\n 2:30 pm\r\nseen by duty dr\r\npt received from ICU\r\nPt doing well\r\npt started taking orally\r\nIVF-1 Unit NS with inj ca.gluconate on flow\r\n\r\n\r\ninformed Dr Tom\r\nblood sugars:\r\npredinner:81 mg/dl-No insulin\r\n10 pm:152 mg/dl-inj Lantus 8 units\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 81 mg/dl-No insulin\r\nFBS: 82 mg/dl-No insulin\r\n \r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\n\r\nSeen by DRA.K.Bhat.\r\nContinue trt.For change of dressing in ICU tomorrow.\r\n\r\nseen by duty doctor\r\nreports informed to dr Bhatt\r\nadviced to give DNS 1\r\nglucerna SR powder for oral intake.\nSeen by Dr.Manoj\r\npulse- 70/min\r\nGBRS at 10:30 am- 189\r\npain score- 3/5\r\nInj. clexaine 0.4 ml ODto be restared.\r\nplan to insulin after lunch PPBS.\r\ninput-3000ML\r\noutput- 3225 ML\r\nI/O CHART TO BE MAINTAINED.\r\n\r\nseen by duty doctor\r\ntime 12 pm\r\nGBRS- 149 mg/dl\r\ninformed Dr. Manoj\r\nAdviced not to give insulin injection.\r\n\r\nSeen by duty doctor\r\ntime 6 pm\r\nGBRS- 236mg/dl\r\ninformed dr. manoj\r\nadviced to give inj. novorapid -4units.\r\nGBRS at 10 pm- 215 mg/dl\r\nadviced to give inj. lantus 10 units\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 236 MG/DL\r\nFBS:108 MG/DL inj. novorapid 6 units given\r\nPPBS : MG/DL\r\nBP:130/70 MM HG\r\nCASE PLAN :\r\nsend for Hb,Na, PCV.\r\nNovorapid 10-10-10; \r\nLantus 10 units\r\n\r\nSeen by DRA.K.Bhat.\r\nDRessings changed.Clean large raw areas of leg and thigh.\r\n\r\n6PM GRBS: 136 mg/dl; given: Novarapid 6 units\r\n10 PM GRBS: 167 mg/dl; Given L 10 units\n6 AM GRBS: 104; given Novoapid 10 units along with food\r\n\r\nSEEN BY DR. LAKSHMI &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 136 MG/DL\r\nFBS: 104 MG/DL\r\n PPBS : 291 MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN :\r\nmake inj novorapid 10-6-6 units\r\nmake inj pactive sos.\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\n\r\nSeen by duty dr\r\ninfomed dr lakshmi\r\nblood sugars:\r\npredinner:209 mg/dl-inj novorapid 8 units\r\n\r\nseen by duty dr\r\nc/o fever\r\ntemp:100 degree F\r\ninformed dr lakshmi\r\ninj pactive 100 ml iv given\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:209 mg/dl-inj novorapid 8 units\r\nFBS: 113 mg/dl-inj novorapid 10 units\r\nPPBS : MG/DL\r\nBP: MM HG\r\nHb- 10.4\r\nPC- 9300\r\nNa- 128\r\ncreatinine- 1.1\r\nCASE PLAN :\r\nSeen by Dr Bhat. \r\n\r\nSEEN BY DUTY DOCTOR-\r\ninformed to dr. manoj.\r\nadviced to give\r\nGBRS at 6 pm-202mg/dl- inj. novorapid 8 units.\r\n 10 pm- 290mg/dl inj. lantus 10 units\r\n\r\n\ncatheter removal today.\r\npt has not yet passed urine.\r\nseen by duty doctor \r\ntime 1 pm\r\npt passed urine- 200 ml.\r\nSeen by DRA.K.Bhat.\r\nDRessings changed.Large raw areas clean.Edema,redness needs observation.Continue trt.\r\ni/v line out with minimal cellulitis \r\nStop i.v antibioyics \r\nTab Lineazolid 600mg 1-0-1( Tab ENTAVER )\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nlooking better\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 202 MG/DL\r\nFBS:158MG/DL inj. novorapid 14 units.\r\n PPBS : MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN :\r\nplasma to be given\r\ncontinue same.\r\nstop ecospirin.\r\n\r\n1.15 PM:\r\npatient vitals recorded & stable.\r\n plasma transfusion started.\r\n\r\n2 pint FFP transfused.\r\n\r\nS/b DrA.K.Bhat.\r\nContinue trt.\r\n\r\n6 PM 215 mg/dl; Given Novorapid 10 units \r\n10 PM ; Lantus 12 units to be given\n6 AM GRBS:152 mg/dl; Given nov 14 units\r\n\r\nSEEN BY DR.Radha &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 215 MG/DL\r\nFBS: 152 MG/DL\r\n PPBS : MG/DL\r\nBP: 140/80 MM HG\r\nCASE PLAN :\r\noozing+\r\nEcospirin may be started from today\r\nto repeat Hb, TC, Urea,Na,K,FBS,Creatinine tomorrow.\r\ninj. novorapid14- 14-10units\r\ninj. lantus 14 units.\r\nhigh protein diet adviced.\r\nSeen by DrA.K.Bhat.\r\nDressings changed.Large raw areas clean.Area of edema anterolateral compt of leg and medial knee needs observation-may need fasciotomy.Continue trt.\r\n\r\nseen by duty doctor\r\nGRBS at 6 pm- 135 mg/dl\r\ninformed dr. radha\r\nadviced to give inj. novorapid- 10 units.\r\nGRBS at 10 pm 245mg/dl\r\ninj. lantus 14 units.\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 135 MG/DL\r\nFBS:142 MG/DL inj. novorapid 14 units.\r\n PPBS : MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN :\r\npain score 3/5\r\ninduration+\r\nexplained the case scenario and plan of management to the patient.\r\nadd:\r\nAcuvin BD\r\nInfusion Pactive SOS\r\nSalt capsules 1-0-1\r\ninj Entaver IV BD\r\nEcospirin W/H\r\nto restart Clexane 0.4 m s/c Od\r\nto recheck Na tomorrow\r\n\r\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\nPlan for fasciotomy under SA,if pain is unrelieved.\r\n\r\n\r\n6PM :GRBS: 321; adv Novarapid 14 units s/c\r\n\r\npatient had an episode of vomiting following intake of salt capsule\r\n\r\n10 PM GRBS 240 mg/dl; Given L- 14 units\n6 AM GRBS: 123;Given novarapid 14 units s/c\r\n\r\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 321 MG/DL\r\nFBS: 123 MG/DL\r\n PPBS : MG/DL\r\nBP: 100/70 MM HG\r\nNA 124 MG/DL\r\nCASE PLAN :\r\nvomiting out salt capsules\r\noozing+\r\n\r\nSeen by DRA.K.BHat.\r\nDressings changed.Raw areas clean.REdness and swelling decreased.Continue trt.\r\n\r\nseen by duty doctor-\r\nGRBS- 143 mg/dl at 6 pm\r\ninformed dr radha.\r\nadviced to give inj.novorapid 10 units.\r\nGRBS at 10 pm- 186 mg/dl\r\nadviced to give Inj. lantus 14 units.\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:0/5\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: 84 MG/DL inj. novorapid 14 units with food.\r\nPPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :continue same , \r\n\r\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\n6.00 pm GRBS- 63 mg/dl, called and informed Dr.Radha\r\nadvised R 8 u a/f, reduce inj: lantus to 10 u.\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 63 MG/DL\r\nFBS: 83 MG/DL advised inj:novorapid 12 u\r\n PPBS : MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN :\r\nchange insulin Nov 8-8-8;L- 8 units\r\n\r\nSeen by DRA.K.Bhat.\r\nDRessings changed.Clean.Continue trt.\r\n\r\ninfusion 2 pint FFP to be given today\r\n\r\n3.15PM: \r\n2 int FFP transfusion to be started .\r\nbag no. 10668; B neg. DOC 3/10/15, DOE 2/10/16\r\nbag no. 10853; B neg. DOC 8/10/15, DOE 7/10/16\r\n\r\nc/o itchy lesions in the forearm.\r\nO/E urticarial lesions+ in both forearms.\r\nadv inj avil iv stat\r\n\r\n6.00 PM GRBS 179 mg/dl; Given Nov 4 units\r\n10 PM GRBS: 202 mg/dl; Given L- 10 units\n6 AM GRBS: 93 mg/dl; Given Novarapid 6 units\r\n\r\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 179 MG/DL\r\nFBS: 93 MG/DL\r\n PPBS : MG/DL\r\nBP: 120/70 MM HG\r\nCASE PLAN :\r\nInj.Novorapid 6-4-4\r\nInj.Lantus 8 units s/c at bedtime\r\nplan for discharge after bhatt sir review.\r\nelectrolyte Sodium to be repeated tomorrow.\r\nProtein powder BD.\r\n\r\nseen by duty doctor\r\nGRBS at 6 pm 123 mg/dl\r\ninformed Dr. Lakshmi.\r\nadviced to give inj. novorapid 2 units.\r\nGRBS at 10 pm- 132 mg/dl\r\ninj. lantus 4 units.\r\n\r\n\r\n\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 123 MG/DL\r\nFBS:99 MG/DL inj. novorapid 4 units.\r\nPPBS : MG/DL\r\nBP: 120/70 MM HG\r\nCASE PLAN :\r\npatient doing fair\r\noozing +\r\nHyponat may be stopped at disharge\r\nstop Metadoze\r\nT. Nexprofast 1-0-1\r\nLantus 8 units at b/t alone\r\nD protien 3 times\r\nAccuvin SOS after dressing.\r\n\r\nSeen by DRA.K.BHat.\r\nDRessings changed.Clean raw areas.Plan fr D/C on saturday.\r\n\r\n\r\n6 PM GRBS: 184 mg/dl; to give L 8 units at bed time alone\n6 AM GRBS: 110 mg/dl\r\n\r\nSEEN BY DR.Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 184 MG/DL\r\nFBS: 110 MG/DL\r\n PPBS : MG/DL\r\nBP: 140/80 MM HG\r\nCASE PLAN :\r\ndischarge tomorrow.\r\n\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\nseen by dr. manoj\r\nGRBS at 6 pm- 270 mg/dl.\r\nadviced to give inj. novorapid 4 units.\r\nGRBS at 10 pm-201 mg/dl\r\nadviced to give inj. lantus 8 units.\r\nc/o cough- to give syp. sufrecof 5 ml stat.\nseen by duty doctor.\r\ninformed dr. Manoj.\r\nGRBS at 6 am- 104 mg/dl\r\nadviced not to give insulin now.\r\n\r\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 270 MG/DL\r\nFBS: 104 MG/DL\r\n PPBS : MG/DL\r\nBP: 140/90 MM HG\r\nCASE PLAN :\r\nmay be discharged today\r\non insulin.L-8 un at b/t; Novarapid 4 u in afternoon\r\n\r\nSeen by DRA.K.Bhat.\r\nDressings changed.Clean.\r\nAdvice:Change of dressings once in 2 days-Jelonet,Oxum gauze.Review 2 weeks.\r\n'}, {'role': 'model', 'content': '\nIP Number: 4876\n\nPatient Number: 27139\n\nAdmission Date: 21-10-2015\n\nDischarge Date: 07-11-2015\n\nDiagnosis: Necrotising Fascitis Rt leg \r\ns/p Fasciotomy with extensive debridement under SA on 24/10/2015\n\nClinical Exam(With BP): pt c/o pain on the rt leg for past 3 days\r\nh/o blunt injury rt leg 2 weeks back\r\nH/O fever since last night .\r\nCellulitis rt leg with an infected eschar\r\n\r\nMedicines patient is taking:\r\nTab Cilacar 5mg 1-0-0\r\nTab Zincovit 1-0-0\r\n\n\nSystolic BP: 160.0\n\nDiastolic BP: 80.0\n\nPhysical examination: dia eye checkup\r\nXray rt leg AP latreral\n\nXray findings: pt is concious, oriented\r\nno pallor, ictrus, clubbing.\r\n\r\nCVS -S1S2 heard\r\nRS- chest clear.\r\nAbd- soft.\n\nDiscussion: 72 year old, Mr P.V. Jacob was admitted with c/o pain and edema of right leg since 3- 4 days with fever since the previous night..He had sustained a blunt trauma rt leg 2 weeks back. Patient is a known case of diabetes for the past 26 years and on treatment with OHAS.At the time of admission , there were features of cellulitis with necrotising Fascitis on the right with an eschar at the site of the trauma . Inj rPipercillin+ Tazobactum along with Inj Dalacin was started . Glycaemic control was achieved with Basal bolus insulin. Podiatric surgical consult was given.By the second day , the fascitis had extended upto the lower part of thigh. There was adequate blood flow to the thigh clinically. Patient was taken up for Fasciotomy with extensive debridement under SA on 24/10.Post operatively patient remained stable. Pus c&S sent earlier showed MRSA + sensitive to Linezolid .As there was increased oozing from the wound 4 pints of FFP was tranfused during the post operative period.He remained in a stable state.Regular alternate day dressings were given .Inj Biopiper and Dalacin were stopped and i/v Linezolid was started after 1 week post op.As the wound showed good healing with adequate granulation i/v antibiotics were stopped by 4/11 and oral Tab Linezolid was started.He was mobilised on walker from 6/11. Inj Lantus was continued while the rapid acting insulins were discontinued as patient was having hypoglycaemia recurrently. Jacob could be discharged in a stable state on 7/11 with advise to continue with alternate day dressings at home and to follow up in podiatric OP .\n\nDiet: nan\n\nRemarks: review with Fbs , PPBS \r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\n'}] |
5,068 | [{'role': 'user', 'content': '\nIP Number: 5068\n\nPatient Number: 24817\n\nPatient Name: LEELA MATHEW\n\nGender: F\n\nDate of Birth: 18-06-1954\n\nAddress: VISHAL,39/5584, THOUNDAYIL ROAD\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 12-12-2015\n\nDischarge Date: 26-12-2015\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nDIABETIC RETINOPATHY\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: Mrs Leela Mathew 61 yrs / Female was brought to casualty unconscious , Her GRBS was - 31 mg/dl Inj 25 % Dextrose and Glucagon given . Admitted for better glycemic control.\n\nXray information: nan\n\nClinical examination: patinet unconsiuos\r\nvitals: \r\nsystems: chest clear\r\nS1S2+\r\nP/A nad\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by dr. Lakshmi.\r\nadviced to stop tab. metadoze IPR 500 mg .\r\nstop tab.galvus 50 mg\r\nstop tab. dytor 10 mg .\r\nto send CBC, electrolytes, RFT. to do chest Xray.\r\nto send TC tomorrow.\r\n\r\nseen by duty doc\r\ninformed dr. lakshmi.\r\ns. potassium 2.9\r\nto start IV NS 500 ML WITH POTASSIUM 40mEq @ 80 ml/hr.\r\n\r\nseen by duty doctor.\r\ninformed Dr. Tom\r\nGRBS at 6 pm- 201 mg/dl.\r\n at 10 pm- 243 mg/dl.\r\nadvised towith hold her insulin dosages.\nSEEN BY DR. RADHA &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Nausea\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS:299 MG/DL INJ NOVORAPID 8 UNITS.\r\nPPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nPatient doing better , started taking orally\r\n To replace Pansec with T Revera D 1-0-0 \r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 233 MG/DL\r\nFBS: 187 MG/DL T galvusMet 1-0-0\r\n PPBS : MG/DL\r\nBP: 130/90 MM HG\r\nCASE PLAN :\r\nW.H - insulin \r\nstop galvusmet\r\nmake it T galvus 50 mg OD\r\ncouncelled regarding ophthal work up\r\n\r\n6pm-GRBS-158mg/dl.informed to Dr.Lakshmi advised inj.novorapid 2u A/F s/c\r\n10 PM GRBS: 192mg/dl ; to give L 10 units\n6 AM GRBS: 421mg/dl; to give Novarapid 18u\r\n\r\nSEEN BY DR.lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 158 MG/DL\r\nFBS: 421 MG/DL\r\n PPBS : MG/DL\r\nBP: 130/90 MM HG\r\nCASE PLAN :\r\nUSG abdomen to r/o Pancreas abnormality done.\r\nto inform about cardiology review\r\n\r\nseen by duty doc\r\ninformed Dr. Radha.\r\nGRBS at 6 pm- 109 mg/dl .inj. novrapid 8 units.\r\n at 10 pm -88 mg/dl.inj. lantus 4units.\r\n\r\n\nSEEN BY DR. AJISH &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS:198 MG/DL inj. novorapid 18 units.\r\n PPBS : MG/DL\r\nBP: 150/100 MM HG\r\nCASE PLAN :\r\nInj. monoscot SB stopped.\r\nplan to put into insulin pump.\r\n\nSEEN BY DR.Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 180 MG/DL\r\nFBS: 146 MG/DL\r\n PPBS : MG/DL\r\nBP: 130/90 MM HG\r\nCASE PLAN :\r\nno bolus dose.\r\ntab. dytor 10 mg 1/2 -0-0 from today.\r\n\r\nseen by duty doc\r\ninformed dr. manoj\r\nGRBS at 7:30 pm- 227 mg/dl. inj.bolus 2.5 units.\r\n at 8:30 pm- 162 mg/dl.\r\n at 10 pm-132mg/dl.\r\n\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS:at 6 am- 195 MG/DL\r\n at 2 am- 245mg/dl\r\nPPBS : 208 MG/DL\r\nBP: 130/90 MM HG\r\nCASE PLAN :\r\ndoing better\r\nContinue same\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 225 MG/DL\r\nFBS: 192 MG/DL\r\n PPBS : MG/DL\r\nBP: 130/90 MM HG\r\nCASE PLAN :\r\nAdvised not to take off the insulin pump.\r\nCardiology fitness today.\r\n\r\nseen by duty doc\r\ninformed Dr. Manoj.\r\ninformed Harold.\r\nGRBS at 7:30 pm-272 mg/dl. inj. bolus 2 units.\r\n at 10 pm-270 mg/dl.\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 210 MG/DL\r\nFBS:190 MG/DL. bolus 1 unit.\r\nPPBS : MG/DL\r\nBP: 136/80 MM HG\r\nCASE PLAN :\r\nwaiting for eye surgery on 22-12-2015\r\nClopilet may be retsarted on 23/12 after D/W Dr Manoj\r\n\r\n\nSEEN BY DR.Lakshmi&TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 236 MG/DL\r\nFBS: 335 MG/DL\r\nPPBS : MG/DL\r\nBP: 140/70 MM HG\r\nCASE PLAN :\r\nto increase the basal to 1 unit.\r\nwatch the sugar levels.\r\n\r\nseen by duty doc\r\nInformed dr. lakshmi.\r\nGRBS at 7:30pm-136 mg/dl.\r\n at 10 pm- 148 mg/dl.\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS:252 MG/DL\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :Patient doing well \r\nPlanned for cataract surgery today at giridhar hospital . \r\n\r\n\r\n\nSEEN BY DR.Lakshmi&TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: 127 MG/DL\r\nPPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nAlcon eye drops 6 times a day from 22.12.2015 to 11.01.2016.\r\nMilflox eye drops 4 times a day for 3 weeks.\r\nHypersol eye drops- 3 times a day on right eye for 5 days.\r\n\nseen by duty doc.\r\nGRBS at 7:30 pm- 151 mg/dl. inj. bolus 1.5 units.\r\n at 10 pm- 120 mg/dl.\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\n\r\n\r\n\nThanks for referral\r\nCase reviewed by Dr Aswin Krishnan Ajit\r\nRecently underwent cataract surgery. Currently on MDD-XR 50 mg and does not report any significant depressive symptoms or biological function impairment.\r\nAdv:\r\n1) Tab MDD-XR 50 mg 0-0-1\r\n\r\nReview after 2 weeks or SOS\nSEEN BY DR. LAKSHMI &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: 106 MG/DL\r\n PPBS : MG/DL\r\nBP: 140/90 MM HG\r\nCASE PLAN :\r\ncontinue same\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 247 MG/DL\r\nFBS: 110 MG/DL\r\n PPBS : MG/DL\r\nBP: 140/90 MM HG\r\nCASE PLAN :\r\nPatient doing better. Plan for Discharge with Basal dose decreased from 1 u to 0.8u/hr\r\n and change bolus to 1-1-1u\r\n Dosage of T .Frusilac increased to 1/2-1/2-0\r\n\r\n\r\n'}, {'role': 'model', 'content': '\nIP Number: 5068\n\nPatient Number: 24817\n\nAdmission Date: 12-12-2015\n\nDischarge Date: 26-12-2015\n\nDiagnosis: Bilateral Cataract and CSME\r\nIschemic cardiomyopathy - complicated by anemia?\r\nMild left ventricular global dysfunction with CCF\r\nCoronary angiogram: insignificant CAD\r\nurinary tract infection\r\n\r\n\n\nClinical Exam(With BP): patient presented to the casualty with hypoglycemic episode, grbs: 31mg/dl\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: Chest X-Ray :\r\n\r\n\n\nXray findings: patinet unconsiuos\r\nvitals: \r\nsystems: chest clear\r\nS1S2+\r\nP/A nad\n\nDiscussion: Mrs Leela Mathew 61 yrs / female K/c/o-Type 2 DM/ HTN/ DLP / ischemic cardiomyopathy on treatment was brought in hypoglycemia she was stabilized and was admitted for insulin titration for better glycemic control . Inview of hypoglycemia she was advised to change to Insulin pump and her sugar levels were optimized . Catarct surgery was done for her rt eye on 22 /12/15 at Giridhar hospital postoperative period was eventful .Psychiatry review was taken was advised to continue same . Patient got better hence planned to discharge with insulin pump .\n\nDiet: nan\n\nRemarks: nan'}] |
5,258 | [{'role': 'user', 'content': "\nIP Number: 5258\n\nPatient Number: 29264\n\nPatient Name: MARY MATHAI\n\nGender: F\n\nDate of Birth: 15-02-1948\n\nAddress: PUTHANPURAYIL H\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 15-02-2016\n\nDischarge Date: 29-02-2016\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nMixed hyperlipidaemia\nEssential (primary) hypertension\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: Mrs MAry Mathai K/c/o Type 2 DM / HTN was admiited with early necrotising fascitis . Blood investigations done and was started on IV antibiotics .\n\nXray information: nan\n\nClinical examination: Pt is concious, febrile.\r\nno pallor.\r\ncvs- s1s2 heard\r\nRs- chst clear.\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by DRA.K.Bhat.\r\nPAIN.Early necrotising fasciitis rt foot extending to leg and medial thigh.Skip lesions present.two wounds dorsum of foot base of medial toes.\r\nAdvice:IV antibiotics.,Supportive and symptomatic treatment.\nSEEN BY DR.Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:129 MG/DL\r\nAT 10 PM- 158 MG/DL\r\nFBS:105 MG/DL INJ. INSUGEN R 4 UNITS.\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\ninj insugen R 4-2-2\r\nInj basalog 4u\r\ninj tremadol SOS\r\ninj Emeset SOS\r\ninj clexaine .4 od iv\r\n\r\nSeen by DrA.K.Bhat.\r\nContinue trt.Plan fr I&D,Fasciotomy under SA on thursday.Preop:Preop.screening,BT,CT,PT,CXR PA,ECG,Medical fitness.\r\n\nGRBS at 6pm- 120mg/dl. informed Dr Lakshmi. advised to give insugen r 2u\r\nGRBS at 10pm- 127mg/dl. informed Dr lakshmi. advised to give basalog 4u\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:3/5\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS:75 MG/DL\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nCardiology consultation today\r\n plan for fasciotomy \r\n Tc , Hb , S. electrolytes today\r\n\r\n\r\n\nSeen by DRA.K.Bhat.\r\nFor I&D fasciotomy rt foot,leg under SA,18TH Feb,2pm.\r\nPreop:Nil oral.Informed consent.Medical fitness.\r\nInformed consent.\r\nThere is pus filled infection of right foot extending from big toe and foot region.This pus infection is extending to the region of whole foot and ankle and leg also.There are multiple pus filled blisters in this region of foot and rest of foot also.There is infection extending to foot and leg.There is diabetes and neuropathy and decreased circulation of leg.The infection of foot needs incision and drainage of pus and slough excision and fasciotomy of leg with multiple incisions ,to be done under anesthesia.During operation, the spreading infection will be opened up and dead and necrotic skin and soft tissues will be removed.In diabetes, the initial wound will be small,but spreading infection will extend below the skin and hence after surgery, the wounds will be multiple.Due to diabetes and decreased circulation,control of infection and healing will be delayed.Repeat surgery may be needed.Due to extent of infection, the healing and circulatory condition of toes and foot will need observation.Understanding the above, consent for anesthesia and operation is given.\r\n=====================\nSEEN BY DR.Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 146 MG/DL inj R 2units \r\nFBS: 74 MG/DL \r\nPPBS :129 MG/DL\r\nCASE PLAN :\r\nNPO from 7 a.30 am today \r\nPremedication given / consent to be taken \r\nPosted for Fasciotomy today at 1.30 pm.\r\nEcho and cardio consult today.\r\nTo start DNS 1 pint.\r\n\r\n\r\nTime 6:15 pm\r\nSeen by duty doc\r\nPt shifted ti ICU at 4 pm.\r\nBP- 148/66 mmHg.\r\nPulse- 90/min.\r\nSpo2- 97 %\r\nPt is tolerating oral feeds.\r\nPost op orders:\r\nTo monitor TPR/BP/IO chart.\r\nInj. Pactiv 8th hourly\r\nIV Antibiotics.\r\n2 pints DNS with insulin according to GRBS.\r\nTo follow physician's orders.\r\nTo repeat Hb, Na, K, Urea, Creatinine, Tomorrow.\r\npt C/O PAIN.\r\nInj. tramadol IV stat.\r\nInj. Emeset 4 mg iv stat.\r\nPt to be shifted to ward.\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:183 MG/DL inj. R2 units.\r\n10 pm- 123 mg/dl. inj basalog 4 units\r\nFBS: 115 MG/DL inj. insugen R 4 units.\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nTo repeat Hb, Na, K, Urea, Creatinine\r\nstart NS wuth 1 amp KCL maintenence\r\ntab calcheck stat\r\nd protein\r\ntab telsite AM from tomorrow onwards\r\n\r\nSeen by DRA.K.Bhat.\r\nFor C&D under IV sedation 20th feb,1.30 PM.Preop:NIL Oral as per anesthetist.Consent.\nGRBS at 6pm-171mg/dl. informed Dr Radha. advised to give insugen R 2 U\r\nGRBS at 10pm- 183mg/dl. informed Dr Radha. advised to give basalog 14u\nc/o pain at 1pm. case seen by duty doctor\r\ninj tremadol 50mg im stat given\r\n\r\nSEEN BY DR. MANOJ&TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Pt doing well.\r\nPAIN SCORE:3/5\r\nBLOOD SUGARS : \r\nPREDINNER:171 MG/DL\r\nFBS:97 MG/DL\r\nBP:160/90 MM HG\r\nCASE PLAN :\r\nposted for C&D under iv sedation\r\nNPO from 7am\r\nKcl 1 amp with one pint NS.\r\nTab. Calcheck 5 mg stat after 1 hour if BP is high.\r\nInj.Insugen R 4-4-6 units.\r\nInj.Basalog 4 units.\r\nSeen by DRA.K.bat.\r\nUnder IV sedation,dressings were changed.Large raw areas of leg.Residual skin and soft tissue necrosis areas seen-need observation;Areas of dorsum foot skin and soft tissue necrosis-partly excised. Continue trt.Transfuse FFP 2 pints tomorrow..\nSEEN BY DR.Manoj\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:135MG/DL\r\npost dinner- 229 mg/dl. inj. basalog 4 units.\r\nFBS:175 MG/DL inj. insugen R 4 units.\r\nBP: MM HG\r\nCASE PLAN :\r\ninj clexaine .4mg OD iv x 2 days\r\ntab nitrest 5 mg HS\r\n2 Pint FFP today\r\nstop biopiper\r\ncontinue inj dalacin\r\n\r\nSeen by DrA.K.Bhat.\r\nTransfuse 2 units FFP.Stop biopiper.\ncase seen by duty doctor. after cross checking patients age name, ip no, bag no:13032 and bag no:14120, blood gp- A+\r\n2 pint FFP was transfused\r\npremeds:\r\ninj avil 1 amp iv stat\nGRBS at 12pm 225mg/dl. informed Dr Manoj. advised to insugen R 4U\r\nGRBS at 6pm 207mg/dl. informed Dr Manoj. advised to give insugen R 4u\nGRBS at 10pm-278mg/dl. informed Dr Manoj. advised to give basalog 8u\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:3/5\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS:102 MG/DL insugen R 2U\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nPatient c/o pain \r\nADvised to stop Inj emeset and pansec \r\n Start on Tab Revera D \r\nSeen by DRA.K.Bhat.\r\nContinue trt.C&D tomorrow.\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:3/5\r\nBLOOD SUGARS : \r\nPREDINNER: 167 MG/DL\r\nFBS: 118 MG/DL advised i nj R 4 units\r\n PPBS : MG/DL\r\nBP:150/100 MM HG\r\nCASE PLAN :\r\nDressing in OT\r\nsleep disturbed\r\ninsugen R- 6-4-4 s/c 1/2 hr before food\r\nBasalog 6 at bed time\r\n\r\n\r\nSeen by DrA.K.Bhat.\r\nDressings changed.Raw areas clean.\r\n\r\n\nGRBS at 6pm-226mg/dl. informed Dr Radha. advised to give insugen R 4U\r\nGRBS at 10pm- 234mg/dl. informed Dr Radha. advised to give basalog 8u\ncase seen by duty doctor\r\nc/o gas trouble advised to give inj pansec 40 mg iv stat.\r\nSeen by DRA.K.Bhat.\r\nContinue trt.May need debridement if pain persists.Rpt, TC,Hb.\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS:119 MG/DL INSUGEN R 6U\r\n Pre dinner - 226 MG/DL\r\nBP: 160/100 MM HG\r\nCASE PLAN :\r\nContinue same\r\nDiscuss with bystandes on the progresss\r\nCBC today\r\nDressing today\r\nStop inj neomol and start Tab acuvin TDS\r\n\r\n\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: 115 MG/DL inj R 6 units \r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nSeen by DrA.K.Bhat.\r\nDressings changed.Areas of residual necrosis-needs slough excision under SA-PLan for on saturday.Arrange packed cell for surgery.\r\n\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:180 MG/DL INJ. Insugen R 4 units.\r\n10 pm- 267 mg/dl. inj. basalog 6 units.\r\nFBS:122 MG/DL inj. insugen R 6 units.\r\nBP: MM HG\r\nCASE PLAN :\r\n\r\n\r\n\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Abdominal discomfort , with increased frequency of stools\r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nPREDINNER:180 MG/DL INJ. Insugen R 4 units.\r\n10 pm- 267 mg/dl. inj. basalog 6 units.\r\nFBS:122 MG/DL inj. insugen R 6 units.\r\nBP: MM HG\r\nCASE PLAN : Patient doing fine\r\n Ct same \r\nWoung debridement planned for tomorrow \r\n\r\nSeen by DRA.K.Bhat.\r\nWound debridement under SA Saturday 27th feb.\r\nPreop:Informed consent.Nil oral.\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Pain rt leg \r\n INj Tramadol 50 mg IM + Inj Emest 4 mg IV stat \r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 240 MG/DL inj R 6 units \r\nFBS:146 MG/DL\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :Npo from 12.00 night\r\nProcedure today morning at 8.00\r\nPlan fr change of dressing under IV Sedation on monday.\r\n\ncase seen by duty doctor\r\nafter cross checking patients age , name, blood group A +, bag no: 15369, 1 pint PRC was transfused\r\npremeds: inj avil 1 amp iv stat\ncase seen by duty doctor\r\ncan be shifted to ward\nGRBS at 6pm- 311mg/dl. informed Dr Tom. advised to give insugen R-8U\r\nGRBS at 10pm- 145mg/dl. informed Dr Tom. advised to give basalog 6u\nSEEN BY DR. radha &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Pt is comfortable.\r\nPAIN SCORE:1/5\r\nBLOOD SUGARS : \r\nPREDINNER: 311 MG/DL inj. R 8 units.\r\n10 pm- 145 MG/DL. inj. Basalog 6 units.\r\nFBS:135 MG/DL insugen R 6 units.\r\nBP:150/80 MM HG\r\nCASE PLAN :\r\nStop Tab. Allegra\r\nStop Tab. Niterest.\r\nStop Inj. Pactiv \r\nStop inj. dalacin.\r\nStop Tab. Calcheck 0-0-1\r\nTO START \r\nTab. Amitone 0-0-1\r\nTab. Pevesca Plus 0-0-1\r\nCap.Camyda 300mg 1-1-1.\r\nInj. Insugen R 6-4-6 units.\r\nInj. Basalog 8 units.\r\nPlan for Discharge tomorrow.\r\n\r\nSeen by DRA.K.Bhat.\r\nCap.Camyda 300mg 1-1-1.\r\n?PLan for D/C tomorrrow.\r\n\nSEEN BY DR. Radha &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:pain\r\nPAIN SCORE:3/5\r\nBLOOD SUGARS : \r\nPREDINNER: 138 MG/DL injR 6 units\r\n10 pm- 197 mg/dl. inj. basalog 8 units.\r\nFBS:130 MG/DL injR 6 units.\r\nPPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :Dressing today\r\n D/C today - with premix insulin\r\nAdvised premix insulin at noon\r\nSeen by DRA.K.Bhat.\r\nDressings changed-clean raw areas leg.\r\nAdvice:Change of dressing once in 2 days-jelonet.Oral antibiotics 1 week.Review OP 2weeks."}, {'role': 'model', 'content': '\nIP Number: 5258\n\nPatient Number: 29264\n\nAdmission Date: 15-02-2016\n\nDischarge Date: 29-02-2016\n\nDiagnosis: 2 D echo -Dilated LA\r\nLVEF -54 %\r\nMild MR\r\nEarly necrotising fasciitis rt foot extending to leg and medial thigh\r\ns/p fasciotomy with debridement of necrotic tissue under SA\n\nClinical Exam(With BP): Pt came in with c/o Fever since 3 days.\r\nc/o constipation.\r\nc/o wound over the right little toe.\r\nc/o swelling and redness associated with pain.\r\n\r\n\n\nSystolic BP: 130.0\n\nDiastolic BP: 70.0\n\nPhysical examination: Chest X-Ray :\r\n\r\n\n\nXray findings: Pt is concious, febrile.\r\nno pallor.\r\ncvs- s1s2 heard\r\nRs- chst clear.\n\nDiscussion: 68 year old lady was admitted with h/o injury to the right little toe later on progressing to early necrotising fascitis with skip lesions and extending upto the thigh. She is known case of Type 2 DM on OHAS and insulin. She was started on Inj Biopiper and Dalacin and basal bolus insulin. She ahd hyponatremia which was corrected with 3 % hypertonic saline . On 18/2/2016, extensive fascitomy and debridement was done under GA . Post operatively hypoalbuminemia was corrected with transfusion of 2 pints of FFP.First post opetive dressing was done under i/v sedation in OT and pockets of pus presnt was deroofed and drained. She c/o unbearable pain at times though well covered with Tab Tramadol and Inj paracetomol. General condition improved well and patient is discharged in a stable condition on oral antibiotics and premixed insulin.\n\nDiet: nan\n\nRemarks: review with FBS ,PPBS \r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\n'}] |
5,288 | [{'role': 'user', 'content': '\nIP Number: 5288\n\nPatient Number: 29379\n\nPatient Name: SUSAN GEORGE\n\nGender: F\n\nDate of Birth: 14-05-1948\n\nAddress: MULAYAKONATHU GIE GEO COTTAGE\n\nPincode: nan\n\nPhNo: 0484 4069389\n\nAdmission Date: 23-02-2016\n\nDischarge Date: 08-03-2016\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nDIABETIC NEPHROPATHY WITH CRONIC RENAL FAILURE\nDIABETIC NEUROPATHY\nPRIMARY HYPOTHYROIDISM\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: 70 year old Mrs susan george c/o non healing ulcer on the medial aspect of left leg since 2 months\n\nXray information: nan\n\nClinical examination: non healing ulcer on the medial aspect of left leg\n\nPrecautions to be taken while treating the patient: hysterectomy 10 years back\r\nPatient was admitted in Jan 2016 with c/o a ulcer medial aspect of left leg of six weeks duartion. \r\nshe was diagnosed with daibetic peripheral neuropathy with POVD \r\nAlong with i/v antibiotics , she was subjected to Vacc therapy .but the ulcer persisted and she is now readmitted for further evaluation and treatment\r\n\n\nRemarks: case seen by duty doctor\r\ninformed Dr Radha. GRBS-241mg/dl. advised to give inj lantus 20u, to do CBC\r\n c/o sleeplessness and pain advised to give tab nitrest 5mg stat and tab welset 500mg stat.\r\n\r\nSeen by DrA.K.Bhat.\r\nLarge necrotic ulcer left leg 7x7 cm,with large area of skin and soft tissue gangrene over tendoachilles area extending to lateral leg also.,with pus and necrotic tissues-C/S taken.There is evidence of undermining necrotising fasciitis extending from ulcer to whole calf region, induration+.Distal pulsations feeble.\r\nPlan:Wound debridement/fasciotomy/slough excision under SA 25th Feb,1.30 pm.Preop:XRay left leg AP,LATERAL.Nil oral.Informed consent.IV antibiotics.C&D.Medical fitness.Preop. workup.Arrange 1 pint packed cells.\r\n-----------------------\r\nInformed consent.\r\nThere is pus filled ulcer infection of left leg extending to back and calf region of leg.This pus infection is extending deep to deeper tissues like fascia and probably bone..There are multiple areas of dead tissues in these regions.The infection needs incision and drainage and removal of dead skin and tissues and fasciotomy under anesthesia.During operation the spreading infection will be opened up in multiple areas and pus will be drained.In necrotising fasciitis there will be infection more extensive than what is seen on the surface.Infected and dead skin and soft tissues need to be removed.Due to extending nature of infection, after surgery the wounds will be large and control of infection and healing will be delayed.There is diabetes and decreased circulation of leg.The healing and circulatory condition of wounds and leg will need observation.Repeat operation may be needed for infection control and wound healing..Understanding the above consent for anesthesia and operation is given.\r\n----------------------------------\r\n 12.30 pm : c/p pain left leg \r\nAdvised limb elevation and Tab Acuvin 1 stat\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS:201 MG/DL ADVISED ACTRAPID 16U AND T. METADOZE\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :sent RFT, electrolytes, A1C,TFT \r\n\r\n\r\n\nCase Plan :Start On Inj Dalacin 300 mg TDS , Start on LMWH \r\n Plan for Debridement tomorrow\nSEEN BY DR.Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: 153 MG/DL Inj Act 10 units \r\nPPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nPlanned for Debridement today\r\nNPO from 7.30 \r\nInj.Actrapid- 16-14-6 units.\r\nInj. lantus 18 units.\r\n\r\nSeen by duty doctor.\r\nPt shifted to ICU at 3:45 pm\r\nBP- 130/90 mmHg.\r\nPulse- 90/min.\r\nSPO2- 99 \r\nPt tolerated oral feeds.\r\nTime 6:15 pm\r\nPt can be shifted to ward.\r\n\r\nPOST OP ORDERS:\r\nTo repeat RFT, S.electrolytes, FBS, Hb tomorrow.\r\nInj. paracetamol 8th hourly.\r\nIV DNS 2 pints with insulin according to GRBS.\r\nIV Antibiotics to be continued.\r\nTO maintain TPR, IO chart.\r\nTo watch for bleed.\r\n \r\n\r\n\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:97 MG/DL\r\n10 pm- 122 mg/dl.\r\nFBS:214 MG/DL inj. actrapid 10 units\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\n\r\nSeen by DRA.K.Bhat.\r\nContinue trt.Cardioplus.\r\n\nSEEN BY DR. MAnoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:PAin over the site\r\nPAIN SCORE:3/5\r\nBLOOD SUGARS : \r\nPREDINNER:97 MG/DL\r\n10 pm- 122 mg/dl.\r\nFBS:214 MG/DL inj. actrapid 10 units\r\nBP: MM HG\r\nCASE PLAN :Patient c/o pain \r\nPlan for blood transfusion today .\r\nCt same \r\nInv: Hb , TC , Total protein , Albumin , globulin , S. creatinine \r\n\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\nSEEN BY DR.radha &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:3/5\r\nBLOOD SUGARS : \r\nPREDINNER: 174 MG/DL actrapid 8 units \r\nAT bed time : Inj Lantus 15 units \r\nFBS: 237 MG/DL inj Actrapid 18 units \r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :start pevesca plus at night\r\ninj lantus 20u at bedtime s/c\r\ninj actrapid 18-12-8\r\nhigh protein diet.\r\nSeen by DrA.K.Bhat.\r\nContinue trt. 2pints FFP transfusion.\r\nPlan fr C&D under IV sedation on monday.\r\n\r\n\r\n\ncase seen by duty doctor \r\nafter cross checking patients age, name, blood group-o+, bag no:-15076, 15198, 2 pint FFP was transfused\r\npremeds:\r\ninj avil 1 amp iv stat\nGRBS at 6pm- 133mg/dl. informed Dr Tom. advised to give actrapid 4u\r\nGRBS at 10pm- 147mg/dl. informed Dr Tom. advised to give lantus 6u\nSEEN BY DR.RADHA \r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Pain\r\nPAIN SCORE: 2/5\r\nBLOOD SUGARS : \r\nPREDINNER:133 MG/DL inj. actrapid 4 units.\r\n10 pm- 147 mg/dl. inj. Actrapid 4 units.\r\nFBS:228 MG/DL inj. actrapid 20 units.\r\nPPBS :194 MG/DL\r\nBP:160/90 MM HG\r\nCASE PLAN :\r\nCandid oral paint for l/a\r\nDehydration++ to drink plenty of fluids.\r\nSyp Looz 20 ml stat.\r\nInj. Clexaine BD.\r\nInj. actrapid- 18-16-18\r\nInj. Lantus 20 units.\r\nTo repeat electrolytes.\r\nFor C&D under IV sedation 29th feb.\r\n\r\nSeen by DRA.K.Bhat.\r\nFor C&D under IV sedation 29th feb.\r\nPreop:Nil oral .consent.\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:4/5\r\nBLOOD SUGARS : \r\nPREDINNER:134 MG/DL inj. Actrapid 8 units.\r\n10 pm- 155 mg/dl inj. lantus 16 units.\r\nPre dinner: 134 mg/dl\r\nFBS:143 MG/DL inj. actrapid 18 units\r\nPPBS : MG/DL\r\nBP: 150/100MM HG\r\nChest clear\r\nCASE PLAN :\r\nC&D under IV sedation 29th feb.\r\nNPO\r\nSeen by DRA.K.Bhat.\r\nDressings changed.Large raw area left leg clean-needs observation.Continue trt.\r\n\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : inj act 8 units\r\nPREDINNER: 113 MG/DL\r\nFBS: 110 MG/DL ionj actrapid 18 units\r\nPPBS:148 MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nInj. clexane OD\r\nSyp. looz 15 ml HS\r\nHigh protein diet.\r\nPhysiotherapy advised bedside -bedside mobilisation.\r\nTotal protein and albumin to be sent.\r\n\r\n\r\n\r\n\r\nSeen by DR.A.K.BHat.\r\nContinue trt.STop IV antibiotics and neomol.Tab.Acuvin 1-0-1.Cap.Camyda 300mg 1-1-1.\r\n\r\nSeen by duty doc.\r\nTo repeat S.Electrolytes .\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nPREDINNER: 120 MG/DL\r\n10PM: 120 MG/DL Inj. LANTUS 12U \r\nFBS: 166 MG/DL Inj Actrapid 12U\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN : CT same \r\n Rpt CBC,s. creatinine , B. urea\r\nStopped Actrapid \r\nINJ Pactiv sos\r\n Tab acuvin- stopped \r\ninj lantus 14u s/c at bedtime\r\nSeen by DRA.K.Bhat.\r\nDressings changed.Clean large raw left leg,except in region of posterior ankle-needs observation..Continue trt.\r\n\r\n\nSEEN BY DR. Lekshmi &TEAM\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: 170 MG/DL Galvus Met \r\nBP:160/90 MM HG\r\nCASE PLAN :\r\nPatient drowsy .\r\nTab. PEVESCA to be withheld.\r\nSeen by DR.A.K.Bhat.\r\nContinue trt.Plan fr D/C on monday.\nSEEN BY DR.Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: pain\r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nPREDINNER: 304 MG/DL Inj. Actrapid 6U\r\n10PM: 269MG/DL Inj. Lantus 18U\r\nFBS: 201 MG/DL Inj. Actrapid 6U\r\nPPBS :MG/DL\r\nBP: 150/90 MM HG\r\nCASE PLAN :\r\nHad 1 spike of fever last night.\r\nCounts elevated (14,800/cu.mm)\r\nUrine for Routine analysis sent- to be followed up.\r\n? urge incontinence\r\nChest clear.\r\nUrine sterile.\r\nTab. meftal forte BD.\r\nStop Tab galvus met.\r\nInj. R 10-10-8 units\r\nInj. lantus 12 units.\r\nSeen by DrA.K.Bhat.\r\nContinue trt.Dressings changed,.Large raw areas granulating,except, posterior ankle and over tibial border-needs observation.1pint packed cell&2 pints FFP transfusion.Tab.Levoflox 500mg 0-1-0.\nSEEN BY DR. Lekshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\n\r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nPREDINNER:156 MG/DL inj. actrapid 4 units\r\n10 pm- 171 mg/dl inj. lantus 12 units\r\nFBS:210 MG/DL inj. actrapid 10 units.\r\n PPBS : MG/DL\r\nBP: 140/80 MM HG\r\nCASE PLAN :\r\nPlanned for transfusion of 1 packed cells and 2 FFPs.\r\nTab. Meftal forte TID\r\nwithhold Tab. Ecosprin.\r\nInj. Actrapid 10-8-4\r\nInj. Lantus 16U\r\nTab Dolo 650mg sos.\r\n\r\nBlood transfusion.\r\nBlood product: 2 FFP\r\nBlood group:O+\r\nDate of transfusion:05/03/2015\r\nBag no.:15728,15472\r\nTime of transfusion:10:30 am\r\nPremeds: Inj. AVIL 2ml\r\n \r\nBlood transfusion.\r\nBloood product:1 Packed cell\r\nBlood group:O+\r\nDate of transfusion:05/03/2015\r\nBag no.:15586\r\nExpiray date:08/04/2016\r\nTime of transfusion: 10:50 am\r\nBP before transfusion:130/80\r\nInj. Lasix 20mg given midway.\r\n\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: pain\r\nPAIN SCORE:2/5 \r\nBLOOD SUGARS : \r\nPREDINNER: 159 MG/DL Inj. Actrapid 4U\r\n10PM: 208MG/DL Inj. Lantus 16U\r\nFBS: 192 MG/DL Inj. Actrapid 14U\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nRepeat Hb- 10.5 g/dl\r\nRestart Tab. Pevesca Plus 0-0-1\r\nTo continue biopiper.\r\nInj. R 12-8-4 units\r\nInj. Lantus 18 units.\r\nTo repeat TC tomorrow.\r\nInj. Pactiv sos\r\n\r\nSeen by DR.A.K.Bhat.\r\nDressings changed.Residual slough medial and distal leg.Posterior ankle slough present.Plan options discussed:SEcond stage debridement under SA OR Wait,.\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nPatient sitting up , well hydrated.\r\n\r\nBLOOD SUGARS : \r\nPREDINNER:172 MG/DL inj. Actrapid 5 units\r\n10 pm- 218 mg/dl inj. Lantus 20 units\r\nFBS:171 MG/DL inj. actrapid 12 units.\r\n \r\nBP:130/80 MM HG\r\nCASE PLAN :\r\nInj. Actrapid 12-8-0\r\nInj Lantus 24U\r\nInj. Clexane to be stopped.\r\nAdvised more mobility.\r\nDiabetic education to be given.\r\nSeen by DrA.K.Bhat.\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 183 MG/DL\r\n10PM: 159 mg/dl Inj. Lantus 20 U\r\nFBS: 167 MG/DL Inj. Actrapid 12U\r\n\r\nBP: 140/80 MM HG\r\nCASE PLAN :\r\nPLan discharge after dressing \r\n Advised To retsart Tab ecospirin\r\nC/s/b Dr Bhat\r\nAdvised : C/s rpt today \r\nAdvised dressing once in 2 days with Gelonet and Betadine\r\nTo start on clindamycin and to stop levofloxacin'}, {'role': 'model', 'content': '\nIP Number: 5288\n\nPatient Number: 29379\n\nAdmission Date: 23-02-2016\n\nDischarge Date: 08-03-2016\n\nDiagnosis: POVD\r\nNon healing ulcer on the medial aspect of left leg with extensive necrotising Fascitis \r\ns/p Fasciotomy and Debridement under SA on 25/2/2016\n\nClinical Exam(With BP): patient conscious oriented\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: Chest X-Ray :\r\n\r\n\n\nXray findings: Patient conscious and oriented \r\nVitals stable \r\nAfebrile\r\nSystems - WNL\r\nnon healing ulcer on the medial aspect of left leg\n\nDiscussion: 67 Year old Mrs. Susan George came to the hospital with c/o non healing ulcer on the medial aspect of left leg since 2 months. She is a known Diabetic, Hypertensive and Hypothyroid on treatment. She was treated at a local hospital for the ulcer, worked up extensively for vasculitis , but to no avail. She was admitted and routine investigations were done.Podiatric surgical consult was taken.Patient was started on IV antibiotics.Sugars were monitored on a 7 point profile and patient was started on a basal bolus regime . Extensive Fasciotomy with debridement with excision of necrotic tissue was done under SA on 25/2 /2016 . First dressings were done in OTunder aseptic precautions . The post -op period was hampered with increased pain and occasional break through fever . She required blood transfusion and FFP . i/v antibiotics were stopped and oral antibiotic as per the C&S report was started. Gradually patient was mobilised and could be discharghed on 8/3 /2016 in a stable state with advise to review in OP.\n\nDiet: nan\n\nRemarks: Advised dressing once in 2 days with Jelonet and Betadine.\r\n\r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\n'}] |
5,302 | [{'role': 'user', 'content': "\nIP Number: 5302\n\nPatient Number: 29458\n\nPatient Name: LALU G VAHAN\n\nGender: M\n\nDate of Birth: 25-12-1966\n\nAddress: SIVASREE\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 26-02-2016\n\nDischarge Date: 12-03-2016\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nDisorder of lipoprotein metabolism, unspecified\nEssential (primary) hypertension\nDIABETIC NEUROPATHY\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: Mr Lalu G Vahan k/c/o Type 2 DM / HTN /DLP was admitted with non healing ulcer over rt heel of 1 month duration ,. Blood investigation done \r\n\n\nXray information: nan\n\nClinical examination: Patient conscious and oriented \r\n Febrile \r\nSystems - wnl \r\nRt heel- non healing ulcer \r\n \n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by DRA.K.Bhat.\r\nLeft foot toe amputations done 2 months ago.Nonhealing ulcer rt heel 1 month.Large necrotic ulcer rt heel-C/S taken.PVD.Neuropathy.\r\nAdvice:Versalab,Vibrometer.XRay rt foot,including heel,AP,Lateral.Arterial doppler rt leg.IV antibiotics.Betadine dressings.\r\nC/s/B duty , clinical summary collected \r\nAdvised : Admission , Start on IV antibiotics \r\n Dr Bhat consultation \r\nINV: CBC , RFT . S .ekectrolytes \r\nUrine ketone , urine r/e \r\nPus c/s \r\n \r\nDr Bhat advised to start on Inj Clexane 40 mg 0.4 ml s/c x od\r\nTab stiloz 50 1-0-1 \r\n 7 point profile \r\n Insulin basal bolus\nSEEN BY DR.radha &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:4/5\r\nBLOOD SUGARS : inj R 10 units \r\nPREDINNER: 272 MG/DL\r\n AT bed time - Inj Basalog 10 units \r\nFBS: 221 MG/DL Inj R 15 units \r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\npatient dehydrated, Na low\r\nadvised salt added diet\r\nStart 3%NS iv\r\ninj insugen R -20-20-16\r\ninj Basalog 16u\r\nparasthesia +\r\nstarting on pevesca plus at night\r\ninj neomol tds\r\ngive plenty of fluids\r\ninj dalacin 300mg tds\r\n\r\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\n\ncase seen by duty doctor. \r\nc/o abdominal discomfort\r\nadvised to give inj pansec 40mg iv stat\r\nGRBS at 6pm- 233mg/dl. informed Dr Tom. advised to give insugen R- 12u\r\nGRBS at 10pm- 231mg/dl. informed Dr Tom. advised to give basalog 15u\nSEEN BY DR. Radha \r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:temp-100\r\nadvised to give tab dolo stat\r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nPREDINNER:233 MG/DL inj. R 12 units.\r\n10 pm- 231 MG/DL. Inj. Basalog 15 Units.\r\nFBS:192 MG/DL insugen R 20\r\nPPBS :130 MG/DL\r\nBP:150/80 MM HG\r\nCASE PLAN :To repeat TC, RFT,Hb.\r\nStart Tab. Telsite 40 1-0-0\r\nStart IV NS 1 pint \r\nSalt added diet.\r\nInj. R 18-18-16 units\r\nInj. basalog 20 units.\r\nSteam inhalation.\r\nTo do ECG, Chest xray.\r\nTo do BT CT.\r\nFor slough excision rt heel, under SA 29th Feb .\r\nTo take medical fitness.\r\n\r\n\r\nSeen by DRA.K.Bhat.\r\nFor slough excision rt heel, under SA 29th Feb .\r\npreop:Nil oral.Informed consent.IV antibiotics.C&D.Medical fitness.\r\n\r\nSeen by duty doctor.\r\nInformed Dr. Radha.\r\nInformed reports- \r\nUrea- 34\r\nuric acid- 2.1\r\ncreatinine- 1.2\r\nHb- 8.4\r\nTC- 26,400\r\nK-2.9\r\nNa- 120.\r\nadvised to start 3% NS slow IV .\r\nSyp. potklor 10 ml BD.\r\nTo arrange 2 pints PRBC.\r\nTo send stool OB and peripheral smear.\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:95MG/DL inj.R 10 units\r\n10 pm- 143 mg/dl inj. basalog 14 units.\r\nFBS:130 MG/DL inj. R 6 units.\r\nPPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nFor slough excision rt heel, under SA 29th Feb .\r\nNPO from 7 am.\r\n2 pints blood arranged.\r\n\r\nInj Avil 1 amp iv stat and then 1 pack PRBC over 3 hrs \r\nPt developed chills \r\nINj Hydrocortisone 100 mg iv stat\r\n Tab hyponat 15 stat\r\n Afetr blood teransfusion :\r\n advised : INj 3 % Saline 15/ ml /hr\r\nTransfuse 2 pints FFP.\nSEEN BY DR.lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 187 MG/DL Inj R 12 unit \r\nAT 10 pm - 202 - Inj basalog 20 units \r\nFBS: 231 MG/DL inj R 22 units \r\nPPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\n2 Pack FFP transfusion today \r\nHb rpt today\r\nNa- 129.\r\nK- 3. 4\r\nHb- 9 g/dl\r\nHigh Protein diet.\r\nTab .Pevesca 1-0-1\r\nRestart Inj. Clexane.\r\nInj. Insugen R 22-18-16 units\r\nInj. Basalog 24 units\r\n\r\n\r\nSeen by DRA.K.BHat.\r\nContinue trt.\r\n\r\nSeen by duty doc\r\nFFP transfusion to be started.\r\nBag no: 15038/FFP\r\n 15161/FFP\r\nStarting time 9:25 am.\r\n\nSEEN BY DR. MAnoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 240 MG/DL Inj. R 16U\r\n10PM: 191MG/DL Inj Basalog 24U\r\nFBS: 161 MG/DL Inj. R 22U\r\nPPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :Ct same \r\nSTart on Iv levofloxacin 500 mg iv od \r\n1 pack PRBC to be transfused today\r\n\r\nSeen by DRA.K.Bhat.\r\nDRessings changed.Large multiple raw areas with slough esp. heel area,exposing bare calcaneum.Pus decreased.Continue trt.\r\nInj Pactiv 100ml iv stat \r\nfollowed bY :\r\n1 pack PRBC - to be trasfused . pre medications - Inj Avil 1 amp - iv stat,Inj Corts 100 mg - if patient c/o shivering \r\nBag No: 14013 \r\n\r\nAdvised to sent blood c/s\r\nTp rpt Tc , Hb tomorrow\nSEEN BY DR. lekshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 190 MG/DL inj R 14 units\r\nAt 10 pm - 179 inj B 22 units \r\nFBS: 156 MG/DL inj R 16 units\r\n PPBS : 192 MG/DL\r\nBP: MM HG\r\nCASE PLAN :Hb , TC, RFT , Urine r/e \r\nseems dehydrated, advised to drink lots of water, and to sit up.\r\ndressing done yesterday, next to be done tommorrow\r\nblood culture sent , to follow up .\r\ninj. R 16-14-14\r\n\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\n\r\n\nSEEN BY DR.Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 140 MG/DL Inj. R 10U\r\n10PM: 216 MG/DL Inj. Basalog 22U\r\nFBS: 197 MG/DL Inj. R 16 U\r\n PPBS : MG/DL\r\nBP: 150/90 MM HG\r\nCASE PLAN :\r\nElectrolytes to be repeated tomorrow.\r\nInj. R 16-14- 14\r\nInj. Basalog 24 units.\r\n\r\nSeen by DrA.K.Bhat.\r\nDRessings changed.Slough of plantar flap.Calcaneum exposed bare.Will need slough excision.Continue trt.\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:219 MG/DL inj. R 14 units\r\n10 pm- 194 mg/dl inj. basalog 18 units\r\nFBS:180 MG/DL inj. R 16 units.\r\n\r\nBP: 140/80 MM HG\r\nCASE PLAN :\r\n\r\nInj R 16-16-14\r\nInj. Basalog 22U\r\n\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\nSEEN BY DR.Lakshmi \r\nGENERAL CONDITION STABLE\r\nC/O: no new complaints.\r\nno fever.\r\nPAIN SCORE:0/5\r\nBLOOD SUGARS : \r\nPREDINNER: 242 MG/DL Inj. R 14U\r\n10PM: 208 mg/dl Inj. Basalog 22U\r\nFBS: 254 MG/DL Inj. R 20U\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nCandid mouth paint.\r\ncap. becosules OD\r\nStop. Inj. Biopiper.\r\nStop salt capsules.\r\nTo continue tab. Hyponat\r\nInj. R 20-20-14 units\r\nInj. Basalog 24 units.\r\nSeen by DR.A.K.Bhat.\r\n\r\nDresssings changed.Residual necrosis of whole heel pad.Plan for slough excision under SA on tuesday.Stop biopiper.\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\n\r\nBLOOD SUGARS : \r\nPREDINNER:259 MG/DL inj. R 15 units\r\n10 pm- 252 mg/dl inj. Basalog 26 units\r\nFBS:264 MG/DL inj. R 24 units\r\nBP: 140/90 MM HG\r\nCASE PLAN :\r\nInj. R 24-24-18\r\nInj. Basalog 30U\r\nSeen by DrA.K.Bhat.\r\nPlan for rt heel slough excision under SA,8THMarch.Preop:Nil oral,Informed consent.IV antibiotics.C&D.\r\n----------------\r\nInformed consent.\r\nPrevious operation done to drain extensive pus of rt foot.There is large ulcer of right foot extending from previous ulcer of heel to rest of foot and ankle area.The necrosis(dead tissue)is extending to heel bone.There is diabetes and neuropathy and decreased circulation of leg.The ulcer infection of foot needs slough excision(removal of dead tissue) under anesthesia.During operation, the necrotic skin and soft tissues ,esp. of heel region,will be removed.In diabetes, the initial wound will be small,but spreading infection will extend below the skin and hence after surgery, the wound will be much larger than the present wound.Due to diabetes and decreased circulation,control of infection and healing will be delayed.Repeat surgery may be needed.Due to extent of infection, the healing and circulatory condition of wound will need observation.Due to Charcot's neuropathy and diabetes ,the importance of long term foot care and footwear and control of diabetes has been explained.Understanding the above, consent for anesthesia and operation is given.\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 200 MG/DL Inj. R 18 U\r\n10PM: 208 mg/dl Inj. Basalog 20U\r\nFBS: 197 MG/DL\r\n PPBS : MG/DL\r\nBP: 150/80 MM HG\r\nCASE PLAN :\r\nSlough excision under SA.\r\n\r\nC/o excessive sweating - advised ECG \r\n11.30 : atient started taking orally \r\n Vitals stabl e\r\nBP -130/80 \r\nAfebrile\r\nMay be shifted to room\r\n\nSEEN BY DR.Radha &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 185 MG/DL injR 18 u\r\nFBS: 226 MG/DL injR 22 u\r\nPPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :Rpt Hb,TC\r\nTo repeat StoolOB, Reticulocyte count, serum Iron.\r\nTab. Nebilong 2.5 1-0-0\r\nTab. Ferox XT 1-0-0\r\n\r\nSeen by DRA.K.BHat.\r\nContinue trt.\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 148 MG/DL inj R 16 u \r\n at 10 pm -234- B 30 units \r\nFBS: 228 MG/DL inj R 25 u\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nStop Hyponat and clexane \r\nSeen by DRA.K.Bhat.\r\nDressings changed.Raw area rt foot mostly clean,but exposing raw calcaneal bone.Oral antibiotics as per C/S.Plan fr D/C after 1 more dressing.\r\n\nSEEN BY DR.Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 180 MG/DL inj R 14 u\r\nat 10 pm - 189 - injB- 15 u \r\nFBS:196 MG/DL inj R 25 u\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\ninj. R25-25-14 units\r\ninj. Basalog 30 units.\r\nstop. hyponat.\r\n\r\nSeen by DRA.K.Bhat.\r\nPlan fr D/C tomorrow.\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:134MG/DL inj. R 10 u\r\n10 pm- 165 mg/dl. inj. Basalog 18 u\r\nFBS:140 MG/DL inj. R 25 u\r\nPPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :Hb, TC today\r\nTo discuss with DR Bhat about antibiotic\r\nCt same \r\nSeen by DrA.K.Bhat.\r\nDressings changed.Large raw area rt foor.\r\nAdvice:Change of dressing once in 2 days-betadine,Jelonet.Leg elevation.No direct pressure on rt heel.Oral LEvoflox 3 weeks.Review OP Monday 21st March.\r\n"}, {'role': 'model', 'content': '\nIP Number: 5302\n\nPatient Number: 29458\n\nAdmission Date: 26-02-2016\n\nDischarge Date: 12-03-2016\n\nDiagnosis: Rt heel non healing ulcer with necrotising fascitis extending from the ulcer to the ankle - s/p Fasciotomy with debridement under SA (29/2/2016)\r\nIncision and drainage of the heel pad , nibbling of calcaneum underSA (8/3/2016)\r\n\n\nClinical Exam(With BP): C/o fever , pain , non healing ulcer rt heel\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: Chest X-Ray :\r\n\r\n\n\nXray findings: Patient conscious and oriented \r\n Febrile \r\nSystems - wnl \r\nRt heel- non healing ulcer \r\n\n\nDiscussion: 49 year old Lalu came to the casualty with very high blood sugars and an infected wound on the heel with surrounding severe fascitis . He was in sepsis with high grade fever and decresed urine output.Clinically, he had an ulcer right heel with surrounding necrotising infection and cellulitis of the leg. He was admitted and started on i/v Biopiper and clindamycin. Sugars were controlled with basal bolus insulin. Podiatry consult was taken . he had a fasciotomy and debridement on 29/2/2016 under SA.Though the general condition improved, there were pockets of necrosis which needed further debridement as he had spikes of fever off and on. Based on the first culture and sensitivity which had grown Klebsiella and was sensitive to Levoflox , he was swithched over to Inj Levoflox. During the post -op and immediate pre-operative period , he was transfused 3 pints of blood and FFP.Rest of post -op period was uneventful. By 12/3/2016 as his general condition remained\n\nDiet: nan\n\nRemarks: review in endo OP with FBS ,PPBS\r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\n \r\n'}] |
5,438 | [{'role': 'user', 'content': "\nIP Number: 5438\n\nPatient Number: 6157\n\nPatient Name: PADMINI E.V\n\nGender: F\n\nDate of Birth: 14-05-1961\n\nAddress: OZHUTHARAYIL HOUSE,EROOR P.O\n\nPincode: 682306.0\n\nPhNo: 9995824399\n\nAdmission Date: 01-04-2016\n\nDischarge Date: 21-04-2016\n\nDiagnosis determined by the doctor when the patient was admitted: Chronic ischaemic heart disease\nTYPE 2 DIABETES MELLITUS\nEssential (primary) hypertension\nDIABETIC FOOT\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: ECG - Q in III non specific ST changes.\r\nEcho - LVDD. No RWMA\n\nClinical examination: Patient conscious, oriented \r\nAfebrile\r\nPR- 88/min\r\nRR- 22/min\r\nBP-140/80 mmHg\r\n\r\nPallor+\r\nNo icterus,clubbing,cyanosis,lymphadenopathy.\r\n\r\nCVS- S1 S2 present, no murmurs.\r\nRS- b/l NVBS\r\nP/A- soft, non-tender,no organomegaly, Bowel sounds present\r\n\r\nL/E: Swelling calf region, ulcer over left leg.\r\n\r\n\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: \r\nSeen by DrA.K.Bhat.\r\nSwelling calf region.May need fasciotomy/tendon debridement.Packed cell transfusion.Iv antibiotics.\r\n\nSEEN BY DR. Tom & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\n\r\nBP: 130/70 MM HG\r\nCASE PLAN :\r\nCardio consult i/v/o CIHD\r\nAdd salt in diet\r\nSalt capsule 2-0-0\r\nInj. R 10-10-10\r\nInj. N 10U\r\n\r\n\nS/B Duty Doctor\r\n\r\nBlood Transfusion\r\nProduct - 450ml PRBC\r\nBlood group - O+\r\nBag no.-16377\r\nExpiry date- 16/4/16\r\nBP before transfusion -160/80 mmHg\r\nPremeds: Inj. Avil 10gm iv\r\n Inj. Lasix 10mg iv\r\nTime of transfusion:3:15 pm\nSEEN BY DR. Radha &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 227 MG/DL Inj. R 12U\r\n10pm: 203 mg/dl Inj N 14U\r\nFBS:183 MG/DL Inj R 15 U\r\n\r\nBP: MM HG\r\nCASE PLAN :Advised Nephrology consultation - CRF - Anemia\r\nCardio consultation tomorrow\r\n1 PRBC transfusion tomorrow \r\nPlan fro doppler - after rounds tomorrow\r\nDebridement under SA on tuesday \r\n\r\n\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 295 MG/DL iinj R 18 u\r\nAt 10 pm - 322 inj B 25 u \r\nFBS: 139 MG/DL inj R 16 u\r\n PPBS : MG/DL\r\nBP: 120/70 MM HG\r\nCASE PLAN :Nephro and cardio consul today \r\n Dopler to be planned after rounds \r\nInsugen R 24-20-20\r\nBasalog 24\r\n\r\n\nS/B Duty Doctor\r\n\r\nBlood Transfusion:\r\nProduct - 450 ml PRBC\r\nGroup: O+\r\nBag no. - 16396\r\nExpiry date - 17/4/16\r\nBP before transfusion: 140/90 mmHg\r\nPremeds: Inj. Avil 10mg iv \r\nMidway : Inj. Lasix 20mg iv\nCASE SEEN BY DR JIJO\r\nADV\r\nPOSTED FOR FASCIOTOMY ON Lt leg on 6/04/16 at 12.30 pm\r\nconsent\r\ninform ot/anesthetist\r\nsaline dressing from tomorrow\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 123 MG/DL Inj. R 16U\r\n10pm: 213 mg/dl Inj. Basalog 20U\r\nFBS: 149 MG/DL Inj. R 24U\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nBP 170/90 mmHg.\r\nTab. Ciladuo 10 mg stat.\r\n\r\n\nThanks\r\nS/B Dr Sooraj\r\n-----------------\r\nDM\r\nLeft diabetic foot\r\n?DKD\r\nanemia - multiple transfusions in the past\r\n\r\nSuggest:\r\n1. Serum iron profile\r\n2. Vit b12 and folic acid levels\r\n3. MCV, retic count\r\n4. stool occult blood\r\n5. Serum Ca, Po4, uric acid, PTH\r\n6. Tab Sobisis 1-0-1\r\n\r\nWill review on Thursday with reports\r\ntransfusions (after sending for investigations) may be considered if surgery is being planned to bring Hb to 10\r\nSEEN BY DR. Manoj \r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nC/O cough \r\nStopTab Allegra\r\nTab L- Montus HS \r\nTab Sobisis 1-0-1\r\nTab Revara D OD \r\nChest X-Ray PAV to be done\r\nTo be arrange PRBC\r\nPlan for surgery tomorrow\r\nNebulization combimist Derinide TID\r\nInsugen R 22-22-18\r\nBasalog 20 \r\n\r\n\r\nSeen by duty doc.\r\nCase to be done after observing the pt's condition for 48 hours.\r\nGRBS \r\nat 6pm- 247 mg/dl inj. R 12 units\r\n10 pm- 113 mg/dl inj. Basalog 14 units and some snacks advised\nSEEN BY DR. & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nFBS:213 MG/DL INJ. R 24 U\r\n\r\nBP:140/80 MM HG\r\nCASE PLAN :\r\nSr. Ca - 9 mg/dl\r\nSr. PO4- 2.7 mg/dl\r\nUric acid - 5.2 mg/dl\r\nHb- 9.6 gm/dl\r\nTC- 15,400 cumm\r\nNa-139 mEq/l\r\nK-2.9 mEq/l\r\n\r\nSyp KCl 50 ml TID\r\n\nSEEN BY DR. Manoj & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nDry cough ++\r\nChest - clear\r\nLow grade fever +\r\n\r\nBLOOD SUGARS : \r\nFBS:213 MG/DL INJ. R 24 U\r\n\r\nBP:140/80 MM HG\r\n\r\nCASE PLAN :\r\nSr. Ca - 9 mg/dl\r\nSr. PO4- 2.7 mg/dl\r\nUric acid - 5.2 mg/dl\r\nHb- 9.6 gm/dl\r\nTC- 15,400 cumm\r\nNa-139 mEq/l\r\nK-2.9 mEq/l\r\n\r\nSyp KCl 50 ml 1-1-1\r\nTab. Avil 25mg 1-0-1\r\nCap AB Phylline 100mg 1-0-1\r\nHead end elevation \r\nFoot end elevation - with 2 pillows\r\nPumonary consult\r\nStop Tab L-montus\r\nDressing today\r\nPlan for conservative management of left leg\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nInformed Dr Sooraj \r\nadvised to give inj Ferrinject 1 gm IV - on saturday \r\n\r\n\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 112 MG/DL Inj. R 10U\r\n10pm: 94 mg/dl Inj. Basalog 14U\r\nFBS:91 MG/DL Inj. R 14U\r\nPPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nTab. Cilacar 10 mg bd\r\n\r\n\ncase seen by DR JIJO\r\nPOSTED FOR FASCIOTOMY AND WOUND DEBRIDEMENT ON 8/4/16 AT 12 NOON\r\nnpo from 6 am\r\ninform OT/ANESTHETIST\r\nCONSENT\nSEEN BY Dr. Radha & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\n\r\nBLOOD SUGARS : \r\nPREDINNER: 93 MG/DL\r\nAt 10 pm - 216 inj B 8 u\r\nFBS: 132 MG/DL\r\nGRBS:\r\nBP: 130/70 mm Hg\r\nCASE PLAN :\r\nPosted for fasciotomy under SA/Epidural today afternoon \r\nNPO from 6 am \r\nPremedications given \r\nTan Rantac 150mg\r\nTab Emeset 4mg \r\nTab Trika .25 mg \r\nIVF 500 ml DNS + 6 u Inj R @ 80 ml/hr \r\n\r\nRepeaT Hb,RFT, Electrolytes\ncase seen by DR Jijo\r\npain reduced after inj\r\nvitals stable\r\nADV\r\narrange for a portable suction apparatus tomorrow\r\ncontinue same\nS/B Duty Doctor \r\n\r\nAfebrile \r\nPR- 100/min\r\nBP- 150/80 mmHg \r\n\r\nL/E : Dressing soaked, dependent drain applied.\r\nTo w/f drainage.\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 123 MG/DL \r\n10pm: 121mg/dl Inj. R 4U with food+Inj. Basalog 6U\r\nFBS: 108 MG/DL Inj. R 8U\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\n\r\n\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:cough and pain left leg \r\nPAIN SCORE:2/5 \r\nBLOOD SUGARS : \r\nPREDINNER: 123 MG/DL \r\n10pm: 121mg/dl Inj. R 4U with food+Inj. Basalog 6U\r\nFBS: 108 MG/DL Inj. R 8U\r\n PPBS : MG/DL\r\nBP: 160/90 MM HG\r\nCASE PLAN :\r\nCt same \r\nContinue irrigation \r\nCatheterisation today \r\nAdvised to stop CIlacar and to start Prazopress \r\n\r\n\r\n\nSEEN BY DR.Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 202 MG/DL inj R 8 u\r\nFBS: 150 MG/DL inj R 8 u \r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nContinue Rx\r\n\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:156 MG/DL inj. R 4 u\r\n10 pm- 97 mg/dl .\r\nFBS:156 MG/DL inj. R 8 u\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\n\r\n\r\n\nC/s/b DR Jijo \r\nDrain removed \r\n Dressing - saline dressing done \r\n Good granulation +\r\nAdvised -saline dressing tomorrow \r\n\nSEEN BY DR.TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 184 MG/DL inj R 4 u a/f\r\nFBS: 155 MG/DL Inj R 6 units\r\nPPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nchange of Antibiotic to Inj.Amox-clav 1.2 1-0-1\r\ninj. Ferinjet 500 ml in 100 ml NS.\r\n\r\n\r\n\r\n\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:179 MG/DL inj. R 4u\r\n10pm- 143 mg/dl inj. basalog 6 u\r\nFBS:164 MG/DL inj. R 4 units.\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nPAtient doing fine.\r\nCt same\r\nDaily RFT and to rpt Electrolytes tomorrow \r\n\r\nSeen by DrA.K.BHat.\r\nRepeat C/S taken.For tendoachilles excision under SA friday 8AM.Preop:Daily dressing.\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 187 MG/DL Inj R 4u \r\nFBS: 114 MG/DL Inj R 4 u \r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nPosted for debridement tomorrow \r\nSeen by DRA.K.BHat.\r\nPosted for debridement under SA 8 AM,15th April..\r\nPreoperative Instructions:\r\nGet informed consent.\r\nNil oral as per Anesthetist advice.\r\nClean&dress area on morning of operation.\r\nIV antibiotics.\r\nMedical &Anesthetic fitness for the procedure.\r\nInform OT and anesthetist.\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:218MG/DL inj. R 4 u\r\n10 pm- 146 mg/dl. Inj. Basalog 6 units.\r\nFBS: 134MG/DL\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nNPO from 10 pm last night.\r\nPosted for tendon excision at 8:30 am\r\n\r\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\n\nS/B Duty Doctor \r\n\r\nAfebrile \r\nPR- 96/min\r\nBP - 200/110 mmHg \r\n\r\nPlan: Tool Tab. Prazopress XL in morning.\r\nTo give Inj. Lasix 20mg and assess.\r\n\r\nRepeat BP after 30 mins - 200/100 mmHg (manual)\r\nInj. Lasix 20 mg iv stat\r\n\r\nRepeat BP after 1 30 mins- 180/90 \r\nOral Anti-HTN given\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Has not passed motion since yesterday.\r\nC/o pain, poor appetite.\r\nPAIN SCORE:4/5\r\nBLOOD SUGARS : \r\nPREDINNER: 163 MG/DL\r\n10pm: 302 mg/dl Inj. Basalog 6U\r\nFBS:125 MG/DL Inj. R 4U\r\nPPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nTab.Torsinex 10 mg 1/2-0-0\r\nInj. pactive SOS.\r\nInj. Ferinject iv 500 ml in 100 ml NS.( dose 2)\r\nTo continue tab. Avil.\r\n\r\n\nSEEN BY Dr. Manoj & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\n\r\nBLOOD SUGARS : \r\nPREDINNER:249 MG/DL inj. R 4 units.\r\n10 pm- 256 mg/dl inj. Basalog 6 u\r\nFBS:174 MG/DL inj. R 6 u\r\n\r\nBP: 160/90 MM HG\r\nCASE PLAN :\r\nInj. Insugen R 6-6-6U\r\nInj. Basalog 6U\r\n\r\nCheck BP in the evening : if high plan to add ARB with K monitoring.\r\nSeen by DRA.K.BHat.\r\nContinue trt.Plan fr C&D under short GA 18th april,2.30PM.Preop:Nil oral.Consent.\r\n\r\nNPO from tmrw 7am\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 243 MG/DL Inj. R 6U\r\n10 pm: 158 mg/dl Inj. Basalog 6U\r\nFBS: 150 MG/DL Inj. R 6U\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nDressing today under short GA.\r\nNPO 7am\r\n\r\n\nSEEN BY DR.Radha&TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Pt doing better\r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nPPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nNpo from 7 am.\r\nStop inj. Ferinject .\r\nAdd Tab. Telsite 20mg OD.\r\nRepeat Hb, TC,RFT,S.Electrolytes tomorrow.\r\nSeen by DRA.K.Bhat/.\r\nUnder GA dressings changed.Clean raw area.\r\nPostop:Nil oral 2 hrs.Oral diet once fully conscious.\r\n\nSEEN BY DR.Tom & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\n\r\nBLOOD SUGARS : \r\nPREDINNER:121 MG/DL inj. R 4 units.\r\n10 pm- 130 mg/dl inj. basalog 6 units.\r\nFBS:135 MG/DL inj. R 12 u\r\n\r\nBP:170/80 MM HG\r\nCASE PLAN :\r\nHb- 8.9g/dl\r\nTC- 9600 cu.mm\r\nUrea- 42 mg/l\r\nCreat-1.5 mg/dl\r\nUric acid-3.5 mg/dl\r\nNa-131 mEq/l\r\nK-4.5 mEq/l\r\n\r\nTab. Torsinex 10mg 1-0-0\r\nDermatology consult on Thursday\r\nTo discuss with Dr. Bhatt regarding wound.\r\n\r\nSeen by DRA.K.Bhat.\r\nContinue trt.Suggested Tab,.XPAND .\r\n\r\nPlan fr D/C after 2 days.\r\n\nSEEN BY DR.Tom&TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nPREDINNER: 154 MG/DL Inj. R 4U\r\n10pm: 218 mg/dl Inj. Basalog 6U\r\nFBS:130 MG/DL Inj. R 6U\r\nPPBS : MG/DL\r\nBP:160/90 MM HG\r\nCASE PLAN :\r\nTab. clonidine 100 mcg 1-0-0\r\n4th hourly BP Chart \r\nDerma consult.\r\nD/C tomorrow.\r\n\r\nSeen by DrAK.Bhat.\r\nPlan fr D/C tomorrow.\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:160 mg/dl inj. R6 u\r\n10 pm- 124 mg/dl inj. Basalog 6 u\r\nFBS:148 mg/dl inj. R6 u \r\nPPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nD/c Today aftyer dressing \r\nDermatology consultation today \r\nStop clexane \r\n\r\nSeen by DRA.K.BHat.\r\nDRessings changed.Clean.\r\nAdvice:DRessings change once in 2 days-betadine,jelonet..Oral antibiotics 1 week.Review OP 10 days-2nd may.."}, {'role': 'model', 'content': '\nIP Number: 5438\n\nPatient Number: 6157\n\nAdmission Date: 01-04-2016\n\nDischarge Date: 21-04-2016\n\nDiagnosis: Non healing ulcer left leg with ascending calf infection and infected tendoachilles \r\nS/p Fasciotomy under SA on 8/4/2016\r\nS/p Fasciotomy with excision of the tendon under Sa on 15/4/2106\r\nCAD- Inferior wall MI - post Angioplasty\r\n?Prurigo Nodularis /? Lichen Planus\n\nClinical Exam(With BP): C/o non healing ulcer of the left leg since 2 months.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: ECG - Q in III non specific ST changes.\r\nEcho - LVDD. No RWMA\n\nXray findings: Patient conscious, oriented \r\nAfebrile\r\nPR- 88/min\r\nRR- 22/min\r\nBP-140/80 mmHg\r\n\r\nPallor+\r\nNo icterus,clubbing,cyanosis,lymphadenopathy.\r\n\r\nCVS- S1 S2 present, no murmurs.\r\nRS- b/l NVBS\r\nP/A- soft, non-tender,no organomegaly, Bowel sounds present\r\n\r\nL/E: Swelling calf region, ulcer over left leg.\r\n\r\n\n\nDiscussion: 54 year old,Mrs. Padmini who is a known diabetic and hypertensive was admitted with c/o non healing ulcer of the left leg with extension of the infection along the tendo Achilles . Routine investigations were s/o septicaemia with impaired RFT, low hb levels and a raised TC . She was started on i/v biopiper and Dalacin .Nephrology consultation was taken a diagnosis of Chronic kidney disease was made and she was started on Tab. Sobisis BD. Serum electrolytes were corrected. Cardio consultation was done prior to surgery and ECHO was done which had a normal EF Patient underwent fasciotomy and wound debridement on 8/4/2016 and was put on dependent drain and irrigation with gentamycin solution. Blood transfusion and Inj.Ferrinjict was administered to correct the Anaemia. She was taken up for Tendon excision under SA on 15/04/2016 and dressing under short GA on 18/4/2016. Post op wound care and limb elevation was advised.Dermatology consultation was asked for -was diagnosed as ?prurigo nodularis /?Lichen Planus and advised topical medications . Pt is discharged in a stable condition. Alternate day dressings and oral antibiotics as advised. Review in OP -both Podiatry and Endo.\n\nDiet: nan\n\nRemarks: Review with FBS ,PPBS\r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\n'}] |
5,795 | [{'role': 'user', 'content': "\nIP Number: 5795\n\nPatient Number: 19306\n\nPatient Name: MOHANAN P M\n\nGender: M\n\nDate of Birth: 25-08-1956\n\nAddress: MADHAVOM\n\nPincode: nan\n\nPhNo: 4829275508\n\nAdmission Date: 04-07-2016\n\nDischarge Date: 18-07-2016\n\nDiagnosis determined by the doctor when the patient was admitted: Essential (primary) hypertension\nDIABETIC PERIPHERAL NEUROPATHY\nDIABETIC FOOT\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: Pt is conscious, afebrile.\r\nNo pallor.\r\nCVS- S1S2+\r\nRS- chest clear.\r\nP/a - soft , non tender , NO HSM \n\nPrecautions to be taken while treating the patient: Allergic to IV Metrogyl.\r\n\n\nRemarks: SEEN BY DR. Tom & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:nil\r\nPAIN SCORE:0/5\r\nBLOOD SUGARS : \r\nPREDINNER:271 MG/DL Inj. Actrapid 8U\r\n10pm: 163 mg/dl Inj. Lantus 16U\r\nFBS:153 MG/DL Inj. Actrapid 10U\r\n\r\nCASE PLAN :\r\nInj. Monoscot SB 1.5gm bd\r\nSSG tmrw\r\n\r\nInj. Lantus 18U\r\n\r\nDr.Rajesh Simon Cx- for right foot\r\n\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 296MG/DL Inj.Actrapid 18U\r\n10pm: 280mg/dl Inj.Lantus 16U\r\nFBS: 233MG/DL Inj.Actrapid 18U\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\n\r\n\r\n\nS/B Dr. Rajesh Simon\r\n\r\nThanks for reference\r\nHistory noted\r\nC/o havng non healing ulcer over both heels (R) >(L) since 2 years.\r\nMultiple procedures done and still not having a healed would.\r\nO/E (R) Foot:\r\nWound over the calcaneum with partially debrided and infected calcaneum in the lateral aspect of the heel. Partially calcaneum with semi sharp edges.\r\nSwab taken from the (R) heel. \r\n(L) Foot: Clean granulating wound over the heel.\r\n\r\nPlan: X-Ray (R) ankle AP/Lat?Oblique ( Standing)\r\nX-Foot: AP/Lat ( standing) Oblique \r\nSkin grafting for the (L) heel\r\nShall review after X rays\nSEEN BY DR. Tom & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:nil\r\nPAIN SCORE:1/5\r\nBLOOD SUGARS : \r\nPREDINNER: 136 MG/DL Inj Novo 12 u \r\nFBS: 67 MG/DL Inj Act 14 u \r\n\r\nCASE PLAN :\r\nMRI rt ankle to be plannned for today with series of CT cuts\r\nInj. Actrapid 16-12-10\r\nInj. Lantus 14U\r\n\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 258 MG/DL Inj. Actrapid 14U\r\n10pm: 109 mg/dl Inj.Lantus 10U\r\nFBS: 84 MG/DL Inj. Actrapid 16U\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nSeen by DRA.K.BHat.\r\nContinue trt.\r\n\r\n\nS/B Dr. Rajesh S\r\nPatient reviewed.\r\nMRI with CT correleation noted. Confirmed finding of OM in calcaneum with thickning of FHL synovium noted.\r\n\r\nD/w Patient and relatives and advised exploration debridement with partial calcanectomy. \r\nTO plan for surgery.\r\n\r\n\nSEEN BY DR.Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Doing well\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 103 Inj Act 4 u MG/DL\r\nFBS: 214 MG/DL InjAct 20 \r\nPPBS : MG/DL\r\nBP:190/110 MM HG\r\nCASE PLAN :\r\nInj. Lantus 18 uits.\r\nStart Tab. Olmetrack H 1-0-0\r\nSeen by DRA.K.BHAT.\r\nContinue trt.DRessings change on sunday.\r\n\nSEEN BY DR.Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Doing well\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 103 Inj Act 4 u MG/DL\r\nFBS: 214 MG/DL InjAct 20 \r\nPPBS : MG/DL\r\nBP:190/110 MM HG\r\nCASE PLAN :\r\nInj. Lantus 18 uits.\r\nStart Tab. Olmetrack H 1-0-0\r\nSeen by DRA.K.BHAT.\r\nContinue trt.DRessings change on sunday.\r\n\r\nS/b Duty doc\r\nTime 12:30 pm\r\nBP- 180/100 mmHg.\r\nTab. CTD 12.5 mg stat\nSEEN BY DR. Radha & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:nil\r\nPAIN SCORE:1/5\r\nBLOOD SUGARS : \r\nPREDINNER:75 MG/DL inj. actrapid 4 units with food\r\n10 pm- 273 mg/dl inj. lantus 18 units \r\nFBS:190 MG/DL inj. actrapid 16 units.\r\n\r\nBP:160/90 MM HG\r\nCASE PLAN :\r\nHb-8.9 g/dl\r\nTC- 7100/cumm\r\nCreat- 1.3mg/dl\r\nUrea- 43mg/dl\r\nPus C/S- E.Coli ; Plan to change Abx- D/W Dr. Rajesh/Dr.Tom\r\nPlan for Blood transfusion tmrw\r\nInj. Actrapid 16-14-10\r\nInj. Lantus 18 U\r\n\r\nSeen by DrA.K.Bhat.\r\nDressings changed.SSG taken up.\r\n\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 180 MG/DL Inj. Actrapid 10U\r\n10pm: 309 mg/dl Inj. Lantus 18U\r\nFBS: 122 MG/DL Inj. Actrapid 16U\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nSeen by DR.A.K.Bhat.\r\nContinue trt.\r\n\r\n\nSEEN BY DR. Tom & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:nil\r\nPAIN SCORE:0/5\r\nBLOOD SUGARS : \r\nPREDINNER:134 MG/DL Inj act 10 u \r\nFBS: 86 MG/DL Inj act 14 u \r\nBP:140/90 MM HG\r\nCASE PLAN :\r\nRpt Hb - 11.2 g/dl\r\nInj. Actrapid 14-10-10\r\nInj. Lantus 16U\r\nPosted for exploration debridement with partial calcanectomy tmrw\r\n\r\nSeen by DRA.K.Bhat.\r\n\r\n\n12/7/2016\r\nS/ B Dr. Rajesh Simon\r\nPatient reviewed\r\nPlan for partial Calcanectomy and remove the infected calcaneum. \r\nDiscussed with the patient about the long term prognosis and explained about the possible complications like wound dehiscence to re infection, osteomyleitis recurrence in talus and possble end in Below knee amputation\r\nPlan for surgery undr anaesthesia on 13th Ju;y 2016\r\n\r\n\r\nSEEN BY DR. & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:91 MG/DL Inj. Actrapid 10U\r\nFBS: 139 MG/DL Inj. Actrapid U\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\n\r\nSeen by DRA.K.Bhat.\r\nGraft taken up. Dressings changed. Continue treatment.\r\n\r\n\r\nS/ B Dr. Rajesh Simon\r\nPOD -0; \r\nC/o minimal pain\r\nSOakage minimal. \r\nPlan for dressing tommorow. \r\nStart on Inj Tazobact +Piperacillin to be added along with ciplox\r\n\nSEEN BY DR.& TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:91 MG/DL Inj. Actrapid 10U\r\nFBS: 139 MG/dl Inj. Actrapid U\r\nCASE PLAN :\r\n---------------------------------------\r\nS/b duty doctor\r\nTime: 9:45 am\r\nPt is shifted to ICU\r\nPost op orders:\r\nInj. Tramadol IV 8th hrly\r\nInj. Emeset IV 8th hrly\r\nInj. Pactiv iv sos\r\nTo start Inj. biopiper TZ 4.5 BD.\r\nXray ankle Lateral view\r\nGlycemic control as per physician's orders.\r\nOrally after 2 hours (12pm)\r\nShift after 3 hours (1 pm)\r\n--------------------------------------------------\r\ns/b duty doctor\r\nTime 12:15 pm\r\nBP- 150/80 mmHg\r\nPulse- 91/min\r\nSPO2- 100%\r\nGRBS- 171 mg/dl\r\nStarted oral feeds .\r\nNo new complaints.\r\n------------------------------------------------\r\nTime- 2:15 pm\r\nBP-170/75 mmHg\r\npulse- 119/min\r\nSPO2- 100 %\r\nTemp- normal\r\nC/o chills and pain.\r\nTab. Calcheck 5 mg+ Tab. Olmetrack 40 stat given at 1:15 pm.\r\nPt to be shifted to ward\nSEEN BY DR. Tom & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:nil\r\nPAIN SCORE:0/5\r\nBLOOD SUGARS : \r\nPREDINNER:342 MG/DL inj. actrapid 12 u\r\n10 pm:460 MG/DL inj. lantus 18 +actrapid 6 u\r\nFBS:167 MG/DL INJ. ACTRAPID 14 U\r\n\r\nBP:120/70 MM HG\r\nCASE PLAN :\r\nSoakage over dressing++\r\nHb- 9.9g/dl\r\nTo repeat counts tmrw\r\n\r\nInj. Actrapid 16-12-10\r\nInj. Lantus 18U\r\n7.30pm\r\nS/B Dr. Rajesh Simon\r\n\r\nPt reviewed.\r\nNo complaints\r\nSoakage +++\r\nChange of dressing done. Clean.\r\nAdv: Continue same treatment.\nSEEN BY DR.TOM&TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nDoing better\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 246 MG/DL Inj. Actrapid 10U\r\n10pm: 242 mg/dl Inj. Lantus 18U\r\nFBS: 195 MG/DL Inj. Actrapid 18U\r\nBP: MM HG\r\nCASE PLAN :\r\nInj. R 14-14-14 units\r\nInj. Lantus 22 units.\r\n\r\nS/B Dr. Rajesh S\r\nPatient reviewed.\r\nNo complaints.\r\nNo soakage\r\nAdv: Continue IV antibiotics and better sugar control\r\nPLAN: Dressing on Monday (18/7/2016)\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 237 MG/DL inj. Actrapid 14 u\r\n10 pm- 256 mg/dl inj. Lantus 18 u\r\nFBS:79 MG/DL inj.ctrapid 8 units.\r\nPPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\n\r\nSeen by DRA.K.BHat.\r\nDressings changed.SSG settling.Donor site healing.\r\nS/ B Dr. Rajesh S\r\nPt reviewed. No complaints.\r\nPlan Dressing on Monday \r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 261 MG/DLInj Act 14 u \r\nFBS: 154 MG/DL Inj Act 12 u \r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nPt doing fine \r\nAdvisewd to ct same\r\n Plan fro d/c tomorrow \r\n\nS/B Dr. Rajesh Simon :\r\nPt reviewed. No complaints.\r\nDressing done, Wound clean. \r\nMay be D/C today.\r\nREview for suture removal on 1/8/2016."}, {'role': 'model', 'content': "\nIP Number: 5795\n\nPatient Number: 19306\n\nAdmission Date: 04-07-2016\n\nDischarge Date: 18-07-2016\n\nDiagnosis: Osteomyelitis (R) calcaneum \r\nCharcot Foot Syndrome\n\nClinical Exam(With BP): 59 yr old with H/o DM admiitted for SSG\n\nSystolic BP: 130.0\n\nDiastolic BP: 80.0\n\nPhysical examination: \r\n\n\nXray findings: Pt is conscious, afebrile.\r\nNo pallor.\r\nCVS- S1S2+\r\nRS- chest clear.\r\nP/a - soft , non tender , NO HSM\n\nDiscussion: 59 year old,Mr.Mohanan, a known case of Type 2 DM/HTN/Chracot foot, was admitted for SSG of left foot. He underwent SSG under SA on 6/7/2016. Post-op, he was started on IV antibiotics and given daily dressings. Ortho consult was taken for Rt. Charcot's Foot, Pus C/S was taken, grew E.Coli and was started on Inj.Biopiper/Ciproflox. He underwent Partial Calcanectomy of Rt. Foot under SA on 13/7/2016. Post op, he was stable, IV Abx was continued and daily dressings were done. During hospital stay, he was found to have high BP recordings and was started on anti-HTN. His blood sugars were monitored on a 7 point profile and was manitained on basal bolus regime. His wounds seemed to be healing well with subsequent dressings and he was discharged in a stable condition and advised to review in OPD for dressings\n\nDiet: nan\n\nRemarks: If You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\n\r\nReview after 2 weeks for Right foot suture removal- 1/8/2016.\r\nReview with Dr. Bhat on 22/7/2016.\r\n"}] |
5,820 | [{'role': 'user', 'content': "\nIP Number: 5820\n\nPatient Number: 27538\n\nPatient Name: VENKITACHALAPATHI SRINIVASAN (V S IYER)\n\nGender: M\n\nDate of Birth: 23-06-1947\n\nAddress: G1 201 MORAJ RESIDENCY PALM BEACH ROAD\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 11-07-2016\n\nDischarge Date: 25-07-2016\n\nDiagnosis determined by the doctor when the patient was admitted: Essential (primary) hypertension\nTYPE 2 DIABETES MELLITUS\nChronic ischaemic heart disease\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: Pt conscious and oriented .\r\nAfebrile \r\nBP - 120/60 mmofhg \r\nPR -94 /mt \r\nGRBS- 230 mg/dl\r\nRS- AEBE, NVBS \r\nP/a - Soft \r\nLeft leg - Lt big toe - appears gangrenous - with slough at the base of the big toe , \r\nDorsalis pedis lt - Not felt \n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Cs/b duty dcotor , clinical summary collecetd \r\nAdvised CBC, LFT , RFT , Urine R/e , S. electrolytes CT, BT ,PT , Screening \r\n ECG , \r\nInj Meropenam 500 mg IV OD \r\nDr Bhat review today \r\nCardiology and ECHO consult today.\r\nSeen by DR.A.K.Bhat.\r\nContinue trt.\r\nPlan for Left big toe amputation under SA .Preop:Nil oral.Informed consent.C&D.IV antibiotics.Medical fitness,.\r\n------------\r\nInformed Consent.\r\nThere is infection of left big toe including bone and other tissues with spreading pus collection.There is gangrene(dead tissues).This needs removal of infected dead tissues of the toe-means amputation of the big toe.The extent of tissue removal and the level of amputation will be decided depending on the finding during operation.In diabetes the surface wound may look small,but the extent of infection on the deeper aspect will be wider in area.Due to neuropathy&anemia&diabetes& nephropathy&decreased blood supply of the leg, the control of infection and wound healing needs close observation.There may be a need for reoperation.There is nephropathy and coronary artery disease-high risk for anesthesia and operation.The importance of offloading and long term footcare and footwear has been explained.Having understood the above,consent for operation under anesthesia is given.\r\n======================\n1 pack pRBC tranfusion today \r\n Premedications : - Inj Avil 1 amp Iv stat \r\n Inj lasix 20 mg Iv mid way \r\n\r\n\r\nPosted for Left big toe amputation under SA .\r\nPreop:Nil oral from 12 midnight \r\nPAC \r\nnformed consent.\r\n\r\nPremedications : HS / CM \r\n Tab Trika 0.25 mg \r\nTab Rantac 150 mg \r\ntab emeset 8 mg\nSEEN BY DR. Tom & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Chest - b/l wheeze +\r\nSpO2- 95% ( on room air)\r\nNo difficulty breathing/no chest pain\r\nPAIN SCORE:0/5\r\nBLOOD SUGARS : \r\nPREDINNER: 240 MG/DL Inj novo 24 u \r\nFBS: 187 MG/DL -\r\n\r\nBP:130/80 MM HG\r\nCASE PLAN :\r\nNPO from 12 midnight \r\nPremedications taken \r\nCardio and ECHO today \r\n\r\nInj. Lasix 20mg iv stat\r\nNebs- Comibimist/Derinide\r\nTo be catheterized\r\nMaintain I/O chart\r\nUrine C/S to be sent\r\n\nS/B Duty Doctor\r\n\r\nS/P Rt. Great toe amputation under SA\r\n\r\nPt. conscious,oriented\r\nAfebrile\r\nPR- 76/min\r\nRR- 20/min\r\nBP - 160/80 mmHg\r\n\r\nChest - Lt. crepts+\r\n\r\nDressing dry\r\n\r\nPt. had coffee orally - well tolerated\r\n\r\nI/O - 1500/1000\r\nPt can be shifted to ward\r\nInj. Lasix 20mg iv in ward\r\n\r\nPost-op :\r\nTPR,BP,I/O\r\nLimb elevation\r\nInj. Pactiv 1gm Q8H\r\nTmrw- Hb, Electrolytes,Urea,Creatinine\nSEEN BY DR. Tom & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nDoing fine\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:382 MG/DL Inj. Novorapid 20U\r\n10pm: 455 mg/dl Inj. Novorapid 14U+Basalog 20U\r\nFBS:258 MG/DL Inj. Novorapid 24U\r\nBP: MM HG\r\nCASE PLAN :\r\nI/O - 2100/2450\r\nINj. Novorapid 24-24-20 units\r\nInj. Basalog 24 units.\r\nInj. Clexane 0.4 ml s/c OD.\r\n\r\nS/b Duty Doctor\r\nGRBS 570 mg/dl\r\nBP-160/80 mmHg.\r\nInsulin infusion started at 6 u/hr.\r\nInput- 1100 ml\r\nOutput- 1420 ml\r\n\r\nSeen by DR A.K.Bhat.\r\nContinue treatment.\r\n\nSEEN BY DR. Tom & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:nil\r\nPAIN SCORE:0/5\r\nBLOOD SUGARS : \r\n10 PM- 314 MG/DL INFUSION AT 12 U/HR\r\n3 AM- 43 MG/DL \r\nFBS:129 MG/DL INJ. NOVORAPID 24 UNITS\r\nPPBS: 302 mg/dl\r\nBP:130/70 MM HG\r\nInput- 2400ml\r\nOutput - 4320 ml\r\nCASE PLAN :\r\nTab. Dytor 10mg 1-1/2-0\r\nRestart Clopilet\r\nInj. Novorapid 10U stat\r\n\r\n\nSEEN BY DR.Tom&TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/o cough.\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 262 MG/DL Inj. Novorapid 24U\r\n10Pm: 364mg/dl Inj.Basalog 30U\r\nFBS:202 MG/DL Inj. Novorapid 28U\r\nBP: MM HG\r\nCASE PLAN :\r\nStart Inj. Celrim TZ OD.\r\nPhysiotherapy\r\n\r\n\r\n\nSEEN BY DR. TOm &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:233 MG/DL inj. novorapid 20 u\r\n10 pm- 308 mg/dl inj. basalog 28 u\r\nFBS:189 MG/DL inj. novorapid 24 u\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nPt doing fine \r\nc/o cough at night \r\n Advised to do CBC .\r\n\r\nSeen by Dr,.A.K.Bhat.\r\nContinue trt.\nSEEN BY DR. LAkshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 190 MG/DL Inj B 2 0u \r\nFBS: 80 MG/DL Inj novo 22 u \r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\n\r\nPt c/o tiredness \r\nSPO2 - 94 @ RA\r\nRS- creps + Rt >Lt \r\nAdvised to rpt - CXR , RFT, Electrolytes \r\n Advised to give \r\n\nSEEN BY DR. Tom & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: better today\r\nPAIN SCORE:0/5\r\nBLOOD SUGARS : \r\nFBS: 322 MG/DL Inj Novorapid 28 u\r\n\r\nBP:130/70MM HG\r\nCASE PLAN :\r\nInj Hydrocortisone - 100 mg iv stat given yesterday night \r\nTab. Dytor 10mg 1-0-0\r\n\r\nDr. Bhat review - for dressing,?Meropenem Day 7\r\nSeen by DrA.K.BHat.\r\nDressings changed.Clean.Oral antibiotics.Stop clexane.\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:227 MG/DL Inj. Novorapid 28U\r\n10pm: 179 mg/dl Inj. Basalog 18U\r\nFBS:147 MG/DL Inj. Novorapid 20U\r\n PPBS : MG/DL \r\nBP: MM HG\r\nCASE PLAN :\r\nPulmonology Cx\r\nSeen by DrA.K.BHat.\r\nContinue trt.\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:227 MG/DL Inj. Novorapid 28U\r\n10pm: 179 mg/dl Inj. Basalog 26U\r\nFBS:147 MG/DL Inj. Novorapid 20U\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nShift to Oral Abx today.\r\nPulmonary consult.\r\n\r\n\r\n\nSEEN BY DR. Tom & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:cough decreased, feels slightly better\r\nPAIN SCORE:0/5\r\nBP:120/70 MM HG\r\nCASE PLAN :\r\nChest - b/l crepts/?wheeze\r\nLimb elevation\r\n\r\nSeen by DrA.K.BHat.\r\nDressings changed.Clean.\r\n\nSEEN BY DR.TOM & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: occasional breathing difficulties.\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:83 MG/DL Inj. Novorapid 16U\r\n10pm: 207 mg/dl Inj. Basalog 24U\r\nFBS: 93 MG/DL Inj. Novorapid 20U\r\nBP: MM HG\r\nCASE PLAN :\r\nINj. Novorapid- 20-18 16 units.\r\nInj. basalog 20 units.\r\nStop iv antibiotics after tomorrow's morning dose.\r\nStart Tab. Levoflox 500 BD.\r\nSeen by DRA.K.BHat,.\r\nContinue trt.\r\n\r\nEvening rounds:\r\nPt doing better after neb.\r\nRepeat Hb\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 111 MG/DL inj. novorapid 16 u\r\n10 pm- 186 mg/dl inj. basalog 24 u\r\nFBS:137 MG/DL inj. novorapid 20 units.\r\nPPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\n To stop Iv antibiotics \r\n Plan to d/c by monday \r\nTo start on Tab Levoflox 500 OD \r\nSeen by DrA.K.Bhat.\r\nDRessings changed.Clean.\r\n\nSEEN BY DR.Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nDoing fine.\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\n PPBS : MG/DL\r\nBP:116/70 MM HG\r\nCASE PLAN :\r\nInj. Basalog 24 u\r\nDR. Ramesh consultation today.\r\nCreatinine, Hb, Electrolytes c/m.\r\nPlan for D/c on monday.\r\nSeen by DRA.K.Bhat.\r\n\r\nSeen By Dr. Ramesh.\r\nAdvice:\r\nContinue Tab. Doxolin 400 mg 1/2--0--1 \r\nTab. Alasp 10 0-0-1 \r\nSyp. Reswas 7.5 ml HS \r\nTab. Mucinac 600 1-0-1 \r\n for 7 days.\r\nTo change to Forair 250 MDR BD\r\nand Duolin MDI 2-0-2 on discharge.\r\nReview in pulmonology OP after 7-10 days.\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 105 MG/DL INJ. NOVORAPID 12 U\r\n10 PM- 243 MG/DL INJ. BASALOG 22 U\r\nFBS: 105 MG/DL INJ. NOVORAPID 18 U\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nCt sam e\r\nD/c tomorrow \r\n Change to inhalors \r\nSeen by DRA.K.BHat.\r\nPlan fr D/C tomorrow.\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nChest- mild crepts and wheeze+\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nDRessing today\r\nNeb. Combimist stat.\r\nPlan to discharge.\r\nSeen by DRA.K.BHat.\r\nDresssings changed.Clean.\r\nAdvice:Change of dressings once in 2 days-betadine,cuticell.Oral levoflox 2 weeks.REview OP 1st august monday.\r\n\r\n"}, {'role': 'model', 'content': '\nIP Number: 5820\n\nPatient Number: 27538\n\nAdmission Date: 11-07-2016\n\nDischarge Date: 25-07-2016\n\nDiagnosis: Severe POVD\r\namputation of the Rt big toe at the level of the 1st MTP\r\nCOPD\n\nClinical Exam(With BP): Came in with infected gangrene of the left big toe, started as an infected callosity then noticed a blister over the dorsum of the big toe . Pt was advised to do vascular check up\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: Chest X-Ray :\r\n\r\n\n\nXray findings: Pt conscious and oriented .\r\nAfebrile \r\nBP - 120/60 mmofhg \r\nPR -94 /mt \r\nGRBS- 230 mg/dl\r\nRS- AEBE, NVBS \r\nP/a - Soft \r\nLeft leg - Lt big toe - appears gangrenous - with slough at the base of the big toe , \r\nDorsalis pedis lt - Not felt\n\nDiscussion: Mr V.S Iyer 69 yrs male known case of type 2 DM, HTN, CAD, s/pCABG , POVD was admitted with gangrenous Rt big toe . He was started on IV antibiotcs ( Meropenam ), based on the prior culture. Pt was seen by Surgeon and was taken up for Rt big toe amputation under SA on 12/7/16 after cardiology and pre-op clearance. His sugars were controlled with insulin basal bolus regimen., 2 days later he developed cough - for which he was treated with bronchodilators and responded to steroids. Pus Cx showed Klebsiella species - sensitive to cefepime hence was started on ( cefepime + tazobactum) . Pulmonology consult was taken , advised to continue nebs and started on antihistamines, was given I.V steroids., Diuretic dose was adjusted. Wound healthy and wound care given. Pt is stable and hence discharged. Advised strict off-loading and dressings. To review as OP.\n\nDiet: nan\n\nRemarks: Review in Podiatry,Endocrine and Pulmonology OP on 1st August with FBS and PPBS reports.\r\n\r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\n'}] |
5,930 | [{'role': 'user', 'content': "\nIP Number: 5930\n\nPatient Number: 32183\n\nPatient Name: HARIDAS KAMATH\n\nGender: M\n\nDate of Birth: 06-08-1950\n\nAddress: LAKSHMI NIVAS\n\nPincode: nan\n\nPhNo: 9387588474\n\nAdmission Date: 06-08-2016\n\nDischarge Date: 23-08-2016\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: 66 year old pt Haridas Kamath presenting with non healing Necrotising fascitis left leg refered from Karothukuzhi Hospital for further mangment and treatments \n\nXray information: Hb-8.2\n\nClinical examination: cns-concious/oriented\r\ncvs-s1,s2-no murmur\r\nr/s-clear chest\r\np/a-soft non tender\n\nPrecautions to be taken while treating the patient: smoking +\r\nNo drug allergies\n\nRemarks: Seen by DRA.K.BHat.\r\nVery extensive necrotising fasciitis left foot,leg.Large unhealthy circumferential raw area exposing all deep tendons around ankle,bare tibia,fibula,dorsum foot tendons and bone,ankle joint capsule necrosis.Pus sent fr C/S.Deep pus pockets in midleg.\r\nOptions discussed:Wound slough excision in stages.OR below knee amputation under SA.\r\n* HB- 8.2 g/dl. 1 pint Packed RBC tomo\nSEEN BY DR.Radha&TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nDoing fine\r\nBP: MM HG\r\nCASE PLAN :\r\nBlood transfusion today.\r\nTab. Calcheck 5 mg Stat and OD.\r\nInj. Pactiv TID.\r\nStool OB and PBF to do\r\n\r\nSeen by DRA.K.Bhat.\r\nPlan options discussed.Patient is willing for Below knee amputation.Plan fr BK amputation under SA on tuesday 9th august.Preop:Screening tests.CXRPA.ECG.,Medical fitness.\r\n\r\nTime: 3:05 pm\r\nSeen by duty doc\r\n1 unit blood ready for transfusion.\r\nBlood group - 'O' negative.\r\nBag number- 2431.\r\nVITALS:\r\nBP- 160/100 mmHg.\r\nPulse- 95/min\r\nSpO2- 99%\r\nPREMEDS:\r\nInj, Avil 1 amp iv stat.\r\nInj. Lasix 20 mg half way through. \r\n\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/o mild pain\r\n1 units PRBC ( O negative ) Transfused last evening.\r\nPAIN SCORE:1/5 \r\nBLOOD SUGARS : \r\nPREDINNER:78 MG/DL\r\n10 pm- 142 mg/dl Inj. Basalog 10 u\r\nFBS:104 MG/DL inj. insugen R 2 u\r\nPPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nPosted for BKA left leg tomorrow.\r\nSeen by DRA.K.Bhat.\r\nPosted for Left Below knee amputation under SA on 9th august 8.30AM.\r\nPreoperative Instructions:\r\nGet informed consent.\r\nNil oral as per Anesthetist advice.\r\nClean&dress area on morning of operation.\r\nIV antibiotics.\r\nMedical &Anesthetic fitness for the procedure.\r\nInform OT and anesthetist.\r\nArrange packed cells.\r\n============\r\nINFORMED CONSENT.\r\nThere is extensive bone,joint and soft tissue infection of left foot extending to lower leg,with pus extending to joint destroying it and adjacent bones.There is diabetes and neuropathy.There is reduced circulation of leg with ascending infection.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 infection,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\n\r\nSIGNED. \r\n=================\nSEEN BY DR.Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nBP: MM HG\r\nCASE PLAN :\r\nPosted for BKA left leg today morning \r\nNPO from 12 midnight \r\nPremedications and antihypertensive given \r\nBP-140/90 mmhg\r\n----------------------------------------------------------\r\nS/b Duty Doc\r\nTime 12:15 pm\r\nPt shifted to ICU at 11:45 am\r\nVItals- \r\nBP- 130/80 mmHg\r\nPulse- 68/min\r\nSpo2- 98%\r\nPt comfortble.\r\n----------------------------------------------------------\r\nPOST- OP ORDERS:\r\nNPO for 2 hours\r\nOral feeds only after fully conscious.\r\nBed rest and limb elevation.\r\nWatch for bleeds.\r\nMaintain TPR/IO/BP chart.\r\nINj. Paracetamol IV 8th hourly\r\nIV Fluids 2 pint according to GRBS.\r\nIV Antibiotics.\r\nTo follow physician's orders.\r\nRepeat Hb, FBS, Na,K, Creatinine and Urea c/m\r\n-------------------------------------------------------\r\nS/b duty doc\r\nTime 2 pm\r\nVitals stable.\r\nNo difficulties to report. \r\nPt to be shifted to ward.\nSEEN BY DR.Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: pain \r\nPAIN SCORE:2/5 \r\nBLOOD SUGARS : \r\nPREDINNER:133 MG/DL inj. R 2 u\r\n10 pm- 80 mg/dl\r\nFBS:84 MG/DL\r\nBP:160/90 MM HG\r\nCASE PLAN :pus culture\r\nXylocaine gel for l/a\r\nSeen by DRA.K.BHat.\r\nContinue trt.\r\n\nSeen by DRA.K.BHat.\r\nContinue trt.\nSEEN BY DR.Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Feels Better.\r\nPREDINNER: 93 MG/DL\r\nFBS: 92 MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN :\r\n*Dressing today\r\n*Setaphil lotion for L/A\r\n*c/o Abdominal discomfort after break fast\r\n-Inj Pansec 1 amp stat.\r\nSeen by DRA.K.BHat.\r\nDRessings changed.Drain removed.Suture line clean.Cap. Dalacin 300mg 1-1-1.\r\n\r\n\r\n\nSEEN BY DR.TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\ndOING FINE\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nPPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nContinue treatment.\r\n\r\nSeen BY DRA.K.BHat.\r\nContinue trt.Plan fr D/C on tuesday.\r\n\nSEEN BY DR.Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nDoing fine,Cough\r\nBP: 130/80 MM HG\r\nCASE PLAN :\r\nPlan D/c tomorrow\r\nHb/TC and LFT.\r\nSyp Sufrecof D tds.\r\nSteam inhalation.\r\nSTOP Basal regimens.\r\nTemp-100 f - Tab dolo 650 stat given\r\n\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nDoing better\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS:133 MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nTC/Urea today.\r\nInj. Cegava 1.5 gm 1-0-1\r\nCap. Vit D3 60 k weekly once.\r\nCap. Vit D cal 0-0-1\r\nCombimist neb TID.\r\n\r\n\nSeen by DRA.K.BHat.\r\nDRessings changed.Suture line clean.\r\nContinue trt.\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPOSTDINNER: 371MG/DL Inj. basalog4 u.\r\nFBS:MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nTo hold OHA's.\r\n\r\nSeen by DrA.K.BHat.\r\nContinue trt.\r\n\r\n Doing better than yesterday \r\nChest physio\r\nI/o Chart\nSEEN BY DR.MANOJ &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nDoing better\r\nPAIN SCORE:\r\nBP: MM HG\r\nCASE PLAN :\r\nRpt TC , Plt today \r\nDNS with polybion stat.\r\nTab. Levofloxacin OD \r\nCap. Yogut BD.\r\nBlood culture reports due.\r\n\r\nSeen by DRA.K.BHat.\r\nDressings changed.Clean.\r\n\nSEEN BY DR.Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Better.\r\nR/s-rt side Mild ronchi +\r\nBLOOD SUGARS : \r\nPREDINNER:144MG/DL\r\nFBS:114MG/DL\r\nBP:140/70 MM HG\r\nCASE PLAN :\r\nStop Inj Clexaine.\r\nStop Syp Sufrecof.\r\nStop Cap Ab phylline.\r\nTab Mucomix BD.\r\nTab Doxolin 400mg 1/2 BD.\r\nTab Galvis 50 1 od.\r\nNebulization with Derynide.\r\n\r\n\r\n\r\n\nSEEN BY DR.Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Better.\r\nR/s-rt side Mild ronchi +\r\nBLOOD SUGARS : \r\nPREDINNER:144MG/DL\r\nFBS:114MG/DL\r\nBP:140/70 MM HG\r\nCASE PLAN :\r\nStop Inj Clexaine.\r\nStop Syp Sufrecof.\r\nStop Tab Abyphyllin.\r\nTab Mucomix BD.\r\nTab Doxolin 400mg 1/2 BD.\r\nTab Galvis 50 1 od.\r\nNebulization with Derynide.\r\nSeen by DRA.K.BHat.\r\nContinue trt.\r\n\r\n\r\n\nSEEN BY DR.RADHA &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nDoing better\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS:140 MG/DL\r\nPPBS :MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nBilateral Rhonchi (R>L)\r\nDr. Ramesh Consult Tomorrow.\r\nStart Tab. Defcort 6 mg BD.\r\n\r\n\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nDoing fine.\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:239 MG/DL inj. Insugen R 4 units\r\nFBS:219 MG/DL INj. Insugen R 8 u\r\nBP: MM HG\r\nCASE PLAN :\r\nInj Pansec 40 mg and inj emeset 4 mg Iv stat\r\nTab Revera D 1-0-0 \r\n SEen by DRA.K.BHat.\r\nDressings changed.Clean.,\r\n LIMB Physiotherapy.\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\n\n21/8/167 -At 4.30 pm \r\nPt developed sudden onset breathing difficulty \r\nO/e - Tachypnea + , Tachycardia +, BP- 85/60 mmof hg\r\nSPo2 - 93 % at RA\r\nRS - AE decreased at Rt infraaxillary region \r\nP/a - soft , non tender \r\nAdvised Nebu with combimist and dernide \r\n Inj Clexane 0.4 ml S/c \r\nInj Hydrocortosone 100 mh IV stat\r\nO2 4 l \r\nInj Pansec 40 mg IV \r\nIVF 500ml NS over 1.5 hrs \r\n\r\n5.30 - Pt Same \r\n Catheterised -with foleys\r\n100 ml total output \r\nAdvised to shift to ICU\r\n\r\n7 pm \r\n7.30 pm \r\nPatient was treated with \r\nInj Penmer 1 gm BD\r\nInj Lasix 10 mg was intially given \r\nNO urine output \r\nIVF 500 ml DNS with Inj R 8 u \r\n\r\n8.00 pm \r\nPatient was started on renal dose of dopamine - \r\n2mc g/kg/min\r\nThen the dose was adjusted to maintain BP\r\n\r\n9.45 pm \r\nNo urine output,\r\nBP- 96/56 mmofhg\r\n patient was started on Inj Dobutamine @ 4 ml /hr \r\nInj Lasix 20 mg iv \r\n\r\n22/8/16\r\n1.45 am\r\nInjlasix 20 mg iV stat \r\n - Urine output - 65 ml \r\n\r\n\r\nI/O - 2000/815 ml.\r\nSeen by DRA.K.BHat.\r\nContinue trt.\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS:55MG/DL\r\nBP:130/70 MM HG\r\nPulse- 100/min\r\nSPO2- 96% without O2.\r\nCASE PLAN :\r\nSeen by DRA.K.Bhat.\r\nDRessings changed.SUtures removed.Healed.Advice:Change of dressing once in 3 days-betadine,pad,crepe bandage.Night splint.REview OP 2 weeks.9th sept.\r\n\r\nRemove catheter .\r\n To stop lasix \r\nTo start Tab Dytor 10 mg 1/2 -0-0\r\nHRCT chest today \r\nPlan D/c \r\n\r\nHb. TC . SGOT, PT\r\n"}, {'role': 'model', 'content': "\nIP Number: 5930\n\nPatient Number: 32183\n\nAdmission Date: 06-08-2016\n\nDischarge Date: 23-08-2016\n\nDiagnosis: Extensive Necrotising Fascitis left leg \r\nS/p BKA left leg under SA on 9/8/2016.\r\nPOVD\r\nCOPD - B/l emphysematous lung.\r\nChronic liver disease -( Modearte ascitis , B/l Pleural effusion , Hepatomegaly )\r\n\n\nClinical Exam(With BP): Admitted for Extensive Necrotising Fascitis left leg\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: HRCT Chest : (23/8/16) Early centri acinar emphysematous changes involving both lungs , in the form of low attenuation , especially in upper lobes \r\nNo air spaces disease /Consolidation /Mass lesions \r\nB/L moderate pleural effusion \r\nVIsualized images through tje upper abdomen showed disproportionate enlargement of left lobe & caudate lobe with nodularity of contour suggestive of chronic liver disease . Moderate ascitis\n\nXray findings: cns-concious/oriented\r\ncvs-s1,s2-no murmur\r\nr/s-clear chest\r\np/a-soft non tender\n\nDiscussion: 66 year old Mr. Haridas Kamath presented with extensive necrotising fascitis of left leg which was treated and debrided at a local hospital. Patient came to us in a septicaemic state . He is a known diabetic and hypertensive on treatment. On admission, blood investigations were sent . He was started on Inj. Piperacillin+ Tazobactum 4.5 gm BD, Inj. Clindamycin 300 mg TID. Blood sugars were well under control with basal dose of insulins and OHA's. Podiatry consultation was taken and patient was taken up for left leg below knee amputation under SA on 9.8.2016.Blood cultures sent on admission tested for MDR klebsiella.Pre and post operatievely PRC and platetlet transfusion was given. Mr Kamath developed fever on the 5 th post -op day . He also had a hacking cough too . Chest on examination showed b/l rhonchi Rt> Lt . X ray chest was repeated and was s/o chronic bronchitis . He was given Tab Levofloxacillin after stopping Clindamycin. Nebulisations and oral steroids were also advised. While this was going , patient ahd an acute onset of dyspnea along with tachypnea on the evening of 21/8/2016.There was an episode of sudden hypotension , followed by a period of oliguria and later a short spell of anuria. He was shifted to ICU, given i/v diuretics along with O2 inhalation. Antibiotics were stepped upto Inj Meropenem . Bedside 2 D Echo was doen and was wnl. An X ray chest done during this period showed an enhanced interlobular fissure on the right side.Ianotropic support was initiated for maintenence of BP.By morning of 22/8, the geneeral condition improved , patient could be weaned off O2 and ianotropic support and output was adequate.patient was shifted out of ICU.The wound was healing well during this period and sutures were removed on the 14 th post op days . Patient is discharged in a stable condition.\n\nDiet: nan\n\nRemarks: Change of dressing once in 3 days-betadine,pad,crepe bandage.Night splint.\r\nReview OP 2 weeks(9th sept.)in podiatry OPD\r\n\r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\n"}] |
6,153 | [{'role': 'user', 'content': '\nIP Number: 6153\n\nPatient Number: 33205\n\nPatient Name: CHINNAMMA\n\nGender: F\n\nDate of Birth: 06-10-1939\n\nAddress: KOOLIYATH HOUSE\n\nPincode: nan\n\nPhNo: 0484-2808163\n\nAdmission Date: 06-10-2016\n\nDischarge Date: 21-10-2016\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nCHARCOTS JOINT\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: well circumscribed ulcer over the lateral malleolus -rt foot .\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: No Fresh Complaints.\r\nVitals stable.\r\nBP:140/80mmHg.\r\nGRBS 6PM 212mg/dl Inj Insugen-R 12 U.\r\n10PM:145mg/dl Inj Basalog 12U.\r\nFBS 135mg/dl Inj Insugen-R 10U.\r\nSeen by DRA.K.BHat.\r\nRt foot acute on chronic charcots.Advice:Offloading.Physio-walker training on normal foot.IV antibiotics.Ortho opinion.\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:No Fresh Complaints\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 91MG/DL inj Insugen-R 4U\r\nFBS: 115 MG/DL Inj Insugen-R 10U\r\n PPBS : MG/DL\r\nBP:140/70 MM HG.\r\nCASE PLAN :\r\nchange insulin dosage\r\nInj Insugen-R 8-8-4U\r\nInj Basalog 12U\r\n\nS/B Dr. Rajesh Simon\r\nThanks for reference. \r\nHistory noted.\r\nC/o having abrasion over the lateral aspect of the ankle.\r\nC/ohaving instability and inward bending over the ankle and foot.\r\nO/E; Complete varus bending over the ankle and mid foot.\r\nNo stability in the ankle. \r\nX-RayFOot and ANkle: Complete disruption of the ankle and mid foot _ Charcot\r\nIMPR: CHARCOT ARTHROPATHY WITH HINDFOOT AND MID FOOT INSTABILITY\r\n\r\nAdV: Tibio Talo Calcaneal fusion for hind foot stability advised once her GC and blood counts improves.\r\n\r\nShall review.\nCase Seen by duty doctor\r\nNo fresh complaints\r\nVitals stable \r\nBP:130/70mmhg\r\nSugars\r\n6PM:203mg/dl Inj Insugen-R 4U\r\n10PM :212 Inj Lantus 12U\r\nFBS:126 mg/dl Inj Insugen-R 6U\r\ncontinue rest of the treatment\r\nSeen by DrA.K.BHat.\r\nContinue trt.Advice as per Ortho.\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:patient better,sleep disturbed,wound clean\r\nPAIN SCORE:1/5\r\nBLOOD SUGARS : \r\nPREDINNER:106 MG/DL inj insugen R 4U\r\nFBS: 94MG/DL inj.insugen R 6 U\r\n PPBS : MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN :To plan on surgery(to discuss with Dr.Rajesh)\r\ncardiology fitness adviced\r\n\r\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 119 MG/DL inj insugen R 4u\r\n10pm:214mg/dl inj basalog 12u\r\nFBS:112 MG/DL inj insugen R 6u\r\n PPBS : MG/DL\r\nBP: 150/80 MM HG\r\nCASE PLAN :\r\ninj Insugen-R 6-6-6U\r\nInj Basalog 12U\r\n\r\n\nSEEN BY DR.Radha &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nno fresh complaints.\r\nPAIN SCORE:1/5.\r\nBLOOD SUGARS : \r\nPREDINNER: 122 MG/DL inj Insugen-R 6U.\r\n10pm:135 mg/dl Inj Basalog 10U.\r\nFBS:89 MG/DL Inj Insugen-R 6U.\r\nBP: 160/90 MM HG.\r\nCASE PLAN :\r\nESR / Swab pus culture tommo morning.\r\n\r\n\nSEEN BY DR. TOm &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:mild pain\r\nPAIN SCORE:1/5\r\notherwise doing fine\r\nBLOOD SUGARS : \r\nPREDINNER:112 MG/DL inj R-4 u.\r\n10pm-145 mg/dl.inj B-8 u.\r\nFBS:123 MG/DL inj R-6 u.\r\n PPBS : MG/DL\r\nBP:160/80 MM HG.\r\nCASE PLAN :\r\ncontinue treatment\r\nStop Dalacin\r\nCT ankle(RT)\r\nX-RAY Digital Right Ankle Ap and stress various position\r\nPus C&S\r\n\nSEEN BY DR.tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nH/O slipped in bathroom\r\nPAIN SCORE:1/5\r\nBLOOD SUGARS : \r\nPREDINNER: 135 MG/DL insugen R 4U\r\n10PM: 11192 basalog 8U\r\nFBS: 108 MG/DL insugen R6u\r\nBP: 150/80 MM HG\r\nCASE PLAN :\r\nwent for CT\r\n\r\n\nSEEN BY DR.Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:no fresh complaints\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 137 MG/DL inj.Insugen R 4 u given\r\n10pm:157mg/dl inj Basalog 8 units given\r\nFBS:136 MG/DL\r\n PPBS : MG/DL\r\nBP:150/80 MM HG\r\nCASE PLAN :\r\ntibio calcaneo tallus fusion surgery today\r\nArrange for blood\r\n\r\n\r\n\nCase seen By Duty Doctor\r\npatient shifted to ICU @ 12:45 AM from OT\r\nAt 1 AM Vitals stable\r\nBP160/90mmhg\r\nPR:92/min\r\nSPO2:99%\r\nCVS:NAD\r\nRS:nad\r\nP/A:Nad\nSEEN BY DR. lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nMild pain\r\nPAIN SCORE:2/5\r\nFBS: 234mg/dl inj Insugen-R 8U\r\n PPBS : 224 MG/DL inj insugen R 10units\r\nBP: 160/90mmhg \r\nSPo2: 98%\r\nPR:96/min\r\nCASE PLAN : Dr Rajesh simon sir saw the patient and started her on\r\nT.vit 60K once weekly\r\nT.citromecalvate 1 g\r\nc.besocule 1 OD\r\nIVF for maintanace\r\nHb for 16/10/2016\r\n\r\n\r\n\nSEEN BY DR.Tom &TEAM.\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:mild pain\r\nPAIN SCORE:1/5\r\nBLOOD SUGARS : \r\nPREDINNER: 196 MG/DL inj.insugen R 6 units\r\n10pm:183mg/dl inj basalog 8 units\r\nFBS: 163 MG/DL inj insugen R 10units\r\n PPBS : MG/DL\r\nBP: 160/80MM HG\r\nCASE PLAN :\r\nX-Ray (Rt) Ankle-AP/Oblique today.\r\n\r\n\nS/B Dr. Rajesh Simon\r\nPt reviewed\r\nPain persisting\r\nOn U Cath\r\nAdv: Clamp the catheter\r\nCheck X-Ray of the ankle: Good position\r\nShort leg splintage applied.\r\nRest continue same.\nSEEN BY DR.Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:no frsh complaints.looks pale\r\nPAIN SCORE:1/5\r\nBLOOD SUGARS : \r\nPREDINNER:157 MG/DL inj R-4 u.\r\n10pm-167 mg/dl inj B-8 u.\r\nFBS:106 MG/DL inj R- 10 u.\r\n PPBS : MG/DL\r\nBP:160/80 MM HG.\r\nCASE PLAN :\r\nrepeat Hb and creatinine \r\nstarted on T.fenavit od\r\nand glucerna sachets\r\n\r\n\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:no fresh complaints\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 159 MG/DL inj R 4 units\r\n10pm:222mg/dl injBasalog 10units\r\nFBS: 158MG/DL inj R 6 units\r\n PPBS : MG/DL\r\nBP: 170/70 MM HG\r\nCASE PLAN :\r\n1 Unit Packed RBC Blood Transfusion :started @ 8:45AM \r\nVitals stable\r\nAdv:inj Avil 2cc slow IV\r\nwatch for reaction\r\nInform SOS\r\n\nSEEN BY DR.Radha &TEAM.\r\nPATIENTS GENERAL CONDITION STABLE\r\nNo Fresh Complaints\r\nPAIN SCORE:0/5\r\nBLOOD SUGARS : \r\nPREDINNER: 190 MG/DL Inj Insugen-R 4u\r\n10PM: 200 mg/dl Inj Basalog 10 u\r\nFBS: 144 MG/DL Inj Insugen-R 6u\r\n PPBS : MG/DL\r\nBP: 150/80 MM HG\r\nCASE PLAN :\r\n\r\n\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:129 MG/DL H.M-10 u.\r\n10pm-137 mg/dl.\r\nFBS:119 MG/DL.H.M-12u.\r\n PPBS : MG/DL\r\nBP:150/80 MM HG.\r\nCASE PLAN :\r\n\r\n\r\n'}, {'role': 'model', 'content': "\nIP Number: 6153\n\nPatient Number: 33205\n\nAdmission Date: 06-10-2016\n\nDischarge Date: 21-10-2016\n\nDiagnosis: Charcot's foot - rt with a non healing ulcer on the lateral malleolus\r\nCharcots Joint -Rt Foot with Subtalar dislocation and instability\r\ns/p TIBIOTALOCALCANEAL FUSION ( Rt ) ankle under epidural anaesthesia\r\nAnaemia of chronic infection\n\nClinical Exam(With BP): came with a non healing ulcer over the lateral malleolus . k/c T2 DM on Inj premixed insulin\n\nSystolic BP: 170.0\n\nDiastolic BP: 80.0\n\nPhysical examination: Chest X-Ray :\r\n\r\n\n\nXray findings: well circumscribed ulcer over the lateral malleolus -rt foot\n\nDiscussion: 77 year old lady came to the op with c/o of difficulty in walking , edema of the right foot with a non healing ulcer over the rt ankle .She had numerous hospital admissions for the same . Clinically she had Charcots joint rt ankle. She was admitted, strtaed on i/v antibiotics and basal bolus insulin. Podiatry surgical consult was taken .After detailed discussions , Ortho consult for taken .A CT scan of the foot with X rays were advised and a TibioTalocalcaneal fusion surgery under epidural anaesthesia was planned. Pre and post operatively she had to transfused with a 2 pints of packed cells .There was significant improvement . After the first dressing , she could be mobilised on a walker . She was discharged in a stable condition with advise to follow up as OP on Tuesday.\n\nDiet: nan\n\nRemarks: Review with FBS ,PPBS \r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\n"}] |
6,213 | [{'role': 'user', 'content': '\nIP Number: 6213\n\nPatient Number: 1450\n\nPatient Name: RUKKIYA\n\nGender: F\n\nDate of Birth: 01-04-1965\n\nAddress: KASINKA GOTHI HOUSE,MINIKOY ISLAND\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 25-10-2016\n\nDischarge Date: 08-11-2016\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: Conscious/oriented.\r\nR/s-clear chest.\r\nP/a-Soft/Nontender.\r\nCvs-S1,S2+.\r\nO/e-Cellulitis left lef.Varicose veins infected.\r\n\n\nPrecautions to be taken while treating the patient: Not known.\n\nRemarks: SEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Fever with chills\r\nPAIN SCORE:1/5\r\nBLOOD SUGARS : \r\nPREDINNER:179 MG/DL Inj Insugen-R 10U\r\n10PM: 245 mg/dl Inj Basalog 14u\r\nFBS: 114 MG/DL Inj Insugen-R8U\r\n PPBS : MG/DL\r\nBP:140/80 MM HG\r\nCASE PLAN :\r\nI/O chart\r\nIVF NS with polybion\r\ndaily creatinine\r\nhb,TC,hba1c and creatinine in the afternoon\r\ninj insugen R 6-6-6\r\ninj basalog 10units\r\nnephro consultation tomorrow\r\nDR.Bhat consultation \r\nSeen by DRA.K.BHAT.\r\nCellulitis left lef.Varicose veins infected.\r\nIV ABx,.Inj.Clexane.Leg elevation.\r\n\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:c/o mild pain\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 228MG/DL inj R 4 units\r\n10pm:187 inj basalog 10units\r\nFBS:117MG/DL inj R 8units\r\n PPBS : MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN :\r\nTab Pevesca Plus BD\r\nInj Pactiv TDS\r\nInj Insugen -R 8-8-4\r\nInj Basalog 10U\r\nDr BHat advices Venous Doppler\r\n\r\n\nThanks \r\n----------\r\nS/B Dr Sooraj\r\nDM, CAD, \r\nwas evaluated last year when she had impaired RFT - likely NSAID \r\n24 hr up - microalbuminuria\r\nimproved with treatment\r\ncreat less than 1.5\r\nnow admitted with Diabetic foot\r\nimpaired RFT \r\n\r\nSuggest:\r\n1. 24 hr urine protein\r\n2. Tab Wynax 1-0-1\r\n3. Tab Sobisis 1-1-1\r\n4. RFT on akt days\r\n---------\r\nSeen by DRA.K.BHat.\r\nContinue trt.\nSEEN BY DR. Radha and Dr Manoj\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Fever\r\nPAIN SCORE:1/5\r\nBLOOD SUGARS : \r\nPREDINNER: 102 MG/DL Inj Insugen-R 4U\r\n10PM: 104 mg/dl Inj Basalog 6U\r\nFBS: 99 MG/DL Inj Insugen r\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :Hb,TC TOMORROW\r\nstool routine\r\ninj. pansec BD\r\nc.becosule\r\nT.calcheck 5mg BD and stopped T.cilacar\r\n\r\nSeen by DrA.K.BHat.\r\nXRay left leg AP,Lat.\r\n\nSEEN BY DR.Tom &TEAM.\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: pain over left leg following crape bandage application\r\nPAIN SCORE:1/5.\r\nBLOOD SUGARS : \r\nPREDINNER: 279MG/DL inj insugen R 6units\r\n10pm:183mg/dl inj basalog 6units\r\nFBS: 145MG/DL inj R 4units.\r\nBP: 165/70 MM HG.\r\nCASE PLAN :\r\nIVF NS 1 pint Slow.\r\n\r\nSeen by DRA.K.Bhat.\r\nSoft tissue screening USG shows no obvious collection.\r\nIf no relief will plan fr aspiration on monday.Continue trt.GM dressing.\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nPain subsided \r\nBLOOD SUGARS : \r\nPREDINNER:166 MG/DL Inj R-6 u.\r\n10pm-133 mg/dl. Inj B-4 u.\r\nFBS:125 MG/DL Inj R-6 u.\r\n PPBS : MG/DL\r\nBP:140/70 MM HG.\r\nCASE PLAN :\r\n\r\n\r\nSeen by DrA.K.Bhat.\r\n?Plan fr fasciotomy.Pt. wants to wait.\r\n\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:pain over left leg\r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nPREDINNER: 215 MG/DL Inj R-6 u.\r\n10pm-149 mg/dl.Inj B-4 u.\r\nFBS:184 MG/DL Inj 12 u.\r\n PPBS : MG/DL\r\nBP:150/80 MM HG.\r\nCASE PLAN :\r\nT.praZopress 2.5mg 1-0-1\r\n discussion with DR. Bhat regarding intervention/change on antibiotics\r\nSeen by DrA.K.BHat.\r\nInduration present.Patient not keen on aNY intervention.Continue trt.\r\n\r\n\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 200 MG/DL injH.mix 10units\r\nFBS: 116MG/DL inj H.mix 14units\r\n PPBS : MG/DL\r\nBP: 140/80 MM HG\r\nCASE PLAN :\r\nStop inj CLexane\r\nInj Biopiper\r\nInj Dalacin\r\n STart Inj LInezolid 600mg IV BD ATD\r\nSeen by DrA.K.BHat.\r\nNot willing for I&D.Continue trt.\r\n\nSEEN BY DR.Radha &TEAM.\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No fresh complaints, Has not spiked fever today .\r\nPAIN SCORE:1/5.\r\nBLOOD SUGARS : \r\nPREDINNER: 263 MG/DL Inj HM 12U.\r\nFBS: 132 MG/DL inj HM 14.\r\nBP: 140/80 MM HG.\r\nCASE PLAN :\r\nSeen by DRA.K.Bhat.\r\nProvisionally Posted for fasciotomy/I&D on 3RD NOV ,8am,under SA.\r\nPreoperative Instructions:\r\nPreop. screening and Investigations.\r\nGet informed consent.\r\nNil oral as per Anesthetist advice.\r\nClean&dress area on morning of operation.\r\nIV antibiotics.\r\nMedical &Anesthetic fitness for the procedure.\r\nInform OT and anesthetist.\r\n==================\r\nInformed consent.\r\nThere is pus filled infection of left leg region.This pus infection is extending deep to deeper tissues like fascia.The infection needs incision and drainage and fasciotomy under anesthesia.During operation the spreading infection will be opened up and pus will be drained.In necrotising fasciitis there will be infection more extensive than what is seen on the surface.Infected skin and soft tissues may need to be removed.Due to extending nature of infection, after surgery the wounds healing will be delayed.The healing and circulatory condition of wounds will need observation.Understanding the above consent for anesthesia and operation is given.\r\n------------------------\r\nHB/TC/RFT tomorrow.\r\nNephro-Consultation.\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Nil special.\r\nPAIN SCORE:0.5/5.\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL.\r\n12pm-154 mg/dl.\r\nFBS:146 MG/DL.\r\n PPBS : MG/DL\r\nBP:140/80 MM HG.\r\nCASE PLAN :\r\n\r\n\r\n\nThanks\r\nS/B DR Sooraj\r\n-----------------\r\nKnown CKD\r\nAcute worsening following diabetic foot\r\nSuggest:\r\n----------\r\nStop Wynax\r\nTab Alfalog 1-0-1\r\nSerum iron next prick\r\n\ncase seen by duty doctor\r\npatient sleeping\r\nPR:87/min\r\nBP:140/80mmhg\r\nblood cross checked.can be transfused\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:pain over fasciotomy site\r\npatient on catheter\r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nPREDINNER: 352 MG/DL inj R 12units\r\n10pm:249mg/dl inj basalog 14units\r\nFBS: 161MG/DL inj R 14units\r\n PPBS : MG/DL\r\nBP: 160/90MM HG\r\nCASE PLAN :\r\nInj Insugen-R 18-16-14\r\nInj Basalog 12 HS\r\nInj Clexane 0.4 ml OD S/C\r\n\r\nSeenby DRA.K.BHat.\r\nContinue trt.\r\n\nSEEN BY DR. Tom &TEAM.\r\nPATIENTS GENERAL CONDITION STABLE\r\n No fresh complaints\r\nBLOOD SUGARS : \r\nPREDINNER: 152 MG/DL Inj Insugen R 12U\r\n10 PM : 80mg/dl Inj Basalog 8U\r\nFBS: 110 MG/DL Inj Insugen R 14\r\n PPBS : MG/DL\r\nBP: 140/80 MM HG\r\nCASE PLAN :\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No fresh complaints\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:158 MG/DL Inj R-6 u.\r\n10pm-180 mg/dl. Inj B-10 u.\r\nFBS:85 MG/DL Inj R-8 u.\r\nBP:140/80 MM HG.\r\nCASE PLAN :\r\n \r\nSeen by DRA.K.BHat.\r\nDRessings changed.Clean.Continue trt.\r\n\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No fresh complaints\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 151 MG/DL INJ Insugen R 8\r\n10 PM : 137 mg/dl Inj Basalog 10U\r\nFBS: 186 MG/DL Inj Insugen R 16 U\r\n PPBS : MG/DL\r\nBP: 150/70 MM HG\r\nCASE PLAN : continue same \r\n\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\nSEEN BY DR.Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Nil special.\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 179 MG/DL inj R 10units\r\n10pm:116mg/dl inj B 10u\r\nFBS: 156MG/DL inj R 12units\r\n PPBS : MG/DL\r\nBP: 150/100MM HG\r\nCASE PLAN :\r\nSeen by DrA.K.BHat.\r\nDRessings changed.Clean ulcer.\r\nAdvice:Change of dressing once in 2 days-betadine,cuticell.Oral antibitoics 1 week.REview OP Monday 21st nov.\r\n\r\n\r\n\r\n'}, {'role': 'model', 'content': '\nIP Number: 6213\n\nPatient Number: 1450\n\nAdmission Date: 25-10-2016\n\nDischarge Date: 08-11-2016\n\nDiagnosis: Necrotising Fascitis\r\ns/p Incision and drainage under SA\n\nClinical Exam(With BP): Patient had come in with C/o redness and pain in the Lt leg h/o fever and vomiting few days back .\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: Chest X-Ray :\r\n\r\n\n\nXray findings: Conscious/oriented.\r\nR/s-clear chest.\r\nP/a-Soft/Nontender.\r\nCvs-S1,S2+.\r\nO/e-Cellulitis left lef.Varicose veins infected.\r\n\n\nDiscussion: 50 year old Mrs. Rukkiya came to the hospital with Cellulitis of (Lt) leg Varicose veins infected associated with fever and vomiting the day before admission. Pt is a known diabetic and hypertensive on treatment. patient was provisionally posted for fasciotomy/I&D on 3rd nov ,8am,under SA which was uneventfull started her on Linezolid 600mg IV ATD BD and patients blood sugar levels were controlled well, Hence patient disharegd under stable conditions.\r\n\n\nDiet: nan\n\nRemarks: If You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\n'}] |
6,414 | [{'role': 'user', 'content': '\nIP Number: 6414\n\nPatient Number: 34468\n\nPatient Name: STEPHEN P A\n\nGender: M\n\nDate of Birth: 25-12-1965\n\nAddress: PUTHEN HOUSE 33/1132 J DRA 51A,DHANYA\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 27-12-2016\n\nDischarge Date: 14-01-2017\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: chest:AEBE, clear\r\nCVS:s1,s2 heard normal\r\nCNS:no focal neurological deficit\r\np/a:soft, non tender , BS+\r\nl/e: bruises and abrasions over rt upper thigh\n\nPrecautions to be taken while treating the patient: NKA\n\nRemarks: SEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:no fresh complaints\r\nBLOOD SUGARS : \r\n9:15pm:153\r\nBP: MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :CT Scan Brain \r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: NO Fresh Complaints\r\nPAIN SCORE:1/5\r\n\r\nBP: 130/80 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR.Radha\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: no fresh complaints\r\nBLOOD SUGARS : \r\nPREDINNER: 131MG/DL\r\nFBS: 106MG/DL\r\n PPBS : MG/DL\r\nBP:130/80 MM HG\r\nCASE PLAN : NS\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. manoj&TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: mild giddiness\r\nPAIN SCORE:1/5\r\nBP: 120/80 MM HG\r\nCASE PLAN :continue same\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: no fresh complaints\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 120/80MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nFBS: 105 MG/DL\r\nBP:120/90 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. TOm &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:no fresh complaints\r\nBP: 120/90MM HG\r\nCASE PLAN : cont same trt\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:NO fresh complaints\r\nFBS: 99MG/DL\r\nBP: 120/80MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nCase Seen by DR Tom & team\r\n NO Fresh complaints\r\nVitals stable\r\nBP:110/80 mmhg\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:No fresh complaints\r\nFBS: 107MG/DL\r\nBP: 110/80MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:No fresh complaints\r\nFBS: 109 MG/DL\r\n PPBS : MG/DL\r\nBP:120/90 MM HG\r\nCASE PLAN :continue same\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:No fresh complaints\r\nPAIN SCORE:0/5\r\nFBS: 101MG/DL\r\nBP: 130/70MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:No fresh c/o\r\nPAIN SCORE:0/5\r\nBP: 110/80 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:No fresh C/o\r\nPAIN SCORE:NIL\r\nBLOOD SUGARS : \r\nFBS: 113 MG/DL\r\nBP: 110/80 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:No fresh complaints\r\nFBS: 105 MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN :nil special\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:No fresh c/o\r\nFBS: 113 MG/DL\r\nBP: 120/80 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:No fresh complaints\r\nFBS: 123 MG/DL\r\n PPBS : MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:No Fresh complaints\r\nFBS: 101 MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:No fresh c/o\r\nFBS: MG/DL\r\nBP: 120/90 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n'}, {'role': 'model', 'content': '\nIP Number: 6414\n\nPatient Number: 34468\n\nAdmission Date: 27-12-2016\n\nDischarge Date: 14-01-2017\n\nDiagnosis: To r/o Intracranial Haemorraghe /any pathology following blunt injury to the head\n\nClinical Exam(With BP): H/O Alleged Assault at around 20:15 on 24/12/2016 at patients residence Edakunnu Karakutty P.O Angamaly\r\nAdmitted for observation following h/o blunt injury to the head on Saturday. He had later on developed vertigo with nausea and feeling of falling.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: CT scan -Brain\n\nXray findings: Conscious , well oriented ,\r\nID Marks: \r\n1) Black Mole left side of Forehead\r\n2) Black Mole left side of chest\r\nmultiple abrasions with erythema \r\nContusion over Right thigh 5cms x 5cms\r\n No Bony tenderness\r\n PUPILS : PEARLS\r\nCNS -no Clinical evidence of neurological deficits\r\n\r\nAll other sys wnl\n\nDiscussion: 51yr/M (MRD No :34468) K/c T2DM on treatment with OHA came to our hospital with history of blunt injury to the head , contusions and bruises and to the rest of the body from assault on 24/12/16 about 8.15pm at Edakunnam, Angamaly (Alleged by his brother Mr. Mathacchan, Mr. Naveen, Mr. Nithin using sickle). He was admitted in our hospital on 27/12/16 at 10pm as he started experiencing vertigo and vomiting. Multiple bruises and contusions all over his body were noticed on admission. A CT head was done to rule out intracranial hemorrhage. No obvious abnormality was detected. He was kept under our observation since he continued to vomit and c/o light headedness and instability while standing up. He continued to have vertigo and vomiting for 1 week but detail evaluation did not reveal any evidence of obvious head injury in the form of focal neurological deficits. His blood sugar levels were stable while in hospital. He is discharged in a stable condition\n\nDiet: nan\n\nRemarks: nan'}] |
6,504 | [{'role': 'user', 'content': '\nIP Number: 6504\n\nPatient Number: 21457\n\nPatient Name: N P PAULOSE\n\nGender: M\n\nDate of Birth: 13-02-1950\n\nAddress: NELLIKUZHYIL HOUSE\n\nPincode: nan\n\nPhNo: 9446448524\n\nAdmission Date: 23-01-2017\n\nDischarge Date: 09-02-2017\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nChronic ischaemic heart disease\nDIABETIC FOOT\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: Chest:clear,AEBE\r\nALl systems WNL\r\n\n\nPrecautions to be taken while treating the patient: NKA\n\nRemarks: SEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:No fresh c/o,mild pain at site of amputation\r\nBLOOD SUGARS : \r\nPREDINNER:96 mg/dl \r\n10 PM:191 MG/DL\r\nFBS: MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\nSeen by DRA.K.BHat.\r\nDressings rt foot changed.Wound healing well.Continue trt.\nSEEN BY DR. tom&TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No fresh complaints\r\nBLOOD SUGARS : \r\nPREDINNER: 187 MG/DL Inj R 26\r\n10 PM : 208 mg/dl Inj Lantuss 30\r\nFBS: 121 MG/DL Inj R 30\r\n PPBS : MG/DL\r\nBP: 140/90MM HG\r\nCASE PLAN :Cont same\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:No fresh complaints\r\nPAIN SCORE:1/5\r\nBLOOD SUGARS : \r\nPREDINNER: 125 MG/DL Inj Act 24u\r\n10 PM: 127mg/dl Inj LAntus 24u \r\nFBS:124MG/DL Inj Act 28u\r\n PPBS : MG/DL\r\nBP: 140/80 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nInj Dalacin 300 mg TDS\r\n Phlermin dressing\r\nNon weight bearing(walker mobilization)\r\nSeen by DrA.K.BHat.\r\nContinue trt.\nSEEN BY DR. tom&TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Pain right lower leg on and off\r\ndisturbed sleep\r\nPAIN SCORE:3/5\r\nBLOOD SUGARS : \r\nPREDINNER: 100 MG/DL Inj Actrapid 20 u\r\n 10 PM : 191 mg/dl Inj Lantus 30 u\r\nFBS:117 MG/DL Inj Actrapid 26 u\r\n PPBS : MG/DL\r\nBP: 110/70MM HG\r\nCASE PLAN : COnt same TRt\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nSeen by DRA.K.Bhat.\r\nC&D plermin.\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: 4 episodes of loosestools\r\nPAIN SCORE:1/5\r\nBLOOD SUGARS : \r\nPREDINNER: 174 MG/DL Inj Act 26\r\n10pm:182 Inj lantus 30u\r\nFBS:131MG/DL Inj Act 26\r\n PPBS : MG/DL\r\nBP: 130/80MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nStop Tab STiloz\r\n Inj Clexane 0.4 ml S/C OD.\r\nSeen by DRA.K.Bhat.\r\nC&D done.REpeat C/S taken.\nSEEN BY DR. Radha &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:No fresh complaints\r\n \r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nPREDINNER: 169 MG/DL Inj Actrapid 22\r\n10 PM: 198 mg/dl Inj Lantus 24\r\nFBS:122 MG/DL Inj Actrapid 22\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :Continue same\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nSeen by DrA.K.Bhat.\r\nDressings done.\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:No fresh complaints\r\nBLOOD SUGARS : \r\nPREDINNER:157 MG/DL Inj Actrapid 20\r\n10 PM: 170 mg/dl Inj Lantus 20\r\nFBS:123 MG/DL Inj Actrapid 22\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :Continue same\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS).\r\nSeen by DRA.K.Bhat.\r\nClean and healing.AGFIX dressing done.\nSEEN BY DR.tom&TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:No fresh complaints\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 168MG/DL Inj R Act 20 \r\n10 PM : 212mg/dl Inj Basalog 20\r\nFBS: 138MG/DL Inj Act 22\r\nBP: 130/70MM HG\r\nCASE PLAN :Continue same.\r\nSeen by DrA.K.Bhat.\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:no fresh complaints\r\nPAIN SCORE:1/5\r\nBLOOD SUGARS : \r\nPREDINNER: 125 MG/DLinj Act 22\r\n10pm:160mg/dl inj Lantus 20\r\nFBS: 180 MG/DL inj Act 22\r\n PPBS : MG/DL\r\nBP: 110/80MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nENT CONSULTATION\r\nTO SEND TOTAL COUNT\r\nTO STOP INJ.MONOSCOT AND INJ.CAMYDA\r\nSeen by DrA.K.BHat.\r\nDRessinsg changed.Clean.AGFix dressing done.\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:no fresh complaints\r\nPAIN SCORE:1/5\r\nBLOOD SUGARS : \r\nPREDINNER: 161MG/DLinj Act 26\r\n10pm:165mg/dl inj Act 20\r\nFBS: 106 MG/DL inj Act 20\r\n PPBS : MG/DL\r\nBP: 110/80MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nsaline gargling.\r\nSeen by DRA.K.Bhat.\r\nDressings changed.For secondary suturing under LA,OT,3rd feb.Get consent.C&D.Continue trt.\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:no fresh complaints\r\nPAIN SCORE:1/5\r\nBLOOD SUGARS : \r\nPREDINNER: 151MG/DLinj Act 20\r\n10pm:153mg/dl inj lantus 20\r\nFBS: 158 MG/DL inj Act 20\r\n PPBS : MG/DL\r\nBP: 110/80MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS\r\nPosted for secondary suturing under LA\r\nWITHHOLDED T.Clopilet+inj clexane\nSEEN BY &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:no fresh complaints\r\nPAIN SCORE:1/5\r\nBLOOD SUGARS : \r\nPREDINNER:\r\n10pm:\r\nFBS: 125mg/dl inj Act 20\r\n PPBS : MG/DL\r\nBP: 140/80MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nsaline gargling.\r\n\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nDIARRHOEA STOPPED AFTER TAKING LOPERAMIDE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 167 MG/DL\r\nFBS: 125MG/DL\r\n PPBS : MG/DL\r\nBP: MM HG\r\nADVICE: \r\nGASTRO CONSULTATION\r\n\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: 145 MG/DL actrapid 18U\r\n PPBS : MG/DL\r\nBP: 140/ 70 MM HG\r\nSeen by DRA.K.BHaT.\r\nDressings changed.Clean.Continue trt.\r\n\nSEEN BY DR. manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE \r\n\r\nadvice: gastro consultation\r\nGastro consultation : seen by Dr. shelly\r\n advice: 1 episode of watery diarrhoea last nightfoul feces no abdominal pain, fever.\r\nO/E: general cndition good \r\nabdomen soft non tender\r\nPLAN: tab redotil 1 sos\r\ntab. rifaxamine 400mg BD * 5 days\r\nreview sos\r\n\r\n\ncase reviewed by dr shelley\r\npt is symptomatically better \r\nadvised to continue rifaxamin 400mg bd up to five days \r\nand may be stopped \r\nreview sos\nSeen by Dr.Tom and team\r\nno fresh complaints\r\ncontnue orders\r\nSeen by DRA.K.Bhat.\r\nDressings changed.Clean.Continue trt.\r\n\r\n 6:30pm patient complains of 2 episodes of loss stool.\r\nno abdominal pain \r\nadvice: tab.redotil\nSEEN BY DR.Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: 3 Episodes of loose stools\r\nmotion n0t passed\r\nPAIN SCORE:nil\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\n PPBS : MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN : Gastro Consultation today\r\nSeen by DrA.K.BHat.\r\n\r\n\ncase seen by drshelley\r\nhad two episodes of loose stools yesterday , not passed bowel today ,had redotil yester day / no fever no abd pain noabd distension \r\nplan continue same , if pt continue to be symptomatic plan for colonoscopy fater few days \r\ncontinue rifaxamin. \r\ntab tryptomer 10mg 1/2 at 7pm may be started\r\nshall reveiw sos \r\n\nno complaints\r\nbowel habit normal.\r\nSeen by Dr. Tom and team\r\nno fresh complaint\r\ncontinue orders.\r\nSeen by DRA.K.BHat.\r\nDRessings changed.Clean suture line.\r\nADVice:Change of dressing once in 2 days-betadine.NO WEIGHT BEARING ON OPERATED AREA.Review OP Friday 17th feb.'}, {'role': 'model', 'content': '\nIP Number: 6504\n\nPatient Number: 21457\n\nAdmission Date: 23-01-2017\n\nDischarge Date: 09-02-2017\n\nDiagnosis: POVD -peripheral angioplasty done on 21/12/2016\r\nRt 2nd Toe amputation under LA on 24/12/2016- with secondary suturing done on 3/2/2017\r\n? PSeudomembranous Colitis\n\nClinical Exam(With BP): came for better wound healing\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: Chest X-Ray :\r\n\r\n\n\nXray findings: Chest:clear,AEBE\r\nALl systems WNL\r\n\n\nDiscussion: 66 year old Paulose who is a known case of Type 2 DM , POVD was admitted with a non healing stump of the amputated right 2 nd toe . He was given i/v antibiotics and advised off loading and daily dressing with debridase . A conservative approach was maintained , but as there was undue delay in wound healing secondary suturing was done under LA on \r\n3/2/2017.As the patient had devloped oral mycosis and recurrent episodes\r\n of diarrhea ( ? pesudomembranous colitis ), antibiotics were withdrawn . \r\nThe patients general condition remained good and sugars were under \r\ncontrol on basal bolus insulins By 9/2/2017 , as the wound was healing\r\n well, patient could be discharged with advise to follow up for dressings.\r\n\n\nDiet: nan\n\nRemarks: If You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\nStrict off loading of Rt foot\r\nReview with FBS ,PPBS'}] |
6,813 | [{'role': 'user', 'content': '\nIP Number: 6813\n\nPatient Number: 36447\n\nPatient Name: A C JOHNSON\n\nGender: M\n\nDate of Birth: 02-05-1959\n\nAddress: ARODHA HOUSE\n\nPincode: nan\n\nPhNo: 9446144461\n\nAdmission Date: 02-05-2017\n\nDischarge Date: 16-05-2017\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: nan\n\nXray information: out side blood reports;\r\ncr-1.4\r\nurea-55\r\ntc -20,400\r\nesr 115\r\nna-130\r\n\n\nClinical examination: left lower limb ;\r\nwarmth++\r\nswealling++\r\nredness++\r\n\n\nPrecautions to be taken while treating the patient: h/o epistaxis two days back -? induced by nose prick\n\nRemarks: Seen by DRA.K.BHat.\r\nNecrotising fasciitis left leg.IV ABx-Inj.Clinda 600 mg 1-1-1 IV.\r\n6.30 PM has fever spike ( tem 100.1)\r\n BP 160/110 mmhg\r\ninformed DR MANOJ sir ; advised to give Tab,Cilacar 10 mg st\n11 am grbs 112mg/dl\r\n12.30 pm grbs 169mg/dl\r\n6 pm grbs 117 mg/dl\r\n10 pm grbs137 mg/dl inj basalog 4 units given \r\ninformed to DR MANOJ\n6 am grbs 103 mg/dl\r\ninformed to DRMANOJ\nSEEN BY DR. TOM BABU &TEAM\r\nPATIENTS GENERAL CONDITION IS STABLE\r\nNO FRESH COMPLAINTS\r\n\r\nBLOOD SUGARS : 103 MG/DL AT 6 AM\r\n\r\nBP: 150/90 MM HG\r\n continue the same medications as per chart\r\nrepeat total count and creatnine today.\r\nSeen by DRA.K.Bhat.\r\nBlistering infection left leg-C/S taken.Continue trt.\nat 6.00 pm GRBS 217 informed to Dr.Tom and adv : insulinogen R to be given 14 units\r\nat 10.00 pm GRBS 172 informed to Dr.Tom and adv : basalog to be given 8 units\r\nat\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nBP : 150/90mmhg\r\nno fresh complaints\r\nGRBS : 109 mg/dl at 6Am informed to Dr.Tom and adviced insulinogen R 12 units\r\nnecrotising fascitis better\r\npus culture sent yesterday\r\nCBC,RFT,LFP to be sent tomorrow\r\nT.ciladuo 10 mg BD to be give\r\n\r\ncontinue medication as per chart.\r\nSeen by DRA.K.BHat.\r\nAdvice:Multiple Fasciotomy under SA 5th May 2pm.Rpt.CBC,LFT,RFT,Group/Rh,Na.K.Preop. workup.ECG.C&D.Medical fitness.Informed consent.\r\n-----------------\r\nInformed consent.\r\nThere is pus filled infection of left foot,ankle and leg extending to near knee region.This pus infection is extending deep to deeper tissues like fascia.There are multiple pus filled blisters in these regions.The infection needs incision and drainage and fasciotomy under anesthesia.During operation the spreading infection will be opened up in multiple areas and pus will be drained.In necrotising fasciitis there will be infection more extensive than what is seen on the surface.Infected skin and soft tissues may need to be removed.Due to extending nature of infection, after surgery the wounds will be multiple and control of infection and healing will be delayed.The healing and circulatory condition of wounds will need observation.Understanding the above consent for anesthesia and operation is given.\r\n---------------------------------\nGRBS 160 mg/dl at 6 pm : informed to DR.Radha and adv to give insulinogen R 2 units\r\nGRBS 150 mg/dl at 10 pm : informed to DR.Radha and adv to give basalog 4 units.\r\njohnson had an episode of fever spike 7.30 100.1 F and inj pactiv was given\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nBP: 160/80mmhg\r\npatient had fever spike yesterday night at 7.00 pm 100.1 F and inj pactiv was given \r\npatient had fever spike in the morning as well and t.,dolo was given \r\n6 am GRBS 163 mg/dl was informed to Dr.Radha and adv nothing to be given\r\n\r\nCBC to be informed to Dr.bhatt\r\nplanned for fascitomy today at 2pm.\r\n GRBS 228mg/dl\r\ncardiac evalution required\r\nSeen by DRA.K.BHat.\r\nPatient not willing for operation today.\r\nAdvice:Multiple Fasciotomy under SA 6th May 12 NOON.Medical fitness.Informed consent.Nil oral.\r\n-----------------\r\nInformed consent.\r\nThere is pus filled infection of left foot,ankle and leg extending to near knee region.This pus infection is extending deep to deeper tissues like fascia.There are multiple pus filled blisters in these regions.The infection needs incision and drainage and fasciotomy under anesthesia.During operation the spreading infection will be opened up in multiple areas and pus will be drained.In necrotising fasciitis there will be infection more extensive than what is seen on the surface.Infected skin and soft tissues may need to be removed.Due to extending nature of infection, after surgery the wounds will be multiple and control of infection and healing will be delayed.The healing and circulatory condition of wounds will need observation.Understanding the above consent for anesthesia and operation is given.\r\n\nGRBS at 6pm 137mg/dl informed to Dr.manoj adv given insulinogen R 4 units\r\nGRBS at 10 pm informed to Dr.Manoj adv given\nGRBS at 6 am is 191 mg /dl informed to Dr.Manoj.patient on NPO\r\necho and cardio consultation to done today \r\nplanned for multiple fasciotomy at 12 pm today\ncardiology fitness obtained;\r\nPatient may be taken up with intermediate risk of cardiac events\r\n6 pm grbs 288 mg/dl inj insugen -r 8 units given\r\n10 pm grbs 331 mg/dl inj basalog 14 units given\r\ninformed to DR TOM\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : 191 mg/dl\r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSeen by DRA.K.Bhat.\r\nContinue trt.Restart clexane.\nSEEN BY DR. MANOJ &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:no specific complaints \r\nPAIN SCORE:\r\nBLOOD SUGARS : 217 mg/dl\r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\n6 am grbs 217 mg/dl inj insugen -r 14 units given \r\ninformed to DR TOM \r\nDr Bhat sir reviewed- advised to restart inj clexane \r\nwound oozing noted ,overpading done \r\nhb drop noted - 7.5 ( 9.8)\r\nplan;\r\n1 point PRBC transfusion\r\ntab nebistar 2.5 mg sos if bp spike\n12 pm grbs 238 mg/dl ins.insugen -r 14 units given \r\n6 pm grbs 192 mg/dl ins.insugen -r 12 units given\r\n10 pm grbs 197 mg/dl ins.basalog 14 units given \r\ninformed to DR MANOJ\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:generalised weakness\r\nPAIN SCORE:\r\nBLOOD SUGARS : 106 mg/dl \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nfoot care ( nail care )\r\nkindly arrange 1 unit PRBC-transfuse today\nSeen by DRA.K.Bhat.\r\nContinue trt.REmove foleys cath.C&D in ICU tmrw.\r\n6 pm grbs 103 mg/dl ins.insugen -r 8 units given \r\n10 pm grbs 155 mg/dl ins.basalog 12 units given \r\ninformed to DR LAKSHMI\r\n\r\nkindly send hb,na,k tomorow\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:decreased sleep yesterday \r\nPAIN SCORE:\r\nBLOOD SUGARS : 88 mg/dl\r\nHB : 8.7mg/dl\r\nfirst dressing to be done today\r\nreduce the insulin requirement as infection has reduced\r\nT.nitrest 5 mg HS to be started.iv antibiotcs changed to oral\r\ninj basalog reduced to 6 units\r\ninj.clexane to be stopped\r\ncontinue same medications as per chart.\r\nSeen by DRA.K.Bhat.\r\nDRessings changed.Clean large raw areas left leg.Advice:Oral Clindamycin.\nblood tranfsuions done .patient is stable.no complaints.patient had fever spike and inj.pactive was given\r\nGRBS at 6 pm 180mg/dl informed to Dr.Tom adv : insulinogen R 10 untis to be give\r\nGRBS at 10 pm 231mg/dl informed to DR.lakshmi adv : basalog 12 units to be given\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE \r\npatient had fever spike at night and T.dolo was given \r\nHB: 11.4 gm /dl \r\nGRBS at 7 am 122 mg/dl informed to DR.Lakshmi and insulinogen R 8 units to be given \r\npus culture report : no growth \r\ncontinue same medications as per chart.\r\nT.ecospirin 75 mg 0-1-0 to be started \r\ninj .H mixtard to be started from tonight \r\n\r\nSEen by DRA.K.Bhat.\r\nContinue trt.\nGRBS informed at 6 pm to Dr.Radha 207 mg /dl amd adv to give H.mixtard 10 units\r\nGRBS ar 10 pm 287 mg/dl informed to DR.Radha\r\ntotal counts and hemoglobin to repeat tomorrow\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\npatient had had fever spike thrice since yesterday \r\nINJ.pactive was given \r\ntoday morning BP was also elevated : 180/100mmhg\r\nantihypertensives were given \r\nGRBS at 6 am 176 mg /dl informed to DR.Radha and adv H.mix 16 units\r\nblood culture to be sent during next fever spike \r\nDressing : oozing +\r\ninj avil 1 amp stat to be given \r\nT.metadoze 500 mg 1-0-1\r\ndressing will be done today\r\nto send URE, TC, HB.\r\nINJ.Biopiper 4.5 gm IV 1-0-1\r\nINJ dalacin 300 mg iv 1-1-1 \r\nSeen by DRA.K.Bhat.\r\nDRessings changed.Most of the large raw areas of leg are clean.Small pocket of slough undermined over tibia shin-needs observation.Adv:Blood C/S.IV ABx.\nGRBS at 6pm 198 mg/dl informed to DR.Manoj and adv H.mixtard 14 units \r\nGRBS at 10 pm 220mg/dl informed to Dr.Manoj\npatient had a fever spike around 9 pm and injection pactive was given \r\nblood culture sent\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\npatient had fever spike yesterday night\r\ni.v anitbiotics started since yesterday\r\nno fresh complaints\r\nGRBS at 6 am 133 mg/dl informed to Dr.Manoj and adv H.MIX 18 UNTIS TO BE GIVEN \r\ncontinue same medications as per chart\r\nrepeat creatnine\r\nINJ.Clexane 0.4mg S/C 1-0-0\r\ncreat : 1.6mg/dl\r\ninj.biopiper 2.5 1-1-1.\r\nSeen by DR.A.K.Bhat.\r\nDressings changed.Clean large raw areas.Pocket of slough over mid tibial region needs observation.Continue trt.Plan fr D/C on monday.\nGRBS at 6 pm 155 mg /dl informed to DR.radha and adv to give \r\n\r\n\nGRBS at 6 pm 155 mg /dl informed to DR.radha and adv to give H.mix 14 units\r\nGRBS at 10 pm informed to DR.radha\r\n\nGRBS at 6 am 118mg/dl informed to Dr.Radha and adv to H.mixtard: 16 units\r\npatient complains of fatigue\r\nto repeat HB , total count, electrolytes\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: mild pain over left lower limb \r\nPAIN SCORE:\r\nBLOOD SUGARS : 118 mg/dl \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nno fever spike reccorded yet\r\ninj clexane 0.4 ml restarted yesterday \r\nplanned for D/S on monday \r\nblood c/s reports due \r\nSeen by DrA.K.Bhat.\r\nPlan fr D/C monday.\n6 pm grbs 187 mg/dl ins.H.M 14 units given \r\n6 am grbs 117 mg/dl ins.H.M 16 units given \r\ninformed to DR TOM.\r\nSeen by DRA.K.Bhat.\r\nPlan fr D/C tmrw.\r\n\r\n6 pm grbs 191 mg/dl ins.H.M 14 units given \r\nrecorded fever spike , tem of 100.1 f -tab dolo 650 mg st dose given\n6 am grbs 116 mg/dl ins.H.M 16 units given -informed to DR TOM\r\n\r\n6 pm grbs 172 inj.H.M 14 units given - informed to DR LAKSHMI\r\n\r\nHAD FEVER SPIKE -tem 100.6 f - tab dolo 650 mg given\nSEEN BY DR. LAKSHMI &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: no fresh complaints\r\nPAIN SCORE:\r\nBLOOD SUGARS : 116 mg/dl \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\n10.45 am BP 150 /100 mmhg.\r\nSeen by DRA.K.Bhat.\r\nDRessings changed.Clean.\r\nAdvice:Change of dressing once in 2 days-betadine,jelonet,roll pad,crepe bandage.Leg elevation.REview 2 weeks.\n6 am grbs 117 mg/dl ins. H.A 18 units given \r\ninformed to DR LAKSHM I\nSEEN BY DR. MANOJ &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: no fresh complaints\r\nPAIN SCORE:\r\nBLOOD SUGARS : 117 mg/dl \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n'}, {'role': 'model', 'content': '\nIP Number: 6813\n\nPatient Number: 36447\n\nAdmission Date: 02-05-2017\n\nDischarge Date: 16-05-2017\n\nDiagnosis: Necrotising Fascitis -Left lower limb\r\ns/p extensive Fasciotomy with debridement of the necrotic tissue under SA\n\nClinical Exam(With BP): 58 year old male,Mr Jhonson , came from SANTHI ORTHO HOSPITAL (kodakara)discharged at request.Pt K/C/O T2DM for more than 12 years - on OHA . H/O fall at home on wed,later developed swelling over left ankle.started fever from friday, later admitted in santhi hospital.started on with iv antibiotics and other supportive measures.came here for further evaluvation and management.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: out side blood reports;\r\ncr-1.4\r\nurea-55\r\ntc -20,400\r\nesr 115\r\nna-130\r\n\n\nXray findings: left lower limb ;\r\nwarmth++\r\nswealling++\r\nredness++\r\n\n\nDiscussion: Johnson , 58 years was brought to the casualty with h/o fall and hit on the left leg followed by edema and cellulitis of the left leg. Patient was being treated at a local hopsital from where he was brought here. He is a known case of Type 2 DM and was on treatment for the same . At the time of admission , patient was in sepsis with high grade fever . All routine investigations were sent and Total count was elevated in the range of 29,000/cu.mm and RFT impaired. He was startedon Inj Pipercillin+ Tazotum( in renal dose) and Clindamycin . Though there was significant improvement in the general conditiion of the patient, the multiple pus filled blisters persisted .So Fasciotomywith debridement of the necrotic tissue was done under SA on 6/5/2017. Post surgery , the patients Hb dropped to 7 gm% and he was transfused with 3 pints of PRC. He recovered well except for a daily spike of fever . Blood culture was sent during a spike .Though there was no obvious cause for fever,patient was restarted on Pipercillin +Tazotum as i/v .Blood cultures remained sterile , but the break through fever came occasionally.The wound healed well and patient could be discharged in a stable condition with advise to review as OP for dressings.\n\nDiet: nan\n\nRemarks: Review with FBS ,PPBS \r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\n'}] |
6,935 | [{'role': 'user', 'content': '\nIP Number: 6935\n\nPatient Number: 37114\n\nPatient Name: MARY JOSEPH\n\nGender: F\n\nDate of Birth: 05-06-1934\n\nAddress: THEVERPARAMBIL HOUSE\n\nPincode: nan\n\nPhNo: 9745577755\n\nAdmission Date: 05-06-2017\n\nDischarge Date: 03-07-2017\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nCORONARY ARTERY DISEASE\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: patient has come with gangrenous left foot.patient has come with gangrenous left foot .patient has underwent amputation of 3 toes in the past 5 months.patien had developed difficulty in breathing in january and was admitted in the icu and was found to have mutliple heart blocks (cad)patient after some period of time developed a blackish discolouration of the second which was amputated first and followed by the 3 rd and the 4 th.patient has had a wound in the 2 nd toe and was completely healed 2 years back.patient is a known case of diabetes since 10 years and was under medications and now changed to insulin since 5 months. \n\nXray information: Peripheral Angioplasty done on 10.6.2017\r\nDiagnosis : CLI Left Lower Limb\r\nProcedure: Left SFA Plasty + STENTING \r\nFindings: CFA normal .Multisegment stenosis of proximal SFA with heavy calcified wall.CTO distal SFA with multiple collaterals and reformation in the popliteal artery.CTO of proximaal posterior tibial artery and short segment stenosis of distal PTA.ATA,Peroneal artey not visualised.\r\nFinal check angiogram showed good flow through SFA ,Popliteal and PTA upto ankle.\n\nClinical examination: BP: 130/70mmhg\r\ntemp : afebrile\r\nCVS : s1 s2 +\r\nRS : b/l NVBS +\r\nCNS : NO FND\r\nP/A : soft , non tender, no organmegaly \n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: GRBS at 6 pm 228 informed to Dr.laksmi and adv to give novorapid 4 units \r\nGRBS at 10 pm informed to Dr.laksmi and adv to give\nGRBS at 6 am informed to Dr.Laksmi and adv to give novorapid 4 units.\r\nSEen by DrA.K.BHat.\r\nContinue trt.\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\n\r\nno fresh complaints\r\narterial doppler required for left leg \r\ncardiac consultation required\r\npatient needs to be catherterised\r\nstop T.lasix\r\nstart INJ.Lasix 40mg iv 1-0-0 \r\n\nGRBS at 6 pm 159 mg/dl informed to DR.Radha and adv to give novorapid 4 units given\r\nGRBS at 10 pm 150mg/dl informed to DR.Radha and adv to give basalog 4 units\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nGRBS at 6 am 91 mg/dl informed to DR.Radha and adv to give novorapid 4 units \r\narterial doppler left leg done \r\ncontinue medications as per chart \r\nelectrolytes repeated\r\nsodium : 131mg/dl\r\npottasium : 3.9mg/dl \r\nstop T.lasix \r\nStop T.aldactone\r\nstart T.Dytor plus 1/2-0-0\r\n start C.fena vit 1-0-0\r\nplan for echo tom\r\nSeen by DRA.K.BHat.\r\nContinue trt.Plan fr midfoot amputation under SA(friday),Pending medical/cardiac fitness,.Preop.BT,CT,PT,INR,.\nGRBS at 6 pm 211 mg /dl informed to DR.Tom adv to give novorapid 4 units \r\npatient requested for discharge tomorrow\nAt 10 pm GRBS :160mg/dl ,Informed to DR.Tom ,advice to give Basalog :4Unit\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nAt 6 am GRBS :132mg/dl ,Informed to DR.Tom ,advice to give Novorapid : 4unit.\r\nno fresh complaints \r\nplan for discharge today \r\nT.dytor plus to be given as 1-0-0.\r\nsyr .looz to be give if still not dulcolax supppository \r\nSeen by DRA.K.BHat.\r\nContinue trt.\n6 pm GRBS 138mg/dl informed to DR.Manoj and adv to given novorapid 4 units .\r\npus culture klebsiella\r\ninj pansec given .\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nAt 6 am GRBS :133mg/dl ,Informed to DR.Manoj ,advice to give Novorapid:4unit \r\ncontinue same treatment \r\n\r\n\nGRBS at 6 pm 190mg/dl informed to Dr.Radha and adv to give novorapid 4 units .\nGRBS at 10 pm 189mg/dl l informed to Dr.Radha and adv to give insugen basalog 4units .\nGRBS at 6 am 1258mg/dl and adv to give novorapid 4 units\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: PATIENT BETTER\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\n\r\nFBS: 135 MG/DL\r\n\r\nCASE PLAN :TO CONTINUE THE SAME\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nSeen by DRA.K.BHat.\r\nPosted for left midfoot amputation on 13th june,under LA/SA.\r\nPreoperative Instructions:\r\nGet informed written consent.\r\nHigh risk consent.\r\nNil oral as per Anesthetist advice.\r\nClean&dress area on morning of operation after betadine scrub ,morning of operation.\r\nIV antibiotics.\r\nArrange one unit packed cells.\r\nMedical &Anesthetic fitness for the procedure.\r\nInform OT and anesthetist.\r\n------------------------------\r\nInformed written consent.\r\nThere is total gangrene of distal part of left foot.Three toes have previously been amputated. Now there is gangrene of remaining toes including big toe and there is large ulcer gangrenous infection and slough of right foot and pus extending to rest of foot in deep layers.There is also decreased circulation of leg from thigh level downwards,for which angioplasty had been done 2 days ago..There is cardiac disease,severe anemia,diabetes and neuropathy.Patient is on antiplatelets treatment.This foot gangrene, requires wound cleaning under Anesthesia.The dead tissues of the foot will be removed.Pus will be drained.The left foot will be assessed during operation,then amputation at mid foot level will be done.The exact level will be decided during operation.There is risk of increased bleeding &cardiac risks.The wound will be left open after the amputation.Due to diabetes and decreased blood circulation ,wound healing will be very much delayed.Regular dressing needs to be done during the healing period.During the recovery period strict nonweight bearing is needed to prevent wound failure.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-----------------------\nSEEN BY DR.TOM&TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:nil\r\nPAIN SCORE:1/5\r\nBLOOD SUGARS :GRBS at 10pm-209mg/dl.Informed to Dr.Radha adviced Inj.Lantus-4units s/c. \r\nGRBS at 6pm-170mg/dl.Informed to Dr.Radha adviced Inj.Novorapid-2units s/c\r\nBP: MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\nSEEN BY DR.tom&TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:ABDOMINAL SWELLING ON THE R SIDE.\r\nPAIN SCORE:NIL\r\nBLOOD SUGARS : GRBS at 6pm-164mg/dl.Informed to Dr.Lakshmi adviced Inj.Novorapid-2units s/c.\r\nGRBS at 10pm-176mg/dl.Informed to Dr.Lakshmi adviced Inj.Lantus-4units s/c. \r\nBP: MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nSeen by DRA.K.BHat.\r\nDRessings changed.Clean.\r\nOral ABx.\nSEEN BY DR. TOM&TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:nil\r\nPAIN SCORE:1/5\r\nBLOOD SUGARS : at 10 pm GRBS-187 mg/dl. Lantus-4 unit given. patient slept well.6 pm GRBS-116mg/dl. Dr Manoj adviced to give novarapid-4 unit. \r\nFBS-125 mg/dl\r\nBP: MM HG\r\nCASE PLAN :Plan on changing to oral antibiotic -Tab Doxy 100mg 1-0-0\r\nCont rest\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nSeen by DRA.K.Bhat.\r\nDRessings changed.Clean.\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaints \r\nBLOOD SUGARS : \r\n\r\nFBS: 178 MG/DL\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. LAKSHMI &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: COUGH\r\nBLOOD SUGARS : \r\nFBS: 128 MG/DL\r\nO/E MILD CREPS B/L\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaints\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nFBS: 151 MG/DL\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSeen by DRA.K.BHat.\r\nC&D.Clean.??PLan fr D/C thursday.SEEN BY DR.TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:nil\r\nPAIN SCORE:\r\nBLOOD SUGARS : 10pm GRBS 179mg/dl informed Dr Lakshmi advice to give Lantus 4u.\r\n6 pm GRBS-144 mg/dl \r\nBP: MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSeen by DrA.K.Bhat.\r\n?Plan fr D/C tmrw.SEEN BY DR.TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:nil\r\nPAIN SCORE:nil\r\nBLOOD SUGARS : 6pm-GRBS-139mg/dl,informed to Dr.Radha advised inj.novorapid 4u afterfood given. \r\n10pm-GRBS-111mg/dl.informed to Dr.Radha advised inj.lantus 4u s/c given. \r\nBP: MM HG\r\nCASE PLAN :continue physio\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nno fresh complaints\r\nphysiotherapy done\r\nBP monitoring adviced \r\ncontinue medications as per chart\r\nSeen by DrA.K.Bhat.\r\nC&D .Clean.\nAt 6 pm GRBS :97mg/dl ,Informed to DR.Tom ,advice to no need insulin now\r\nAt 10 pm GRBS :223mg/dl ,Informed to DR.Tom ,advice to Give lantus 4 units\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nno fresh comlpaints\r\nGRBS at 6 am 157mg/dl informed to DR.Tom and adv to give novorapid 6 units \r\ncontinue medications as per chart\r\nrepeat creatnine tomorrow\r\n\nT.azmarda 50mg to be made 1-0-1.\r\nSeen by DRA.K.BHat.\r\nContinue trt.\nGRBS at 6 pm informed to Dr.Lakshmi and adv to give\nGRBS at 6 pm 126mg/dl informed to Dr.Lakshmi and adv to give novorapid 2 units\nGRBS at 10 pm 156mg/dl informed to DR.laksmi adv to give lantus 4 units\nSEEN BY DR.TOM&TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:nil\r\nPAIN SCORE:\r\nBLOOD SUGARS : At 6 pm GRBS :126mg/dl ,Informed to DR.Lakshmi ,madam advice to give Novorapid :2unit.\r\nAt 10 pm GRBS :156mg/dl ,Lantus :4unit. \r\nBP: MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\nSeen by DRA.K.Bhat.\r\nDRessings changed.Clean.\nSEEN BY DR. RADHA &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:PATIENT BETTER\r\nBLOOD SUGARS : \r\nFBS: 107 MG/DL\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nno fresh complaints\r\ncontinue medications as per chart\r\nSeen by DRA.K.Bhat.\r\nDRessings changed.Clean.Continue trt.\nsyr.looz 101 ml to be given HS\r\nlignocaine ointment to be applied\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nno fresh complaints\r\nGRBS at 6 am 113mg/dl informed to Dr.Lakshmi and adv to give inj.novorapid 4 units\r\nthrombophob appointment to be applied\r\ncontinue medications as per chart\nGRBS at 6 am 121mg/dl informed to Dr.Radha and adv to give insugen R 4 units\nSeen by DRA.K.BHat.\r\nDRessings changed,.Clean.C/S taken.\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nno fresh complaints\r\npus culture sent \r\n continue medications as per chart\r\n\r\n\n\r\n injlantus 4 units given\nGRBS at 6 am 116mg/dl informed to DR.Manoj and advice to give novorapid 4 units\r\nSeen by DRA.K.Bhat.\r\nDressing once in2 days/.\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:no SPECIFIC COMPLAINTS\r\nFBS: 116 MG/DL\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:NO SPECIFIC COMPLAINTS\r\nFBS: 97 MG/DL\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR.Tom & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\n\r\n\r\nCASE PLAN :\r\nPus C/S Citrobacter\r\nContinue Tab. Doxycycline.\r\n\r\n\nS/B Dr. Kriti \r\n\r\nImp: Keratolysis Exfoliata\r\n\r\nAdv: Venusia max cream L/A twice daily\nSEEN BY DR. Manoj & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\n\r\nBLOOD SUGARS : \r\nPREDINNER: 212 MG/DL Inj. Novorapid 4U\r\nFBS:111 MG/DL Inj. Novorapid 4U\r\n\r\nBP:130/80 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nD/S tmrw after review by Dr.Bhatt\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:No specific complaints\r\nFBS:100 MG/DL\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nSeen by DRA.K.Bhat.\r\nDRessings changed.Clean.\r\nAdv:Change of dressing once in 2 days-betadine,cuticell.Oral ABx for 1 week.Review friday.\r\n'}, {'role': 'model', 'content': '\nIP Number: 6935\n\nPatient Number: 37114\n\nAdmission Date: 05-06-2017\n\nDischarge Date: 03-07-2017\n\nDiagnosis: Nonhealing Ulcer -left foot\r\nSevere LV dysfunction ( both systolic and diastolic)\r\nPOVD- underwent peripheral angioplasty and stenting of SFA and Tibial plasty\r\nTarsometatarsal amputation under ankle block on 13/6/2017\n\nClinical Exam(With BP): BP: 130/70mmhg\r\ntemp : afebrile\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: Chest X-Ray :\r\n\r\n\n\nXray findings: CVS : s1 s2 +\r\nRS : b/l NVBS +\r\nCNS : NO FND\r\nP/A : soft , non tender, no organmegaly\n\nDiscussion: 83 year old Mary was who is a known case of Type 2 DM was admitted with a non healing ulcer over the left foot . She has h/o amputation of 3 toes of the same foot over the past 5 months . Patient was started on i/v antibiotics( Inj Piperacillin+ Tazotum and Clindamycin) and supportive care. X ray chest done on admission showed a raised CTR with b/l CP angle blunting . Clinically she had b/l basal crepitations.As she had h/o CAD , patient was started on i/v diuretics .Podiatric surgical consult was taken. Dopplers study of the left lower limb was done and showed dampening of blood flow to the limb from below SFA . CT angiogram done elsewhere was also s/o Severe POVD . Keeping all this in mind , it was decided to go on with a trans metatarsal ( mid foot) amputation after revascularisation of the left lower limb. This was discussed in detail with the bystanders and relatives.Vascular surgical consult was taken with the reports of CT angiogram. The vascular surgeon opined for a angioplasty and stenting . Patient was shifted to Lourdes Hospital for the same where she underwent SFA angioplasty and stenting along with Tibial plasty. She recovered without complications and 2 days later underwent a atrans metatarsal amputation under ankle block. Prior to surgery , cardiac evalaution was done and cardiac fitness taken. Two pints of packed red cells were transfused during the surgery and one pint post surgery. There were no post operative complications .She recovered well. i/v antibiotics and LMWH were continued for a week post surgery. Later she was shifted to culture specific oral antibiotic and dual anti platelets as advised by the vascular surgeon.She could be discharged in a stable condition with advise to review in Podiatry and Endo OP.\n\nDiet: nan\n\nRemarks: Review on Friday in Podiatry OP\r\nReview in Endo OP in 2 weeks \r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor\r\n'}] |
6,969 | [{'role': 'user', 'content': '\nIP Number: 6969\n\nPatient Number: 21835\n\nPatient Name: V M PHILIP\n\nGender: M\n\nDate of Birth: 16-01-1940\n\nAddress: PARAMPATHOOR\n\nPincode: nan\n\nPhNo: 0479-2465331\n\nAdmission Date: 17-06-2017\n\nDischarge Date: 05-07-2017\n\nDiagnosis determined by the doctor when the patient was admitted: DIABETIC NEPHROPATHY WITH CRONIC RENAL FAILURE\nDIABETIC RETINOPATYH WITH NPDR\nTYPE 2 DIABETES MELLITUS\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: Pateint acme with complaints of nonhealing ulcer right foot.Patient is being ,managed with IV Antibiotics and other supportive measures.\n\nXray information: nan\n\nClinical examination: Temperature :98.6 °F\r\npulse :82 /min\r\nRespiration :20 /min\r\nBP :140 / 80 mm Hg\r\n\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: SEEN BY DR. LAKSHMI &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: PATIENT BETTER\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nFBS: 174 MG/DL\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: LEG PAIN\r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nFBS: 154 MG/DL\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSeen by DRA.K.BHat.\r\nInfected multiple ulcers rt foot,leg.PVD.\r\nAdv:IV ABx,BBact,cuticell,saline gauze dressings.SEEN BY DR.TOM&TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:nil\r\nPAIN SCORE:\r\nBLOOD SUGARS :10pm GRBS 139mg/dl informed Dr Lakshmi advice to give B 15u. \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSeen by DrA.K.Bhat.\r\nContinue trt.SEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:nil\r\nPAIN SCORE:\r\nBLOOD SUGARS : 6pm-GRBS-193mg/dl,informed to Dr.Radha advised inj.novorapid 6u afterfood given. \r\n10pm-GRBS-122mg/dl.informed to Dr.Radha advised inj.basalog 12u s/c given. \r\nBP: MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR.TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nno fresh complaints\r\n\r\ncontinue medications as per chart \r\nrepeat Hb, creat , TC , electrolytes \r\ninj.novorapid 8-8-4\r\ninj.basalog 4 units\r\ninj.clexane to be continued for two more days.\r\nSeen by DrA.K.Bhat.\r\nPlan fr D/C saturday.BBact,debrin,saline dressing.\nAt 6 pm GRBS :124mg/dl ,Informed to DR.Tom ,advice to give Novorapid :4 unit. \r\nAt 10 pm GRBS :mg/dl ,Informed to DR.Tom ,advice to give basalog 4units \r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nno fresh complaints\r\nGRBS at 6 am 60mg/dl informed to DR.Tom and Adv no insulin \r\nT.Ultracet to be given S.O.S\r\ninsulin to be stopped\r\nTab.Tragenta 5 mg 1-0-0 to be started\nSeen by DRA.K.BHat.\r\nContinue trt.Plan fr D/C tmrw.\nGRBS at 6 pm 246mg/dl informed to Dr.Lakshmi\nGRBS at 10 pm 251mg/dl informed to DR.laksmi adv to give basalog 4 units\nAt 6 am GRBS :126mg/dl ,Informed to DR.Lakshmi ,advice to no need insulin now.\r\nSEEN BY DR. TOM&TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:nil\r\nPAIN SCORE:\r\nBLOOD SUGARS : At 6 pm GRBS :246mg/dl ,Informed to DR.Lakshmi \r\nAt 10 pm GRBS :251mg/dl ,Basalog:4 unit \r\nBP: MM HG\r\nCASE PLAN :Pus culture,Start levoflox,Stop biopiper.\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\nSEEN BY DR. RADHA &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:PATIENT BETTER\r\nBLOOD SUGARS : \r\nFBS:190 MG/DL\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nno fresh complaints\r\n\r\ninj.clexane to be stopped\r\ninj.biopiper TZ to be stopped\r\ncontinue medications as per chart\r\nplan for bed side physiotherapy\r\nBuergers exercise to be done.\r\nSeen by DR.A.K.Bhat.\r\nContinue trt.\r\n\nGRBS at 6 pm 158 mg/dl informed to Dr.Lakshmi .patient on OHA\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nGRBS at 6 am 155 mg/dl informed to DR.lakshmi and patient is on OHA\r\nto stop levoflox . To start inj.cifran 2mg/iv 1-0-1\r\ncandid mouth paint adviced \r\nno fresh complaints\r\npus culture revelead psuedomonas\r\ninj.dalacin stopped\r\ncontinue same medications as per chart\nGRBS at 6 am 222mg/dl informed to Dr.Rahda and adv to give insugen R 10units\nSeen by DRA.K.BHat.\r\nContinue trt.Vascular opinion.\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nno fresh complaints\r\narterial doppler to be done today \r\nRBS to be checked \r\ncontinue medications as per chart\nGRBS at 6 pm 251mg/dl informed to Dr.Manoj and advice to give novorapid 4 units \r\nGRBS at 10 pm informed to DR.Manoj and adv to give basalog 6 units\nGRBS at 6 am 129mg/dl informed to Dr.Manoj and advice to give OHA.\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\nSEEN BY DR. Tom & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\n\r\nCASE PLAN :\r\nPlan to continue Inj. Biogladen x 5 days\r\nMedical managament with regular dressings with Cuticell, Debridase and B-bact.\r\n\nSEEN BY DR. Manoj & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\n\r\nBLOOD SUGARS : \r\nPREDINNER: 216 MG/DL Inj. Novorapid 2U\r\n10pm: 294mg/dl Inj. Basalog 6U\r\nFBS:131MG/DL Inj. Novorapid 4U\r\n\r\nBP:130/70 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nContinue Inj. Biogladen\r\n\r\n\nSEEN BY DR. TOM & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 172 MG/DL Inj. Novorapid 2U\r\n10pm: 197mg/dl Inj. Basalog 4U\r\nFBS:110MG/DL Inj. Novorapid 4U\r\n\r\nCASE PLAN :\r\nGRBS OD\r\nSeen by DRA.K.Bhat.\r\nCOntinue bbact,debridace dressings.\nSEEN BY DR. Manoj & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\n\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\n PPBS : MG/DL\r\n\r\nBP: MM HG\r\n\r\nCASE PLAN :\r\nL/E: Rt foot- wound healing granulated\r\nLt. foot - candid lotion for L/A on toe nails\r\n\r\nPlan for D/S tmrw.\r\n\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:NO SPECIFIC COMPLAINTS\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nFBS: 149 MG/DL\r\nCASE PLAN : TO DISCHARGE TODAY\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\nSeen by DRA.K.Bhat.\r\nContinue trt.'}, {'role': 'model', 'content': '\nIP Number: 6969\n\nPatient Number: 21835\n\nAdmission Date: 17-06-2017\n\nDischarge Date: 05-07-2017\n\nDiagnosis: OM Lt foot 4th and 5th amputated site.- High risk Foot \r\nUlcer Big Toe ( right foot) and calf with ascending cellulitis \r\n Severe POVD\n\nClinical Exam(With BP): ?OM Lt foot 4th and 5th amputated site.\r\n?Multiple ulcers -right foot\n\nSystolic BP: 140.0\n\nDiastolic BP: 80.0\n\nPhysical examination: Chest X-Ray :\r\n\r\n\n\nXray findings: Temperature :98.6 °F\r\npulse :82 /min\r\nRespiration :20 /min\r\nBP :140 / 80 mm Hg\r\n\n\nDiscussion: 77year old Philip came to the OP with h/o Type 2 DM and a non healing ulcer over the left foot ( toes ) with ascending cellulitis. He had h/o amputation of the 4th and 5 th left toes. Podiatry surgical consult was taken and in view of the POVD , a conservative approach was taken and patient was advised i/v antibiotics and complete off loading . Anti platelets and LMWH were started in view of the POVD along with tight glycaemic control with basal bolus insulin. Daily dressings were given . Doppler done showed severe POVD and as MRI was contraindicated in view o nephropathy vascular surgical opinion was taken.Vascular surgeon advised PGE1 injections, which he was given as per protocol over 5 days in ICU under close monitoring. There was adequate improvement with this treatment plan and the wound was granulating well. He was discharged in a stable condition on culture specific oral antibiotic and asked to review in OP.At the time of discharge , blood sugar were well controlled on a basal plus regime with a DPP 4 I ( Tab Trajenta).\n\nDiet: nan\n\nRemarks: Review with FBS ,PPBS \r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\n'}] |
7,097 | [{'role': 'user', 'content': '\nIP Number: 7097\n\nPatient Number: 37114\n\nPatient Name: MARY JOSEPH\n\nGender: F\n\nDate of Birth: 05-06-1934\n\nAddress: THEVERPARAMBIL HOUSE\n\nPincode: nan\n\nPhNo: 9745577755\n\nAdmission Date: 24-07-2017\n\nDischarge Date: 10-08-2017\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: patient has come for skin grafting.patient had come with a non healing ulcer left foot 1 month back.Patient has undergone amputation of 3 toes in the past 6 months. She had developed DOE in January and was admitted in the ICU and was found to have mutliple heart blocks (CAD).patient after some period of time developed a blackish discolouration of the second toe which was amputated first and followed by the 3 rd and the 4 th.patient is a known case of diabetes since 10 years and was under medications and now changed to insulin since 5 months. patient when admitted here last month had a report of CT angiogram done elsewhere was also s/o Severe POVD .Dopplers study of the left lower limb was done and showed dampening of blood flow to the limb from below SFA .Vascular surgical consult was taken with the reports of CT angiogram.Vascular surgical consult was taken with the reports of CT angiogram. The vascular surgeon opined for a angioplasty and stenting . Patient was shifted to Lourdes Hospital for the same where she underwent SFA angioplasty and stenting along with Tibial plasty. She recovered without complications and 2 days later underwent a atrans metatarsal amputation under ankle block. patient has now come for SSG\n\nXray information: nan\n\nClinical examination: CVS : S1 S2 +\r\nRS: B/L NVBS\r\nCNS : NO FND\r\nP/A : SOFT NON TENDER NO ORGANOMEGALY\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: At 6 pm GRBS :167mg/dl ,Informed to DR.Lakshmi ,advice to give Novorapid :4Unit. \r\nAt 10 pm GRBS :146mg/dl ,Informed to DR.Lakshmi ,advice to give Lantus:4unit. \r\n\nSeen by DRA.K.BHat.\r\nDaily dressing saline.Plan fr SSG under SA on Friday.\nSEEN BY DR. TON &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nno fresh complaints continue medications as per chart\r\nAt 6 am GRBS :121mg/dl,Infornmed to DR.Lakshmi ,advice to give Novorapid :4unit \r\nPGI infusion to be started \r\n ECG to be done\r\nInj.Monosoct 1 gm IV 1-0-1 to be started \r\ncontinue medications as per chart\r\n\r\n\n6pm GRBS 128 mg/dl informed Dr.Lakshmi adv: Novorapid 2u\r\nGRBS at 10 pm 201mg/dl informed to DR.Lakshmi and adv to give lantus 4 u\nGRBS at 6 am 105mg/dl informed to DR.lakshmi and adv to give novorapid 2 units\r\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nBP: 130/80 MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:No specific compliants\r\nFBS: 105 MG/DL\r\nCASE PLAN :Cardiology review today\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\nSeen by DRA.K.Bhat.\r\nFor Nibbling &SSG under SA 28th July 2 pm.Preop:Nil oral.Consent.C&D.Betadine scrub thigh.IV ABx.Medical fitness.\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nBLOOD SUGARS : \r\n\r\nFBS: 129 MG/DL\r\n\r\nBP: 130 80 MM HG\r\nCASE PLAN :\r\nCase today at 2 pm .Hold Antihypertensives.\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\nSEEN BY DR. Manoj and Dr Lakshmi \r\nPATIENTS GENERAL CONDITION STABLE\r\n\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: 102 MG/DL\r\n PPBS : MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN :\r\nContinue same treatment.\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. MANOJ &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: PATIENT BETTER\r\nFBS: 102 MG/DL\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:no specific complaints\r\nFBS: 103 MG/DL\r\nBP; 160/80 mmhg\r\nCASE PLAN :\r\nContinue same \r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nSeen by DRA.K.BHat.\r\nDressings changed.SSG taken up.Oral Doxycycline.\r\n\nSEEN BY DR. Tom &TEAM\r\n\r\nFBS: 119 MG/DL\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nDoing well, Contimue same.\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\n no fresh complaints\r\ncontinue medications as per chart.\r\nSeen bY DR.A.K.Bhat.\r\nContinue trt.\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\n no fresh complaints\r\nGRBS 6am 103mg/dl inform to Dr. Manoj advice novorapid 2units given.\r\ncontinue medications as per chart\r\nplan for physiotherapy\r\ncontinue T.azmarda 5 mg\r\nstop inj.monoscot\r\nto start Tab.Doxy LDR Forte.\r\nSeen by DRA.K.Bhat.\r\nDresings changed.SSG settling well.\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:No specific complaints\r\nFBS: 106 MG/DL\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nSeen by DrA.K.Bhat.\r\nContinue trt.\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:No specific complaints\r\nFBS:114 MG/DL\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\n\r\nSeen by DRA.K.Bhat.\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nno fresh complaints\r\nstart Tab.Galvus met 50/500 1-0-0 from today\r\nstop insulin\nSeen by DRA.K.Bhat.\r\nDressings changed.Clean.\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nno fresh complaints\r\ncontinue medications as per chart.\r\nSeen by DRA.K.BHat.\r\nContinue trt.\npla for physiotherpay today\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nno fresh complaints \r\ncontinue medication as per chart\r\nplan for discharge tomorrow.\r\nSeen by DRA.K.Bhat.\r\nPlan for D/C tmrw.\nSeen by DRA.K.Bhat.\r\nC&D.Clean SSGnad healed donor site.\r\nAdvice:Leg elevation.Review 2 weeks Friday OP.Dressings change once in 3 days-jelonet,pad,crepe bandage.Oil application thigh.'}, {'role': 'model', 'content': '\nIP Number: 7097\n\nPatient Number: 37114\n\nAdmission Date: 24-07-2017\n\nDischarge Date: 10-08-2017\n\nDiagnosis: Severe POVD, S/p angioplasty\r\ngangrene of the LT foot ,s/p tarsometatarsal amputation\r\nS/p SSG to the Lt foot\n\nClinical Exam(With BP): Temperature :98.6 °F\r\npulse :58 /min\r\nRespiration :20 /min\r\nBP :120 / 60 mm Hg\r\n\r\n\r\nLocal Examination :left foot ulcer healing.\n\nSystolic BP: 120.0\n\nDiastolic BP: 60.0\n\nPhysical examination: Chest X-Ray :\r\n\r\n\n\nXray findings: CVS : S1 S2 +\r\nRS: B/L NVBS\r\nCNS : NO FND\r\nP/A : SOFT NON TENDER NO ORGANOMEGALY\n\nDiscussion: 83 yr old with H/o HTN, DM ,POVD, ischemic heart disease. admitted for SSG to the amputated lt foot. pt was admitted, started on IV antibiotics, glycemic control achieved on insulin basal bolus regimen, seen by surgeon, Skin grafting to the LT foot was done on 28/7/17. Post op was uneventful. Regular follow up dressings were done as an outpatient. Pt clinicaly improved and being discharged under stable condition\n\nDiet: nan\n\nRemarks: Advice:Leg elevation.\r\nReview 2 weeks Friday OP.\r\nDressings change once in 3 days-jelonet,pad,crepe bandage.\r\nOil application thigh.\r\n'}] |
7,531 | [{'role': 'user', 'content': '\nIP Number: 7531\n\nPatient Number: 40178\n\nPatient Name: FRANCIS ANTONY\n\nGender: M\n\nDate of Birth: 18-11-1952\n\nAddress: D B F S\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 09-12-2017\n\nDischarge Date: 02-01-2018\n\nDiagnosis determined by the doctor when the patient was admitted: TYPE 2 DIABETES MELLITUS\nMixed hyperlipidaemia\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: Local Examination :left 2nd toe ulcer-infected-C/S taken.Cellultis.\r\n\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by DRA.K.Bhat.\r\nContinue trt\nSeen by DRA.K.Bhat.\r\nXRay -TPx tip OM.Continue trt.\ns/b Dr Prameela joseph ( dermatologist )\r\n\r\nAsteatotic dermatitis with? lipodermatosclerosis\r\nDiabetes\r\n\r\nAdv:\r\n\r\n1) Venusia max cream 3 times daily\r\n2) suggest doppler studies ( venous & arterial )for left lower limb.\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\nSEEN BY DR.TOM BABU &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nBLOOD SUGAR:\r\nFBS: 148 MG/DL\r\nBP:140/90 MM HG\r\nCASE PLAN :VENOUS DOPPLER LEFT LOWER LIMB TO BE DONE . \r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nBetter, afebrile.\r\nSeen DRA.K.BHat.\r\nDressings changed.\r\nFor bone nibbling and closure left 2nd toe under LA,16th DEC.OT.\r\nPreop:Informed Consent.C&D.IV ABx.Preop:HIV,HBsAg,anti HCV,BT,CT,PT,INR.\r\n----------------------\r\nInformed consent-There is ulcer infection of left 2nd toe including bone and other tissues with pus collection.This needs Bone nibbling and shortening of the toe,to control the infection.The exact loevel of shortening of the toe will be decided during operation.Due to neuropathy&diabetes the control of infection and wound healing needs close observation.The importance of offloading and long term footcare and footwear has been explained.Having understood the above,consent for operation is given.\nBettre, dressing insitu no oozing.\nSeen by DRA.K.Bhat.\r\nDressings changed.Suture line clean.Oral Clinda.Continue trt.\nSEEN BY DR. MANOJ &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nBLOOD SUGARS :\r\nFBS: 99 MG/DL\r\nBP: 120/80 MM HG\r\nCASE PLAN :INSUGEN 30/70 16-0-12. CST\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\nSeen by DRA.K.BHat.\r\nDRessings changed.Suture line clean.Plan fr D/C tuesDAY.\nBetter. wound healthy, no oozing.\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\nSEEN BY DR. MANOJ &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nBLOOD SUGARS : \r\nFBS: 325 MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN :TO DO HB, CREATININE BEFORE DISCHARGE\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nSeen by DRA.K.Bhat.\r\nDRessinsg changed.Clean.\r\n\nSeen by DRA.K.Bhat.\r\nPlan fr D/C tmrw.\nSeen by DRA.K.Bhat.\r\nSutures removed.Healed.\r\nAdv:Change of dressing once in 2 days-betadine.Review OP 2weeks.\nSEEN BY DR. MANOJ &TEAM\r\nPATIENTS GENERAL CONDITION STABLE, CLINICALLY BETTER.\r\nBP: 120/80 MM HG\r\nCASE PLAN :STOP CAP. DALACIN\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSeen by DR.A.K.BHat.\r\nBetadine dresings.\nBetter , afebrile.\nSeen by DrA.K.Bhat.\r\nDRessings changed.Clean.\nNil complaints.\r\nWound healthy.'}, {'role': 'model', 'content': '\nIP Number: 7531\n\nPatient Number: 40178\n\nAdmission Date: 09-12-2017\n\nDischarge Date: 02-01-2018\n\nDiagnosis: Infected ulcer on the 2nd left toe-Tip OM\r\n s/p Bone nibbling on 16/12/17\r\n\n\nClinical Exam(With BP): nan\n\nSystolic BP: 131.0\n\nDiastolic BP: 61.0\n\nPhysical examination: X-Ray L foot : Tip OM -2nd toe\r\n\r\n\n\nXray findings: Local Examination :left 2nd toe ulcer-infected\n\nDiscussion: Mr Francis Antony 65 year old presented with infected ulcer Left second toe since one month.Initially treated in another hospital but symptoms persisted.He was admitted and started on IV antibiotics.Clinically osteomyelitis was suspected.X-ray confirmed osteomyelitis.Blood sugar levels were controlled with basal bolus and premix insulin.After giving IV antibiotic for 5 days I and D and bone nibbling was done on 16/12/2017 under LA.Intra and post operative period were uneventful.Alternate day dressing given and suture removal done after 10 days.Wound healing was good and patient getting discharged under stable state.\n\nDiet: nan\n\nRemarks: Review after 1 weeks with FBS/PPBS'}] |
7,553 | [{'role': 'user', 'content': '\nIP Number: 7553\n\nPatient Number: 32830\n\nPatient Name: K M ABDUL RAHMAN\n\nGender: M\n\nDate of Birth: 15-09-1951\n\nAddress: KARUPPUMMOPIL HOUSE\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 16-12-2017\n\nDischarge Date: 01-01-2018\n\nDiagnosis determined by the doctor when the patient was admitted: PRIMARY HYPOTHYROIDISM\nDIABETIC NEUROPATHY\nCORONARY ARTERY DISEASE\nTYPE 2 DIABETES MELLITUS\nDIABETIC NEPHROPATHY WITH MICROALBUMINUREA\nDIABETIC RETINOPATYH WITH NPDR\n\nData from scanning: nan\n\nImpression data from scanning: nan\n\nDiscussion: nan\n\nXray information: nan\n\nClinical examination: Infected necrotic ulcers left leg-subcut.undermined infection/slough-fasciitis.Periosteitis tibia.\r\nDistal pulsations present\n\nPrecautions to be taken while treating the patient: POVD Lt. leg \n\nRemarks: SEEN BY DR. LAKSHMI &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nFBS:124 MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN :INS. R 14-12-6. B: 10U . CST\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSeen by podiatrist.Nail care done.\r\nSeen by DRA.K.Bhat.\r\nInfected necrotic ulcers left leg-subcut.undermined infection/slough-fasciitis.Periosteitis tibia.Distal pulsations present.Betadine/debrin dressings.Continue trt.\nSEEN BY DR. LAKSHMI &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nBLOOD SUGARS : \r\nFBS:165 MG/DL\r\nBP:130/80 MM HG\r\nCASE PLAN :T. FEVASKA PLUS HS. CARDIO CONSULTATION TODAY.ECHO TO BE DONE TODAY.SERUM CREATININE REPEAT TODAY. \r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nSeen by DRA.K.Bhat.\r\nContinue trt.Plan for Biopsy under LA-20th DEc.OT.Preop:Tests.XRay left leg AP./Lateral.Consent.Test dose.\r\n\nSEEN BY DR.LAKSHMI &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nBLOOD SUGARS : \r\nFBS: 135 MG/DL\r\nBP: 140/80 MM HG\r\nCASE PLAN :INJ. TRAMADOL SOS. CST\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nBetter, afebrile.\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\nSEEN BY DR. MANOJ &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nBLOOD SUGARS :\r\nFBS:132 MG/DL\r\nBP:140/80 MM HG\r\nCASE PLAN :INS. R 18-18-18. B 20 U. T . NEBICARD 2.5 OD. T. PANTOP OD. CAP. BECOSULES OD.CST\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\nSeen by DRA.K.Bhat.\r\nDressings changed.Ulcer slough present.\nSeen by DRA.K.Bhat.\r\nPlan for slough excision under SA on wednesday.PREOP:Preop tests.Medical fitness.\nSeen by DRA.K.Bhat.\r\nPosted for slough excision under SA,27th dec..\r\nPreoperative Instructions:\r\nGet informed consent.\r\nNil oral as per Anesthetist advice.\r\nClean&dress area on morning of operation.\r\nIV antibiotics.\r\nMedical &Anesthetic fitness for the procedure.\r\nInform OT and anesthetist.\r\n---------------\r\nInformed consent.\r\nThere is unhealthy ulcers of left leg to about 8x8 cm.This ulcer infection is extending to the deep regions of leg, possibly upto bone.There is diabetes and decreased circulation of leg.Previously operations had been done in another hospital .Now the ulcer infection of leg needs incision and drainage and slough(dead tissues) removal under anesthesia.During operation the spreading infection will be opened up and dead and necrotic skin and soft tissues will be removed.The extent and amount of tissues removed will be decided during operation.In diabetes the initial wound will be small,but spreading infection will extend below the skin and hence after surgery the wound will be larger than the present wound.Due to diabetes and extent of ulcer, control of infection and healing will be delayed.Due to extent of infection the healing and circulatory condition of the wound after operation will need observation.Regular dressings and followup will be needed.Understanding the above consent for anesthesia and operation is given.\r\n-----------------------\nSeen by DRA.K.Bhat.\r\nContinue trt.Preop:HB,Urea,Creat.Surgery rescheduled tomorrow.\nPosted for bone nibbling today.\r\nBone nibbling and slough excission done Lt. leg under Spinal done on 28/12/17.Px actively moved his both legs after the procedure.He is shifted to room from SICU with stable vitals.\nSeen by DRA.K.BHat.\r\nContinue trt.TAB.Wakcef 500 mg 1-0-1.\nSEEN BY DR.MANOJ &TEAM\r\nPATIENTS GENERAL CONDITION STABL\r\nBLOOD SUGARS : \r\nFBS: 105 MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN :INS. R 10-10-10. B 26 U. CST\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nSeen by DrA.K.Bhat.\r\nDRessings changed.Clean.Plan fr D/C monday.\r\n\nSeen by DrA.K.Bhat.\r\nContinue trt.\r\nBetter.One episode fever spike yesterday.\r\nTem. 100.2 F.\r\nDressing insitu , no oozing.\r\nInvws : TC, URE today.\nSEEN BY DR. LAKSHMI &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nBLOOD SUGARS : \r\nFBS:141 MG/DL\r\nBP:140/90 MM HG\r\nCASE PLAN :PLAN FOR DISCHARGE TODAY.\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\nSeen by DrA.K.Bhat.\r\nDRessings changed.Clean.\r\nAdv:Change of dressing once in 2 days-betadine,cuticell.Oral ABX 1 week.Review OP 1 Week.'}, {'role': 'model', 'content': '\nIP Number: 7553\n\nPatient Number: 32830\n\nAdmission Date: 16-12-2017\n\nDischarge Date: 01-01-2018\n\nDiagnosis: NPDR+\r\nDSPN\r\nPOVD\r\nUAER- elevated \r\nECG- normal\r\nCXR- P/A - normal\r\nLiver Enzymes- normal\r\nMusculoskeletal Manifestations of Diabetes++\r\nInfected ulcer Lt leg, s/p wound debridement\n\nClinical Exam(With BP): nan\n\nSystolic BP: 120.0\n\nDiastolic BP: 70.0\n\nPhysical examination: Chest X-Ray :\r\n\r\n\n\nXray findings: Infected necrotic ulcers left leg-subcut.undermined infection/slough-fasciitis.Periosteitis tibia.\r\nDistal pulsations present\n\nDiscussion: Mr.Abdul Rahman,66 years old came with c/o infected ulcer left leg.He is a k/c/o Type2 DM,CAD.He was admitted and evaluated.He was managed with IV Antibiotics, analgesics,LMWH, Basal Bolus of Insulin and other supportive measures.Dermatology and Surgery opinion was sought.Biopsy was taken from the Ulcer and HPE showed Ulceration with supurative inflammation.Bone nibbling and slough excission was done under Spinal done on 28/12/17.Post op period was uneventful.His symptoms have improved and is being discharged in a stable state.\n\nDiet: nan\n\nRemarks: Review in Medicine and Surgery OP 1 Week\r\n.Adv:Change of dressing once in 2 days-betadine,cuticell.\r\n\r\n\r\n\r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\n'}] |
7,856 | [{'role': 'user', 'content': "\nIP Number: 7856\n\nPatient Number: 42733\n\nPatient Name: RAJU L\n\nGender: M\n\nDate of Birth: 14-09-1951\n\nAddress: AROMAL HOUSE\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 10-04-2018\n\nDischarge Date: 28-04-2018\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: nan\n\nXray information: nan\n\nClinical examination: Pt conscious,oriented\r\nchest clear\r\nP/A soft\r\nCNS - NFND\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: c/s/b Duty Doc\r\nClinical Summary collected\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nPAIN SCORE:3/10\r\nBLOOD SUGARS : \r\nPREDINNER: 135 MG/DL\r\nFBS:135 MG/DL\r\nBP: 120/70 MM HG\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nSeen by DRA.K.BHat.\r\nCASE PLAN : Left foot severe infective,ischemic gangrene left foot(lateral 3 toes already amputated)upto midfoot region.POVD.?PLAN.Continue trt.\r\n\nSEEN BY DR. MANOJ &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nBLOOD SUGARS : \r\nPREDINNER: 180 MG/DL\r\nFBS: 159 MG/DL\r\nBP: 130/70 MM HG\r\nCASE PLAN : INS R 20-20-20U. B 18 U\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nSeen by DRA.K.BHat.\r\n\nSEEN BY DR. MANOJ &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nBLOOD SUGARS : \r\nPREDINNER: 217 MG/DL\r\nFBS:150 MG/DL\r\nBP: 160/80 MM HG\r\nCASE PLAN : CBC, ELECTROLYTES, CREATININE TO BE SENT ON TOMAROW\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\nPlan for left proximal foot amputation under EPidural on 17th April(tuesday).Preop:Blood workup.Medical fitness.Daily Betadine dressings.IV ABx continue.Stop Inj.Clexane 24hrs before.\nSEEN BY DR. TOM&TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:PAIN OVER THE THE ULCER\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:128MG/DL\r\nFBS155MG/DL\r\nBP:150/80MM HG\r\nCASE PLAN :CONTINUE CURRENT MEDICATION\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSeen by DrA.K.Bhat.\r\nPosted for proximal foot amputation, left foot, on 17th APr.under SA,8AM..\r\nPreoperative Instructions:\r\nGet informed consent.\r\nNil oral as per Anesthetist advice.\r\nClean&dress area on morning of operation.\r\nIV antibiotics.\r\nMedical &Anesthetic fitness for the procedure.\r\nInform OT and anesthetist.\r\n=====================\r\nInformed consent.\r\nThe Left foot toes has previously been amputated at multiple levels . Now there is gangrene of 2nd/1st toe and there is large ulcer gangrenous infection and slough of left foot and pus extending to rest of foot in deep layers.There is coronary artery disease.There is also decreased circulation of leg.There is diabetes and neuropathy.The foot condition requires wound cleaning under Anesthesia.The dead tissues of the foot will be removed.Pus will be drained.The left foot will be assessed during operation,then amputation at proximal foot level will be done.The exact level will be decided during operation.Due to diabetes and decreased blood circulation ,wound healing will be delayed.Due to the nature &severity of infection and gangrene,repeat operation may be sometimes needed.During the recovery period strict nonweight bearing is needed to prevent wound failure.The overall recovery and function of the foot will need close observation.The above points have been explained and understood and full high risk consent for anesthesia &operation is given.\r\n------------------------------\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nPt shifted to room\r\nculture sent\r\nBLOOD SUGARS : \r\nPREDINNER: 160 MG/DL\r\nFBS: 145 MG/DL\r\n PPBS : MG/DL\r\nBP: 140/80 MM HG\r\n\r\n\nSEEN BY DR. MANOJ &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nPAIN SCORE:4/10\r\nBLOOD SUGARS : \r\nPREDINNER: 167 MG/DL\r\nFBS:236 MG/DL.\r\nBP:160/80 MM HG\r\nCASE PLAN : T. FLEXLAST HS. CST\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS).\r\nSeen by DrA.K.BHat.\r\nContinue trt.\r\n\r\n\nSeen by DRA.K.Baht.\r\nContinue trt.\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\n\r\nBLOOD SUGARS : \r\nPREDINNER: 173 MG/DL\r\nFBS: 140 MG/DL\r\n\r\nBP:140/80 MM HG\r\n\r\n\nSeen by DrA.K.BHat.'\r\nDRessings changed.Clean.Adv:Oral Oxcip 500mg 1-0-1.\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\n\r\nPAIN SCORE:5/10\r\nBLOOD SUGARS : \r\nPREDINNER: 103 MG/DL\r\nFBS: 152 MG/DL\r\n\r\nBP: 170/80 MM HG\r\nCASE PLAN : Podiatry review\r\n\r\n\r\n\nSEEN BY DR.TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Occatoional pain on amputation site.\r\nPAIN SCORE:3/10\r\nBLOOD SUGARS : \r\nPREDINNER:159 MG/DL\r\nFBS: 197 MG/DL\r\nBP:150/90 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\nWALKER TRAINING BY PHYSIO.\nSeen by DRA.K.BHat.\r\nDRessings changed.Clean.Plan fr D/C after one more dressing,.\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 188 MG/DL\r\nFBS: 144 MG/DL\r\n\r\nBP:140/70 MM HG\r\nCASE PLAN : continue dressing,Physio\r\n\r\n\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nPAIN SCORE: 3/10\r\nBLOOD SUGARS : \r\nPREDINNER:200 MG/DL\r\nFBS: 177 MG/DL\r\nBP: 140/90 MM HG\r\nCASE PLAN : CST\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS).\r\nSeen by DRA.K.BHat.\r\nContinue trt.?Plan FR D/C FRiday.\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\n PPBS : MG/DL\r\nBP: MM HG\r\nCASE PLAN : CBC, CREATININE, ELECTROLYTES TO BE DONE ON FRIDAY. . T . GLUFORMINI 500 BD. \r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nSeen by DRA.K.Bhat.\r\nDRessings changed.Continue trt.\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nBLOOD SUGARS : \r\nPREDINNER: 207 MG/DL\r\nFBS:140 MG/DL\r\nBP:120/80 MM HG\r\nCASE PLAN : BED SIDE PHYSIO TO BE START. \r\nINS R16-16-16U. \r\nT. ROSEDAY A 10 0-0-1. \r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS).\r\nSeen by DRA.K.BHat.\r\nContinue trt.\nSEEN BY DR. MANOJ &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nPAIN SCORE:1/10\r\nBLOOD SUGARS : \r\nFBS: 128 MG/DL\r\nBP:120/80 MM HG\r\nCASE PLAN : CST\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nSEEN BY DR. MANOJ &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nPAIN SCORE:2/10\r\nBLOOD SUGARS : \r\nFBS: 130 MG/DL\r\nBP:140/80 MM HG\r\nCASE PLAN : CST\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nSeen by DR.A.K.Bhat.\r\nContinue trt.Plan fr D/C tmrw.\r\n\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBP: 150/80 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\nSeen by DR.A.K.BHAT.\r\nDressings changed-clean.\r\nAdv:Change of dressings once in 2 days-betadine,cuticell.Oral ABx 2 weeks,.Review 10days.\r\n\nSEEN BY DR. MANOJ &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nPAIN SCORE:3/10\r\nBP: 150/80 MM HG\r\nCASE PLAN :PLA FOR DISCHARGE TODAY.\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n"}, {'role': 'model', 'content': '\nIP Number: 7856\n\nPatient Number: 42733\n\nAdmission Date: 10-04-2018\n\nDischarge Date: 28-04-2018\n\nDiagnosis: CAD - PTCA done 15 years back\r\nPOVD\r\nDiabetic foot - p/s mid foot amputation left\n\nClinical Exam(With BP): He presented to us with h/o amputation Left 3rd, 4th and 5th toe came with infected gangrene left 2nd toe since 2 months.\r\nk/c/o DM,HTN\r\nCAD - PTCA done 15 years back\r\nPt conscious,oriented\r\nchest clear\r\nP/A soft\r\nCNS - NFND\r\n\r\n\n\nSystolic BP: 130.0\n\nDiastolic BP: 80.0\n\nPhysical examination: Chest X-Ray : nil\r\n\r\n\n\nXray findings: Pt conscious,oriented\r\nchest clear\r\nP/A soft\r\nCNS - NFND\n\nDiscussion: 66 yr old Mr Raju L with h/o amputation of left 3rd,4th and 5th toe came with infected gangrene left 2nd toe since 2 months. He is a k/c/o of DM, HTN with h/o CAD, PTCA done 15 yrs back. He was admitted and started on iv antibiotics. He and his relatives were briefed on the options with regards to the viablity of the remaining toes - retaining the left big toe versus mid foot amputation. They opted for the latter. A proximal foot amputation left foot under SA done on 17-04-2017. Post op period was uneventful. Alternate day dressings were given and he is discharged in a stable condition.\n\nDiet: nan\n\nRemarks: To report SOS in case of discharge from the wound site, pain, fever, or acute swelling of the limb.\r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\nAlternate day dressing as advised\r\nComplete offloading of left foot\r\nSelf mointoring of blood glucose as advised - to maintain a log book\r\nPPBS after 2 weeks and review at Endo and Podiatry OP.'}] |
7,943 | [{'role': 'user', 'content': "\nIP Number: 7943\n\nPatient Number: 42255\n\nPatient Name: AHMED KHAMIS\n\nGender: M\n\nDate of Birth: 24-04-1982\n\nAddress: OMAN\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 07-05-2018\n\nDischarge Date: 23-05-2018\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: Xray (R) foot - Disorganised tarsal and metatarsal bones and joints\n\nClinical examination: nan\n\nPrecautions to be taken while treating the patient: Tab. Cefdinir x 2 weeks \r\nTO start on Calcium supplementation along with Vit D3 seperately for long period. \r\nContinue B complex and Iron for further of 2 weeks\n\nRemarks: c/s/b Duty Doctor\r\nclinical Summary collected\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nPATIENT POSTED FOR RIGHT FOOT RECONSTRUCTION TODAY\r\nBP: 160/80 AT 10AM\r\nADVICE: TAB PRAZOSIN 1 MG STAT\r\n\r\n\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nBLOOD SUGARS : \r\nPREDINNER: 319 MG/DL\r\nFBS: 224 MG/DL\r\n PPBS : 434 MG/DL\r\nBP: 140/80 MM HG\r\n\r\n\nSEEN BY DR.TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nPAIN SCORE:2/10\r\nBLOOD SUGARS : \r\nPREDINNER:381 MG/DL\r\nFBS:251MG/DL\r\nBP:140/80 MM HG\r\nCASE PLAN :Foleyes catheter removal today.\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS).\nS/B Dr. Rajesh Simon\r\nHistory noted\r\nC/o having increased soakage after he attempted to go to bathroom after keep the foot down. \r\nO/E : Soakage ++ \r\nChange of dressing done and wound ooze still persist. \r\nCulture taken from the bloody ooze.\r\nAdv: Repeat blood parameters along with protien and renal profile\r\nTO build up protiens\r\nTO continue IV antibiotics.\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nPAIN SCORE:5/10\r\nBLOOD SUGARS : \r\nPREDINNER: 253 MG/DL\r\nFBS: 165 MG/DL\r\n PPBS : 268 MG/DL\r\nBP:150/70 MM HG\r\nCASE PLAN :Stop linizolid.\r\n Nephro consultation\r\n S.alb,globulin,total protein\r\n T.Nebicard 2.5 stat\r\n\r\n\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nPAIN SCORE:5/10\r\nBLOOD SUGARS : \r\nPREDINNER: 253 MG/DL\r\nFBS: 165 MG/DL\r\n PPBS : 268 MG/DL\r\nBP:150/70 MM HG\r\nCASE PLAN :Stop linizolid.\r\n Nephro consultation\r\n S.alb,globulin,total protein\r\n T.Nebicard 2.5 stat\r\n 1 pint blood transfusion today\r\n\r\nPRBC transfusion started- A positive\r\n unit number- 1264\r\n collection date - 23/4/18\r\n exp date- 4/6/18\nSEEN BY DR.TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nPAIN SCORE:1/10\r\nBLOOD SUGARS : \r\nPREDINNER: 150 MG/DL\r\nFBS: 154 MG/DL\r\nBP:150/70 MM HG\r\nCASE PLAN : IV Ab's \r\nTransfusion 1 Pack PRBC today.\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\n\nS/ b Dr. Rajesh S\r\nPt reviewed\r\nno complaints\r\nWound examind and clean\r\nMinimal soakage present\r\nChange of dressing done\r\nPlan: Follow up culture\r\nTo continue medications as before anc change of antibiotics if needed\r\n\nFollow up.\r\nNo complaints.\r\nWound examined and found clean. \r\nMinimal soakage continuing from the K wire site. Rest of the wounds has healed.\r\n\r\nAdv: Continue same. \r\nPlan for alternate suture removal after 3 days. \r\n\r\n\nSEEN BY DR.TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nPAIN SCORE:1/10\r\nBLOOD SUGARS : \r\nPREDINNER:109 MG/DL\r\nFBS:195 MG/DL\r\nBP:140/90 MM HG\r\nCASE PLAN :Hb 6.7\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS).\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\n\r\nPAIN SCORE:5/10\r\nBLOOD SUGARS : \r\nPREDINNER: 162 MG/DL\r\nFBS: 125 MG/DL\r\n\r\nBP: 150/80 MM HG\r\nCASE PLAN :reduce bolus dose- 12-12-8\r\n\r\n\nS/ B Dr. rajesh Smon\r\nPt reviewed. No complaints.\r\nWound clean. Sutures in the dorsum of the foot removed. Foot in the medial side reasonably healing well except for the area of K wire. \r\nK wire removed.\r\nWound approximated\r\nPlan : can be discharged with Tab. Cefdinir x 2 weeks \r\nTO start on Calcium supplementation along with Vit D3 seperately for long period. \r\nContinue B complex and Iron for further of 2 weeks\r\n\r\n"}, {'role': 'model', 'content': '\nIP Number: 7943\n\nPatient Number: 42255\n\nAdmission Date: 07-05-2018\n\nDischarge Date: 23-05-2018\n\nDiagnosis: Secondary Hypertension - (CRF)\r\nCHARCOTS FOOT (R) with extensive marrow edema in the tarsal and tarsometatarsal bones with degenerative changes, deformity, destruction and dislocation\r\nP/S Charcots Foot Reconstruction\r\nDimorphic Aneamia (Secondary to CRF and Chronic Disease) \r\nHIGH RISK- Lt foot\n\nClinical Exam(With BP): nan\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: Xray (R) foot - Disorganised tarsal and metatarsal bones and joints.\r\n(R) 3rd toe amputation due to wet gangrene on october 2017.\r\nMRI (R) foot : signs of osteomyelitis, primary bon marrow oedema.Tenosynovitis of the flexor and paroneal tendons.Extensive marrow edema in the tarsal and tarsometatarsal bones with degenerative changes, deformity, destruction and dislocation.\r\nX-Ray (R) foot : Multiple fractures in the proximal metatarsal bones and charcot joint.\r\nWound culture : (09/01/18) Enterococcus faecalis sensitive to ampicillin.\n\nXray findings: nan\n\nDiscussion: Mr.Ahmed Khamis 36yr/M presented with history of acute charcots foot with marrow edema in the Right tarsal and tarsometatarsal bones with degenarative changes deformity, destruction and dislocation.\r\nHe was admitted here for Rt. foot reconstruction (he was seen here prior to this and he was given BK slab and strict offloading with foot elevation for 1 month to reduse the swelling and inflamation).He was re-admitted for Right foot reconstruction.An insulin pump (640 G) was deployed temporarily for achieving tight glycemic control. Right foot recontruction done under GA was done on 08/05/18 after attaining fitness from medicine and cardiology.His intra and post op days were uneventful. His hemoglobin levels were stable immediately post OP but started to decline after a few days after the surgery. 2 units oF PRBC`s were given to correct the anemia immediately. On further investigation of the anemia, he was found to have nephrotic range protienuria. His hematocrit and PCV were very low as well - suggesting a hemodilution (as a result of protienuria). EPO + iron injections were given for the anemia. Peripheral blood picture was suggestive of dimorphic anemia. Dressings were changed once in 3 days. His blood sugars were maintained in a tight range through out with the help of a insulin pump.Sutures in the dorsum of the foot was removed on 22/05/18. Foot in the medial side reasonably healing well except for the area of K wire. K wire was removed and wound is approximated. He is beign discharged in stable condition with a healthy surgical sites/ wounds.\n\nDiet: nan\n\nRemarks: Report SOS to the hospital in case of discharge from the wound, fever, vomiting or loss of appetite\r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\nHe is advised to completely off load Rt. foot\r\nSMBG as advised - to maintain a log book (his blood sugars are to be maintained below 200 mg/dl at all times)\r\nAdvised to review on Friday for wound inspection\r\nAdvised to do a Se Creat, Se Hemoglobin once he gets back home\r\n'}] |
8,108 | [{'role': 'user', 'content': '\nIP Number: 8108\n\nPatient Number: 44360\n\nPatient Name: ALI KHAMIS ALI\n\nGender: M\n\nDate of Birth: 14-05-1935\n\nAddress: AL BALUSHI\n\nPincode: nan\n\nPhNo: 7025767790\n\nAdmission Date: 04-07-2018\n\nDischarge Date: 21-07-2018\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: echo done shows adequate LV systolic function\r\ngrade1 diastolic dysfunction\r\nmild MR\r\nusg done shows gall bladder sludge,b/l renal stones,prostatic urethral stone,active cystitis,prostatomegaly\r\nxray chest taken\r\npft done shows small airway obstruction\r\nhb-8.6\r\nesr-90\r\ncreat-1.35\r\nhba1c-6.53\r\n\n\nClinical examination: Left foot large discharging ulcer foulsmelling pus-C/S taken.Pus tracks subcut. plantar aspect upto instep.&dorsum foot.Ulcer at bases of lateral 4 toes,with exposed bones of 4th toe-suggesting OM(Complete OM destruction of 4th ray),toes edematous.DP present.Cellulitis extends to leg.\r\nPLAN:I&D,Slough excision,fasciotomy,bone nibbling under SA,6th July.\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: SEEN BY DR. tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:ulcer on plantar aspect of left foot\r\ndressing done by podiatry\r\nCASE PLAN :\r\nxray left foot AP & Oblique\r\ndr bhat consultation\r\nPATIENT CONDITION ( AS EXPLAINED TO THE BYSTANDERS)\r\n\r\nSeen by DRA.K.Bhat.\r\nLeft foot large discharging ulcer foulsmelling pus-C/S taken.Pus tracks subcut. plantar aspect upto instep.&dorsum foot.Ulcer at bases of lateral 4 toes,with exposed bones of 4th toe-suggesting OM(Complete OM destruction of 4th ray),toes edematous.DP present.Cellulitis extends to leg.\r\nPLAN:I&D,Slough excision,fasciotomy,bone nibbling under SA,6th July.Preop:Nil oral.INformed written consent.IV ABx.C&D.Medical and anesthetic fitness.\r\n----------------------\r\nInformed consent.\r\nThere is large pus filled infection of left foot extending from base of 4th toe to mid foot region.This pus infection is extending to the region of base of other toes all around 4th toe and its base,upto bone and joint-complete infective destruction of bone.There are multiple pus filled tissue in this region of foot and on dorsum of foot also.There is infection extending to foot.There is diabetes and neuropathy and decreased circulation of leg.There is history of coronary artery disease and pacemaker insertion.The infection of foot needs incision and drainage and slough excision and nibbling of infected bones, under anesthesia.During operation, the spreading infection will be opened up and dead and necrotic skin and soft tissues will be removed.In diabetes, the initial wound will be small,but spreading infection will extend below the skin and hence after surgery, the wound will be larger than the present wound.Due to diabetes and decreased circulation,control of infection and healing will be delayed.Repeat surgery may be needed.Due to extent of infection, the healing and circulatory condition of toes will need observation.The importance of long term offloading of ulcer has been explained.Understanding the above, consent for anesthesia and operation is given.\r\n-------------------------------\nSEEN BY DR. LAKSHMI &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: ABDOMINAL DISCOMFORT\r\nPAIN SCORE:1/5\r\nBLOOD SUGARS : \r\nPREDINNER: 171 MG/DL\r\nFBS: 89 MG/DL\r\nBP: 140/80 MM HG\r\nCASE PLAN : T. F PAN 40 0-0-1. SYP LOOSE 15 ML 1-0-1. INJ. CLIXANE 0.4MG 1-0-0. T . ATORVA 10 MG 1-0-1. \r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.BHat.\r\nDressings changed.Clean.Continue trt.\r\n\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBP: 140/90 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\nSeen by DRA.K.BHat.\r\nDRessings changed.Clean.Plan fr secondary suturing next week.Tab.Faropenem bd.\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBP: 140/90 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.BHAt.\r\nContinue trt.\r\n\nSEEN BY DR. tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: no fresh complaints\r\nPAIN SCORE: 0/5\r\nCASE PLAN :\r\nIron infusion today\r\ncheck Hb tomorrow\r\nstop inj clexane\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\ncontinue same line of management.\r\nSeen by DRA.K.BHat.\r\nDRessings changed.Clean.\r\n\r\n\nSeen by DRA.K.BHat.\r\nContinue trt.Plan for secondary suturing under SA on Tuesday 17th july.\nSeen by DRA.K.BHat.\r\nDRessings changed.Clean.\nSeen by DRA.K.BHat.\r\nFor secondary suturing under SA,OT,17th JUly.Preop:Nil oral.Consent.C&D.Inj.Biopiper 4.5 gm IV bd.\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 134 MG/DL\r\nFBS: 237 MG/DL\r\nBP:140/90 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DR.AK.BHat.\r\nContinue trt.Inj.Biopiper 2.25 gm IV 8th hrly.\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nNO FRESH COMPLINTS\r\nPAIN SCORE:1/5\r\nBLOOD SUGARS : \r\nPREDINNER:207 MG/DL\r\nFBS: 101 MG/DL\r\nBP: 140/90 MM HG\r\nCREATININE=2.8\r\nUREA=54\r\nCASE PLAN :\r\nURINE R/E\r\nNEPHROLOGY CONSULT\r\nLEG ELEVATION\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.BHat.\r\nDRessings changed.Clean.Tab.Faronem.\r\n\nS/B Dr Sooraj\r\n-----------------\r\nelderly gentleman\r\nDM, Ac on CKD\r\ncreat - 1.5 - improved to 1 (?wrong value) - sudden jump to 2.4-2.9\r\nThe in between value of 1 cannot be explained\r\nno nausea, vomiting\r\nno abdominal discomfort\r\nmoving bowels, urinating well\r\ndenies hematuroa\r\n\r\no/E - pale, adequate hydration, P/A - soft, nontender no bruit\r\n\r\nImp: Acute on CKD - likely underlying DKD - ?superadded AIN ?microscopic hematuria secondary to stones ?PIGN- no previous urine reports available to compare\r\n\r\nSuggest:\r\n1. In view of the suspicion of an Acute Interstitial Nephritis, to stop Piperacillin Tazobactum and to consider shifting to meropenem\r\n\r\n2. To do serum C3, C4, ASO titre\r\n\r\n3. Tab GFRSAVE 1-0-1\r\n Cap Ferisome 1-0-0\r\n\r\n4. Repeat urine routine tomorrow. To do 24 urine protein, serum CPK, LDH, platelets, peripheral smear\r\n\r\n5. To add Cap Ferronemia 1-0-0 in view of high ferritin\r\n\r\nstrict glycemic control\r\n\r\n\r\n\r\n\nSeen by DRA.K.BHat.\r\nPlan fr D/C tmrw.\nSeen by DRA.K.BHat.\r\nDressings changed.Clean.\r\nAdv:Change of dressings once in 2 days-betadine oint.Suture removal on August 1st.NO WEIGHT BEARING ON Left foot for 1 month.Specialised footwear after that.'}, {'role': 'model', 'content': '\nIP Number: 8108\n\nPatient Number: 44360\n\nAdmission Date: 04-07-2018\n\nDischarge Date: 21-07-2018\n\nDiagnosis: s/p I&D,Slough excision,fasciotomy,bone nibbling - Left foot done on 6/7/18\r\nCAD S/P PCI to LAD with DES\r\nPermanent Pacemaker in situ\r\n\n\nClinical Exam(With BP): nan\n\nSystolic BP: 140.0\n\nDiastolic BP: 80.0\n\nPhysical examination: Echo done shows adequate LV systolic function\r\ngrade1 diastolic dysfunction\r\nmild MR\r\nUSG done shows gall bladder sludge,b/l renal stones,prostatic urethral stone,active cystitis,prostatomegaly\r\nxray chest taken\r\npft done shows small airway obstruction\r\nhb-8.6\r\nesr-90\r\ncreat-1.35\r\nhba1c-6.53\r\n\n\nXray findings: O/E- Left foot large discharging ulcer - foul smelling. Pus tracking subcutenously. plantar aspect upto instep.& dorsum foot. Ulcer of bases - lateral 4 toes with exposed bones of 4th toe - suggesting OM, toes edematous. DP present. Cellulitis extends to leg.\n\nDiscussion: Mr.Ali Khamis Ali, 83 year old with h/o DM, HTN, CAD presented with a large foul smelling osteomyelitic ulcer on plantar aspect of left foot with exposed bone of 4th toe. He was admitted and started on I.V broad spectrum antibiotics. His blood sugars were monitored closely. He was seen by podiatric surgeon, advised slough excision and bone nibbling. He had a preop medical check up, noted to have anaemia. Cardiology fitness obtained and advised to continue on beta blockers. Slough excision with bone nibbling was done under SA on 6/7/18. He was transfused 2 units of PRBC and Inj Ferinject (iron). Regular dressings were done and he improved clinically. He had suturing of the wound done on 17/7/18 under regional anesthesia following which there was a slight increase in his serum creatinine which later improved. Wound is healing well and he is discharged in a stable condition.\n\nDiet: nan\n\nRemarks: To report SOS in case of discharge, bleeding from the wound, swelling of the foot/limb or in case of fever.\r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\nAdv: Change of dressings once in 2 days-betadine oint.\r\nSuture removal on August 1st.\r\nNo weight bearing on Left foot for 1 month.\r\nSpecialised/modified footwear is advised once the wound completely heals.'}] |
8,262 | [{'role': 'user', 'content': '\nIP Number: 8262\n\nPatient Number: 45223\n\nPatient Name: K P NARAYANAN NAIR\n\nGender: M\n\nDate of Birth: 25-09-1954\n\nAddress: INDUSREE\n\nPincode: 682020.0\n\nPhNo: nan\n\nAdmission Date: 26-08-2018\n\nDischarge Date: 10-09-2018\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: CBC \r\nRFT \r\nelectrolyte\n\nClinical examination: BP 110/60 grbs 164 \r\no/e infected little toe on right foot \r\n\n\nPrecautions to be taken while treating the patient: dusky toe \r\nprognosis explained to patient\n\nRemarks: c/s/b Dr.Rajesh Simon\r\nPt reviewed.Swelling is less.Blisters present\r\nContinue leg elevation and IV antibiotics.\nBP:130/80\r\nHR:92\r\nTemp:100.1\r\nGRBS:203\r\nAdvice:\r\n Inj.biopiper 4.5gm 1-1-1\r\n Inj.Dalacin 300mg 1-1-1\r\n CBC and Electrolytes \r\n4;25pm-\r\nPt seen and examined.\r\nPlan:Debridment Tmw\nshifted from OT at 12.15am\r\nconscious oriented\r\nBP 120/80 PR 80 SPO2 96 \r\nNO ozing from site \r\nhb PCV RFT tommorow\r\npus/tissue c/s sent\r\ncontinue same antibiotic analgesic\r\nc/o abdomen pain ,catheter removal done \r\nurine output 1400ml\r\n\nPatient is clinically better\r\nBP:\r\nHR:\r\nTemp:\r\nGRBS:\r\nAdvice:\r\n Repeat Tc,Electrolytes,Urine R/E,\r\n Increase fluid intake orally\r\n USG -Abdomen and pelvis\r\n Catheterization\r\n cold and hot bag(alternatively)lower abdominal area\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: pain surgery site\r\nPAIN SCORE:3/5\r\nBLOOD SUGARS : \r\nPREDINNER: 186 MG/DL\r\nFBS:187 MG/DL\r\nBP: 110/60 MM HG\r\nCASE PLAN :Nephro consultation \r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nCase seen by dr tom nd team \r\ngeneral condition stable \r\npain score 3/5 \r\npre dinner 157 BP 150/70\r\nCBC RFT Electrolyte Ca PO4 peripheral smear\r\nmeropenem 500 TID \r\ni/o chart \r\nnephro med started\r\nbedside echo today.\r\nSeen by DRA.K.Bhat.\r\nResidual necrotising fasciitis rt foot dorsum, ankle,anterolateral/posterolateral leg.Large unhealthy ulcer dosum foot&ankle.Extensor tendon loss,exposing ankle joint dorsum.Raw area edges necrotic,gangrenous.Posterior tibisl feebly felt.\r\nPlan:DEbridement,multiple fasciotomy under SA,1st Sept,2pm.\r\nPreop:Nil oral.High risk consent.Written informed consent.IV ABx.Medical fitness.\r\n===========================\r\nInformed consent.\r\nThere is residual pus filled infection of right foot,ankle and leg extending to mid leg region.This pus infection is extending deep to deeper tissues like fascia.There are multiple pus filled blisters in these regions.There is diabetes and decreased circulation of leg.There is septicemia& renal dysfunction.There is previous h/o CABG.The infection needs repeat incision and drainage and fasciotomy under anesthesia.During operation the spreading infection will be opened up in multiple areas and pus will be drained.In necrotising fasciitis there will be infection more extensive than what is seen on the surface.Infected skin and soft tissues will be removed.Due to extending nature of infection, after surgery the wounds will be large and control of infection and healing will be delayed.The healing and circulatory condition of wounds will need observation.Repeat surgery may be needed.Understanding the above , high risk consent for anesthesia and operation is given.====================================\nPatient is better\r\nBP:150/80\r\nHR:86\r\nTemp:98.4\r\nGRBS:303\r\nPlan:\r\n Today Fasciotomy under SA\r\n NPO-8am onwards\r\n Keep I/O chart\r\n Rpt CBC,RFT,Electrolytes\nSeen by DRA.K.BHat.\r\nContinue trt.Remove foleys catheter.\nSeen by DR.A.K.BHat.\r\nContinue trt.C&D in ICU Tmrw.\nPatient is better.\r\nBP:130/70\r\nHR:67\r\nTemp:98.6\r\nGRBS:365\r\nAdvice:\r\n Blood sugar gone high so start Insulin infusion 3units/hr\r\n Inj.Clexane 0.4mg 1-0-0\r\n Tab.Acuvin 1-0-1\r\n Tab.Nebistar 2.5mg 1-0-0\r\n Inj.Pansec 40mg 1-0-1\r\n Stop Inj.Dalacin\r\n Tab.Aztor 10mg 0-0-1\nSeen by DRA.K.BHat.\r\nDRessings changed.Large raw area exposing ankle structures-needs observation.Continue trt.\nseen by dr tom and team \r\npatient c/o decrease sleep \r\npain score 4/5 \r\npre dinner grbs 169 AT 6AM \r\nBP 140/80 Temp 98.6 spo2 97%\r\nrepeat CBC RFT \r\ntab tramadol 50 1-1-1.\r\nSeen by DRA.K.BHat.\r\nContinue trt.\npatient c/o pain\r\nBP:120/80\r\nHR:72 \r\nTemp:99\r\nGRBS:261\r\nPain score-4/10\r\nInsulin R:14-14-14\r\n B:20\r\nAdvice:\r\n start Tab.Lonazep 0.25 0-0-1\r\n Surgeon review and dressing.\r\n Today discharge\r\nSeen by DRA.K.Bhat.\r\nDressings changed.Large raw area foot &leg exposing bare bones/joints on dorsum foot&fascia of foot and leg. Kaltostat dressings done.\r\n\nSeen by DRA.K.BHAT.\r\nContinue trt.\nSeen by DRA.K.BHat.\r\nDRessings changed. Large raw area exposing ankle structures.Continue trt.\nPatient feels better\r\nBP:120/70\r\nHR:74\r\nTemp:98.6\r\nGRBS:199\r\nAdvice:\r\n Patient is on RuPatch patch(Buprenorpine) 10mcg/hr for 7days (7/9/2018,10.00pm)\r\n Stop Inj.Tramadol \r\n Surgeon Review and dressing\r\n\nPatient c/o pain\r\nBP:130/70\r\nHR:78\r\nTemp:98.6\r\nGRBS:261\r\nPain score-4/10\r\nAdvice:\r\n Tab.Dolo 650mg 1-1-1\r\n Planning to discharge tmw after dressing'}, {'role': 'model', 'content': "\nIP Number: 8262\n\nPatient Number: 45223\n\nAdmission Date: 26-08-2018\n\nDischarge Date: 10-09-2018\n\nDiagnosis: Necrotizing Fascitis Right foot\r\ns/p Wound exploration, debridement with 5th toe amputation done on 28/8/2018\r\ns/p Debridement and fasciotomy done on 1-9-2018 \r\nAcute kidney injury - Urosepsis - resolving\n\nClinical Exam(With BP): nan\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: USG-Abdomen: Bilateral pleural effusion \r\n B/l Medical renal parenchymal disease Grade 1\r\n Prostatomegaly grade 1 with significant PVR\r\nArterial Doppler Right limb : Diffuse atherosclerotic wall thickening with calcification of right lower limb arteries with low velocity monophasic flow in right dorsalis pedis artery.\n\nXray findings: Conscious,oriented\r\nVitals stable \r\no/e interdigital infection 5th toe - early necrotizing fascitis - ischaemic infection little toe\n\nDiscussion: Mr.K.P.Narayanan Nair, a 63 yr old male with h/o Type 2 DM, CAD - s/p CABG in the past. He presented with necrotising infection of the right foot with gangrene of the 5th digit. Blood investigations showed elevated total counts(25300 cells/cumm). He was admitted and started on IV antibiotics,antipyretics, and analgesics. His blood sugars were controlled with basal bolus insulin regimen. Arterial doppler showed diffuse atherosclerotic wall thickening with calcification of right lower limb arteries with low velocity monophasic flow in right dorsalis pedis artery. Ankle and Foot surgeon's consultation was obtained and he was taken up for wound exploration, debridement with 5th toe amputation under spinal anaesthesia on 28/8/2018. Nephrology consultation was sought out for urosepsis and treatment initiated accordingly. Cardiology consultion was done and echo showed good LVEF. The wound margins were not satisfactory and there were signs of ascending necrotizing fascitis over the right leg. On 1-9-2018, he was taken up for debridement and multiple fasciotomy under regional block. Intra operative and postoperative period was uneventful. Alternate dressing were given. He is being discharge in stable condition with an analgesic patch.\n\nDiet: nan\n\nRemarks: Report SOS incase of any discharge from wound site or fever\r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\nDept Of Diabetes Education: Checked and corrected insulin technique, No signs of Hypertrophy \r\nAdvised to rotate the site.\r\nAdvised SMBG (Fasting prelaunch and predinner (6 point).To maintain a log book and to bring the same when coming for review\r\nGiven awareness about Hypoglycemia and its management.\r\nSymptoms of Hypoglycemia (Sweating, Shivering, Blurred vision, Giddiness, Poor concentration, Increased Hunger, Nervousness, Rapid Heart Beat, Cold and Clammy Skin, Slurred Speech) which can be corrected by giving Glucose tabs, 1 -2 sugar candies, Half glass of Fruit Juice, 1 - 2 teaspoons\r\nAlternate day dressings at our Podiatry OPD\r\nReview with PC after 2 days"}] |
8,315 | [{'role': 'user', 'content': '\nIP Number: 8315\n\nPatient Number: 29547\n\nPatient Name: JACOB MATHEW\n\nGender: M\n\nDate of Birth: 22-05-1938\n\nAddress: FIZELCHEMBERS, 2ND FLOOR\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 12-09-2018\n\nDischarge Date: 15-11-2018\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: Echo \r\nDoppler Study\r\nECG\n\nClinical examination: Pt conscious,oriented\r\nchest clear\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: c/s/b Duty Doctor\r\nClinical Summary Collected\nSEEN BY DR. LAKSHMI.A.BABU &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nPAIN SCORE:3/10\r\nBLOOD SUGARS :\r\nPREDINNER: MG/DL\r\nFBS:159 MG/DL\r\nBP:140/100MM HG\r\nCASE PLAN :XRAY OF FOOT AND ANKLE WITH AP/L\r\nARTERIAL AND VENOUS DOPPLER\r\nSURGEION CONSULTATION\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\nSeen by DRA.K.BHat.\r\n?Resolving necrotising fasciitis rt foot&leg. Multiple ulcers leg. DProtien.IV ABx.Cap.Bcomplex bd. PHYSIOTHERAPY.BBact,saline pad dressings.Continue trt.\r\n\r\n\r\n\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:pain foot\r\nPAIN SCORE:2/5 \r\nBLOOD SUGARS : \r\nPREDINNER: 112 MG/DL\r\nFBS: 120 MG/DL\r\nBP: 140/90 MM HG\r\nCASE PLAN : continue same. Dermatology consultation tomorrow.\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\nSeen DRA.K.BHat.\r\nBBact,Saline pad dressings.\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 140/90 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nadvice physio derm consultation \r\nrepeat hb electrolyte\r\nIVF NS polybion\r\n\r\n\nCase of subacute dermatitis with cellulitis on treatment\r\nIntertrigo of web spaces of feet\r\nEVLT for left leg done in 2016 \r\n\r\nVenous doppler - right lower limb normal\r\n\r\nAdv:\r\n-----------------------\r\nSeen by DRA.K.Bhat.\r\nContinue trt.,\r\n?Plan for I&D rt foot,if no relief from pain&swelling.\r\n\r\n1)Candid cream 2 times daily for web spaces\r\n\r\n\r\n\nSEEN BY DR.LAKSHMI.A.BABU &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:NIL\r\nPAIN SCORE:2/10\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS:126MG/DL\r\nBP: 150/90 MM HG\r\nCASE PLAN :\r\nPLANNING FOR I&D\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\nSeen BY DRA.K.B.\r\nContinue trt.\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: pain leg\r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nPREDINNER: 110 MG/DL\r\nFBS: 123 MG/DL\r\nBP:140/100 MM HG\r\nCASE PLAN : continue dressing\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\nSeen bY DRA.K.BHat.\r\nContinue trt.\r\n\nPatient is not active\r\nBP:140/90\r\nHR:60\r\nTEMP:98\r\nSpO2:98\r\nFBS-121\r\nPAIN SCORE-3/10\r\nADVICE:\r\n Change T.Nebistar to T.Nebicard 2.5 1-0-0\r\n Physiotherapy twice a day\r\n USG of dorsum Rt foot-Hypoechoic collection on the dorsum of Rt foot with ischemic flow in DPA\nSeen by DRA.K.BHat.\r\nContinue trt.\r\nPlan fr I&D under regional block.\r\nPreop:Investigations.Medical fitness.\nBP:130/70\r\nHR:76\r\nTemp:98.6\r\nGRBS:118\r\nPain score:3/10\r\nPlan:\r\n I&D tmw after all Preop workup\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Pain right foot\r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nPREDINNER:126 MG/DL\r\nFBS:109 MG/DL\r\nBP: 140/90 MM HG\r\nCASE PLAN : I and D today\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nc/s/b Dr.Lakshmi\r\nbradycardia (HR-38/min)\r\nInj Atropine 1 amp IV given - HR picked up to 78/min\r\nECG taken.No significant ST-T changes\r\nAdv:Trop T,S.electrolytes\nSEEN BY DR. &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: MM HG\r\nCASE PLAN : Inj. Pactiv & Clexene started\r\ntab roseday A 0-0-1\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\nSeen by DRA.K.BHat.\r\nContinue trt.\nSeen by DRA.K.BHat.\r\nContinue trt.Oral Camyda.\nPatient is stable\r\nBP:150/80\r\nHR:82\r\nTEMP:98.6\r\nFBS:123\r\nPain Score-2/10\r\nInsulin Fixed: Insugen R 4-4-4\r\n B----4\r\nAdvice:\r\n T.Lupisoz 40 1-0-0\r\n BP Monitoring to done.\r\n\r\nSeen by DRA.K.BHat.\r\nDRessings changed.Clean.Continue trt.\nSeen by DRA.K.BHat.\r\nDREssings changed,.Clean.Continue trt.\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Constipation\r\npain and eschar left forearm\r\nPAIN SCORE: 2/5\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 140/100 MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 140/80 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\nSeen by DRA.K.Bhat.\r\nDRessings changed. Clean.\r\n\r\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:slight pain\r\nPAIN SCORE:2/10\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS:140 MG/DL\r\nBP: 130/90 MM HG\r\nCASE PLAN :\r\nRyzodec 4unit tmw onwards.\r\nPhysiotherapy today\r\ncontinue same treatment\r\n\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 140/90 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:1/10\r\nBLOOD SUGARS : \r\nPREDINNER:137MG/DL\r\nFBS:120 MG/DL\r\nBP:130/80 MM HG\r\nCASE PLAN : \r\nPhysiotherapy today\r\nPlanning for discharge\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.BHat.\r\nContinue.\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE: 2/5\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 130/90 MM HG\r\nCASE PLAN : Continue same, discharge today after Podiatry consult\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.Bhat.\r\nDressings changed.Clean.\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 120/80 MM HG\r\nCASE PLAN : Electrolytes, continue physio, Nexito\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DR.A.K.Bhat.\r\nDResings changed.Clean.Continue trt.\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Nil\r\nPAIN SCORE:1/10\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS:134 MG/DL\r\nBP: 130/90 MM HG\r\nCASE PLAN :\r\n Continue Same treatment\r\n Planning for SSG later\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSeen by DRA.K.BHat.\r\nContinue trt.Plan fr SSG under SA on saturday.\r\nDaily Microdacyn dressings.Medical fitness.Betadine scrub daily for thigh..\nSeen by DRA.K.Bhat.\r\nContinue trt.Plan fr SSG under SA on Monday.\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:nil\r\nPAIN SCORE:2/10\r\nBLOOD SUGARS : \r\nPREDINNER:113MG/DL\r\nFBS:136MG/DL\r\nBP: 100/60 MM HG\r\nCASE PLAN :\r\n Planned SSG under SA on monday\r\n Cardiology followup regarding SA for SSG\r\n Repeat CBC,Electrolytes and RFT \r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSEEN BY Dr.A.K.B.\r\nPlan fr SSG under SA on MOnday 1pm.\nSeen by AK.Bhat.\r\nPlan for SSG under SA, 8th October 1pm.\r\nPreop:\r\nGet consent.\r\nNil oral as per Anesthetist advice.\r\nClean&dress areas on morning of operation.\r\nShave and betadine scrub rt thigh ,morning of operation.\r\nIV antibiotics-Inj.Monoscot 1gm IV bd after test..\r\nMedical &Anesthetic fitness for the procedure.\r\nInform OT and anesthetist.\r\n----------------------------\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nHe is on NPO\r\nC/O:Nil\r\nPAIN SCORE:1/10\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS:153MG/DL\r\nBP: 160/90 MM HG\r\nCASE PLAN :\r\n Continue Same treatment\r\n SSG today at 1pm \r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Pain left leg\r\nPAIN SCORE: 3/5\r\nBLOOD SUGARS : \r\nFBS:139 MG/DL\r\nBP: 110/70 MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS.\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\nSeen by DRA.K.BHat.\r\nContinue trt.Cap.Dalacin.Yogut.\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE: 2/5\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 140/80 MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE: 2/5\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS:130MG/DL\r\nBP: 140/90 MM HG\r\nCASE PLAN : Continue same treatment\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaints\r\nPAIN SCORE: 2/5\r\nBLOOD SUGARS : \r\nFBS: 135 MG/DL\r\nBP: 140/90 MM HG\r\nCASE PLAN : Suture removal today, BP monitoring\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.Bhat.\r\nDressings changed.SSG clean.Continue trt.\r\n\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE: 2/5\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS:152MG/DL\r\nBP: 130/70 MM HG\r\nCASE PLAN : Few taple removed, physio today\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Karthik &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN : Restart Roseday-A. Take ECG rythm strip, Cardiology review.\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.Bhat.\r\nDressings changed.SSG clean.Stop Dalacin.\r\n\r\n\nSEEN BY DR.Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:nil\r\nPAIN SCORE:2/10\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS:125 MG/DL\r\nBP: 150/100 MM HG\r\nCASE PLAN: Continue same treatment\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\nSeen by DR.A.K,.Bhat.\r\nContinue trt.\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nNo specific complaints\r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nFBS: 130 MG/DL\r\nBP:130/90 MM HG\r\nCASE PLAN : continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DR,.A.K.BHAT.\r\nContinue trt.\r\n\nSeen by DRA.K.BHat.\r\nDressings changed.SSG taken up. Donor site healed.\nSEEN BY DR.Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:pain\r\nPAIN SCORE:3/10\r\nBLOOD SUGARS : \r\nPREDINNER:125MG/DL\r\nFBS:116MG/DL\r\nBP:110/60MM HG\r\nCASE PLAN :\r\ncontinue same treatment\r\nphysio today\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nc/o constipation\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 140/70 MM HG\r\nCASE PLAN : Emema stat\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.BHat.\r\nContinue trt.\r\n\nSEEN BY DR.Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nc/o constipation\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS:117MG/DL\r\nBP: 140/70 MM HG\r\nCASE PLAN : Emema stat\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.Bhat.\r\nDRessings changed.SSG taken up.\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:1/10\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: 118 MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN :continue same treatment\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaints. Wound healing well.\r\nPAIN SCORE: 2/5\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN : Dr. Bhat consultation, physio\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.BHat.\r\nDressings changed.SSG stable.\r\n\nSEEN BY DR. Karthik &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 120/80 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:nil\r\nPAIN SCORE:1/10\r\nBLOOD SUGARS : \r\nPREDINNER:147MG/DL\r\nFBS: 123MG/DL\r\nBP: 130/60 MM HG\r\nCASE PLAN :\r\nPhysio today\r\ncontinue same treatment\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaints\r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nFBS: 121 MG/DL\r\nBP: 120/90 MM HG\r\nCASE PLAN :Continue Physio\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 120/70 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.BHat.\r\nDressings changed.Clean,Continue trt.\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaints\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 120/80 MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.BHat.\r\nContinue trt.\r\n\nSEEN BY DR.Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaints\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 140/90 MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.BHAT.\r\nContinue trt.\r\n\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaint\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\nSEEN BY DR.Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS:100 MG/DL\r\nBP: 140/90 MM HG\r\nCASE PLAN :\r\nAdvice ortho consultation\r\ncontinue same treatment\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\nSeen by Dr. Vinod\r\nHistory noted\r\nC/o LBA since 1 month\r\nHad been bedridden for last 2.5 months\r\nLS spine - PSMS+, movements restricted painfully, reduced sensation in both feet, able to walk FWB with support\r\nDiagnosis: - Mechanical back pain\r\nAdvice: -\r\nX-ray LS spine AP/lateral\r\nS. Vit D, calcium, phosphorus, alkaline phosphatase\r\nDEXA Scan (Both hips & AP spine)\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Generalised weakness\r\nPAIN SCORE:2/5\r\n\r\nBP: 140/90 MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.BHat.\r\nContinue trt.\r\n\nSEEN BY DR. Manoj & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:nil\r\nPAIN SCORE:1/10\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: 119MG/DL\r\nBP:140/90MM HG\r\nCASE PLAN : continue the same treatment\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.BHat.\r\nContinue trt.\r\n\nSeen by DRA.K.BHat.\r\nSSG settling well.Continue trt.\nSEEN BY DR. Manoj & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:nil\r\nPAIN SCORE:1/10\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: 111MG/DL\r\nBP:100/70MM HG\r\nCASE PLAN :Tab.Vit D3 K once a week\r\n Tab.Vit D cal OD\r\ncontinue the same treatment\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\nSeen by Dr. Vinod\r\nCase reviewed\r\nX-ray LS spine - Multiple level degenerative changes with syndesmophytes, Grade I listhesis L5-S1\r\nBlood investigations - WNL, Vit D insufficiency\r\nAdvice - \r\nPhysio - IFT, UST, graded spine exercises, MFR, strengthening exercise for upper and lower limbs\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O : Generalised weakness\r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nFBS: 115 MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN :Continue physiotherapy\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 140/80 MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.Bhat.\r\nContinue trt.Jelonet,kaltostat dressing.\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaints\r\nPAIN SCORE: 2/5\r\nBLOOD SUGARS :\r\nFBS: 110 MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.BHat.\r\nContinue trt.\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaint\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 150/80 MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\nSEEN BY DR. Karthik & TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Pain over right big toe\r\nPAIN SCORE:3/10\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: 173MG/DL\r\nBP:130/80 MM HG\r\nCASE PLAN : \r\nTab.Acuvin 1-0-1\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\nSeen by DRA.K.BHat.\r\nTab.Allegra 120 mg HS.\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaints\r\nPAIN SCORE: 2/5\r\nBLOOD SUGARS :\r\nFBS: 106 MG/DL\r\nBP: 100/60 MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR.Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaints\r\nPAIN SCORE: 1/5\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 110/70 MM HG\r\nCASE PLAN : Discharge tomorrow\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\r\n\nSeen by DRA.K.BHat.\r\nADv:Change of dressings once in2 days-REview OP 2 weeks.'}, {'role': 'model', 'content': '\nIP Number: 8315\n\nPatient Number: 29547\n\nAdmission Date: 12-09-2018\n\nDischarge Date: 15-11-2018\n\nDiagnosis: CVA - old\r\nCAD\r\nVaricose veins Lt leg s/p Endovenous Laser Ablation under LA\r\nHyperuricaemia \r\nNecrotising fasciitis right foot & leg\r\nS/P SSG\r\n\n\nClinical Exam(With BP): nan\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: X-Ray foot : No signs of osteomyelitis\r\nVenous Doppler Right limb : No evidence of DVT\r\nX-Ray LS spine-Multiple level degenerative changes with syndesmophytes, Grade I listhesis L5-S1\r\n\r\n\n\nXray findings: Pt conscious,oriented\r\nChest clear\r\nCNS - NFND\r\nNecrotising fasciitis with multiple ulcers over right foot and leg\n\nDiscussion: Mr.Jacob Mathew 80 year old with h/o CVA, CAD, Type 2 DM,HTN was shifted from a local hospital with c/o swelling, multiple ulcers with discharge from right lower limb. He was bed ridden for last 20 days. He was admitted and started on IV antibiotics and analgesics. His blood sugars were controlled with basal bolus insulin regimen. Podiatry consultation obtained and I&D with fasciotomy under spinal anesthesia done on 20/9/2018 after all pre-operative workups. Specimen sent for histopathology examination. He was started on bed side physiotherapy. On 8/10/2018, SSG done under regional block. Cardiology consultation was sought for an episodes of bradycardia. Dermatology consultation taken for Tinea versicolor and post inflammatory depigmentation and started antifungal treatment. Alternate dressing were given. Ortho opinion was taken for mechanial back pain. He clinically improved with treatment and is being discharged in stable condition.\n\nDiet: nan\n\nRemarks: To report SOS in case of discharge, bleeding from the wound, swelling of the foot/limb or in case of fever.\r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\nChange of dressings once in 2 days\r\nReview Podiatry OP after 2 weeks.\r\nReview in Endo OP with AC, PC after 1 week'}] |
8,334 | [{'role': 'user', 'content': '\nIP Number: 8334\n\nPatient Number: 45738\n\nPatient Name: RAQIYA GHASSAN SINAN AL MAYAHI\n\nGender: F\n\nDate of Birth: 01-01-1965\n\nAddress: C/O JSS\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 19-09-2018\n\nDischarge Date: 05-10-2018\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: Blood culture and sensitivity, CBC, creatinine, sodium, potassium, chloride, LFT, Xray left foot AP/oblique, Doppler arterial both legs, HbA1c, pus c/s, Fundus examination, 24 hours urine protein , 24 hours urine creatinine, ECG, calcium, phosphate, serum parathyroid hormone.\n\nClinical examination: Patient is conscious and oriented\r\nVitals are stable\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by DRA.K.BHat.\r\nExtensive severe infective gangrene left foot&ankle. Foul smelling pus. Cellulitis foot.\r\nPlan:Below knee amputation under SA(High risk).\r\nPreop:Medical assessment. IV ABx. Transfuse two packed cells.\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Pain left foot\r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nPREDINNER:340 MG/DL\r\nFBS: 300 MG/DL\r\nBP:130/80 MM HG\r\nCASE PLAN :Blood transfusion 1 pint PRBC\r\n \r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\n1 pint PRBC tranfusion started\r\nGroup: B positive\r\nunit number:46766\r\nInj Avil 1 amp IV stat.\r\nSeen by DRA.K.Bhat.\r\nPlan for left Below knee amputation under Epidural, 21st Sept.\r\nPreoperative Instructions:\r\nGet informed(high risk) consent.\r\nNil oral as per Anesthetist advice.\r\nClean&dress area on morning of operation.\r\nShave &betadine scrub HS&CM.\r\nIV antibiotics.\r\nMedical &Anesthetic fitness for the procedure.\r\nInform OT and anesthetist.\r\nArrange one unit packed cells.\r\n---------------------------\r\nThere is extensive bone,joint and soft tissue infection and gangrene of left ankle&foot with infection extending.Pus extending to joint destroying it and adjacent bones.There is diabetes and reduced circulation of leg as seen in Arterial Doppler report.There h/o CAD &nephropathy.The extensive and severe gangrene 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 have been explained.Also close medical followup is essential. The above points have been explained and understood and high risk consent for anesthesia and operation is given.\r\n\r\nSIGNED.\nc/s/b duty doctor \r\nblood transfusion started at 9am \r\nblood group B+\r\nUNIT NUMBER \r\nInj avil 1amp stat\r\npatient is stable BP 136/94 HR 89 spo2 o2 91% GRBS \r\nIpint PRBS started AT 5.30 PM \r\nw/f Bleeding \r\nTPR/BP/I/Ochart \r\ncontinue same AX\r\npatient generaL condition stable \r\nnot fully conscious\r\nBP 139/73 HR 86 SPO2 with 3L o2 93% GRBS 202 \r\nINJ apidra 8u\r\ncontinue same AX \r\nINJ pactiv IV Q8H \r\nRepeat Hb fbs Urea CREATININE Na K tommorow\r\n\nSeen by DRA.K.BHat.\r\nContinue trt.Inj.Clexane.\nPatient is stable\r\nBP:150/80\r\nHR:76\r\nTEMP:98.6\r\nSpO2:90% with out O2\r\nFBS:146\r\nPain Score-3/10\r\nInsulin Fixed:Api 14-14-10\r\n Toujeo- 14units\r\nAdvice:\r\n Continue same treatment\r\n Maintain I/O chart\r\nSeen by DRA.K.BHat.\r\nContinue trt.\nSEEN BY DR. Karthik &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Pain Left Foot\r\nPAIN SCORE: 3/5\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN : Catheter removal, Chest physio\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 130/70 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.Bhat.\r\nContinue trt.DRessings changed.Clean Suture line.DT Removed.,PHYSIO.Oral ABx.\r\n\r\n\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE,CHEST IS BETTER\r\nC/O:NIL\r\nPAIN SCORE:1/10\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS:204 MG/DL\r\nBP: 140/90 MM HG\r\nInsulin fixed: Api 8-8-8\r\n Tojeo 8\r\nCASE PLAN : RFT AND Electrolytes and iron study to be reviewed\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Karthik &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 150/100 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Pain of right leg\r\nPAIN SCORE:2/10\r\nBLOOD SUGARS : \r\nPREDINNER:257MG/DL\r\nFBS:249 MG/DL\r\nBP: 160/100 MM HG\r\nCASE PLAN : CBC, RFT, Electrolytes\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\nSeen by DRA.K.BHat.\r\nDressings changed.Clean.\r\n\nSeen by DRA.K.BHat.\r\nContinue trt.\r\n\r\nSEEN BY DR. Karthik &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 160/90 MM HG\r\nCASE PLAN : Dressing today.\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSeen by DRA.K.BHat.\r\nAlternate sutures removed.Healing well.\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 160/90 MM HG\r\nCASE PLAN :Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DR.A.K.Bhat.\r\nContinue trt.\r\n\r\n\nSeen by DRA.K.Bhat.\r\nContinue trt.DRessings tomorrow.\n\r\n\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Nil\r\nPAIN SCORE:2/10\r\nBLOOD SUGARS : \r\nPREDINNER:171MG/DL\r\nFBS:230MG/DL\r\nBP:130/60 MM HG\r\nCASE PLAN :\r\n 2am-sugar level to be checked\r\n Tab.kombiglyza 5/1000 1-0-0 \r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSeen by DRA.K.BHat.\r\nDRessings changed.Sutures removed.Healed.\r\nAdvice:\r\n-Protective dressings [(L) below knee stump] with Betadine ointment/pads & crepe bandage. Plaster slab support in the night\r\n-Quadriceps strengthening exercises\r\n-Physiotherapy to all limbs\r\n-Once the leg stump is supple & healed, artificial limb prosthesis may be prescribed [after a period of about 3 months]'}, {'role': 'model', 'content': "\nIP Number: 8334\n\nPatient Number: 45738\n\nAdmission Date: 19-09-2018\n\nDischarge Date: 05-10-2018\n\nDiagnosis: Left foot infective wet gangrene - post BK amputation status\r\nAcute on CKD - diabetic nephropathy\r\nB/l severe PDR\r\nSevere PAD\r\nCAD - moderate LV dysfunction with RWMA\r\nRight foot DSPN\n\nClinical Exam(With BP): nan\n\nSystolic BP: 170.0\n\nDiastolic BP: 83.0\n\nPhysical examination: X-ray left foot - Shows evidence of bony destruction and osteolysis in mid foot with osteosclerotic changes in 1st metatarsal, air shadows also noted.\r\nDoppler arterial both legs - Diffuse wall thickening noted in both lower limb arteries with luminal narrowing & low intensity ischemic flow from CFA, no flow in PTA & DPA.\r\nEcho -Mild concentric LVH, dilated LV, IAS/IVS TNTACT\r\nMild LV systolic dysfunction stage III diastolic dysfunction \r\nRWMA-BASAL and inferior inferoseptal inferolateral apical inferior septal segments\r\nHypokinetic with mild thinning, low moderate MR, no LA, LAA, LV clot/PE\n\nXray findings: Patient is conscious and oriented\r\nVitals are stable\n\nDiscussion: Mrs. Raqiya Ghassan Sinan Al Mayahi, 53 yrs/F, k/c/o Type 2 DM with poor control and h/o left 1st toe amputation presented with swelling, redness, foul smelling discharge, fever and pain in left foot for 1 month. On admission, she was in frank sepsis & x-ray of left foot showed evidence of osteomyelitis/charcot foot with wet gangrene. She was started on broad spectrum antibiotics with guarded fluid administration. Hence, she was planned for surgery after stabilization. She was severely anemic (Hb - 6 g/dl) on presentation & was transfused 3 units of packed cells prior to surgery. Cardiologist performed an echo which showed moderate LV dysfunction and titrated her medications. He had opined that she was at moderate risk of complications during surgery. She also had an AKI, probably sepsis induced which recovered post surgically. Her glycemia was well controlled with basal bolus regimen and was discharged on oral antidiabetic agent.\r\n\r\nSurgeon's Notes:\r\nA case of extensive severe infective gangrene of left foot & ankle. Foul smelling pus. Cellulitis foot/leg. PVD. On 21.9.2018, under regional block anesthesia, left below knee amputation was done. Postoperative course uneventful. On 12th postop day, sutures were removed. Wounds were healing well.\r\n\r\nOphthalmologist on evaluation found high-risk PDR in both eyes and had advised urgent vitrectomy. But since she was unable to sit upright, the procedures were not done & was advised to follow up with the Ophthalmologist at her native place.\r\n\r\nShe was stable on discharge.\n\nDiet: nan\n\nRemarks: To report SOS to nearby surgeon in case of discharge, bleeding from the wound, swelling of the foot/limb or in case of fever.\r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor."}] |
8,453 | [{'role': 'user', 'content': '\nIP Number: 8453\n\nPatient Number: 42733\n\nPatient Name: RAJU L\n\nGender: M\n\nDate of Birth: 14-09-1951\n\nAddress: AROMAL HOUSE\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 02-11-2018\n\nDischarge Date: 20-11-2018\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: Conscious,oriented\r\nVitals stable\r\nchest clear\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: SEEN BY DR.Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:1/10\r\nBLOOD SUGARS : \r\nPREDINNER: 170MG/DL\r\nFBS:243MG/DL\r\nBP: 140/90 MM HG\r\nCASE PLAN :\r\ncontinue same treatment\r\nCarotid Doppler \r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.Bhat.\r\nDRessings changed.Bone stum exposed.Inj.Monoscot SB 1.5 gm IBV bd.Continue trt.\r\n\r\n\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Generalised weakness\r\nPAIN SCORE: \r\nBLOOD SUGARS : \r\nPREDINNER: 127 MG/DL\r\nFBS: 177 MG/DL\r\nBP: 140/90 MM HG\r\nCASE PLAN : continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.BHat.\r\nContinue trt.\r\n\nSeen by DRA.K.BHat.\r\nContinue trt.Plan fr Bone nibbling slough excision under regional block wednesday 7th nov.\nSeen by DRA.K.BHat.\r\nFor bone nibbling/slough excision under ankle block,7th Nov. 8.30am.Preop:Nil oral.Consent.C&D,.IV ABx continue.Medical fitness.\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Generalised weakness\r\nPAIN SCORE: 2/10\r\nBLOOD SUGARS : \r\nPREDINNER: 198 MG/DL\r\nFBS: 202MG/DL\r\nBP: 110/60 MM HG\r\nCASE PLAN : \r\nSyndopa110 MG 1/0-0-1/2 X 5days increase 1/2-1/2-1/2 x 2week then increase 1-1-1.\r\ncontinue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nPREDINNER: 149 MG/DL\r\nFBS:198 MG/DL\r\nBP:110/70 MM HG\r\nCASE PLAN :Bone nibbling and slough excision\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 120/80 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Constipation\r\nPAIN SCORE: 2/5\r\nBLOOD SUGARS : \r\nPREDINNER: 151 MG/DL\r\nFBS: 199 MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.BHat.\r\nContinue trt.\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: no specific compliant\r\nPAIN SCORE: 2/5\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.Bhat.\r\nDressings changed.Open infected ankle/tarsal joints,exposed ankle,tibialis tendon.?PLan for BKA.Continue trt.\r\n\nSEEN BY DR. Karthik &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: no specific compliant\r\nPAIN SCORE: 2/5\r\nBLOOD SUGARS : \r\nPREDINNER:158MG/DL\r\nFBS:137MG/DL\r\nBP:140/90MM HG\r\nCASE PLAN :\r\nTab.Nebistar 5mg 1-0-0\r\nInj.Tazowak 4.5g 1-1-1\r\nInj.Ferrinject 500 stat\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\nStop Roseday A\r\nStart Roseday 10mg and Aspirin 150mg.\r\nSeen by DRA.K.BHat.\r\nDRessings changed,.Inj.Heparin.\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Pain in right leg\r\nPAIN SCORE: 2/5\r\nBLOOD SUGARS : \r\nPREDINNER: 134 MG/DL\r\nFBS: 114 MG/DL\r\nBP: 140/90 MM HG\r\nCASE PLAN : Surgery tomorrow\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSEEN BY DRA.K.BHat.\r\nPosted for left Below knee amputation under SA on 14th Nov. 9am.\r\nPreoperative Instructions:\r\nGet informed consent.\r\nNil oral as per Anesthetist advice.\r\nClean&dress area on morning of operation.\r\nBetadine scrub leg&C&D.\r\nIV antibiotics.\r\nMedical &Anesthetic fitness for the procedure.\r\nInform OT and anesthetist.\r\nArrange 1 unit packed cells.\r\nArterial Doppler.\r\n-------------\r\nInformed consent.\r\nThere is extensive bone,joint and soft tissue infection of left ankle region.Pus extending to joint destroying it and adjacent bones.There is diabetes and neuropathy.There is reduced circulation of leg .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 will be delayed.The overall recovery and function of the amputated leg will need close observation. .Also close medical followup is essential. The above points have been explained and understood and full consent for anesthesia and operation is given.\r\n\r\nSIGNED. \r\n------------------\n1unit A+ VE BLOOD GIVEN WITH PREMEDICATION INJ. AVIL,INJ.LASIX GIVEN .\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Pain left leg\r\nPAIN SCORE: 3/5\r\nBLOOD SUGARS : \r\nPREDINNER: 204 MG/DL\r\nFBS: 160 MG/DL\r\nBP: MM HG\r\nCASE PLAN : Catheter removal. Continue same.\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.BHat.\r\nContinue trt.\nSEEN BY DR.Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:pain over left leg\r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 150/80 MM HG\r\nCASE PLAN :\r\nStop IV antibiotics\r\nPlanning for sensitivity oral antibiotics \r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.BHat.\r\nContinue trt.Tab.Faropenem.,.\r\n\nSeen by DRA.K.BHat.\r\nDRessings changed.DT removed.Clean suture line.Continue trt.\nSEEN BY DR. MANOJ &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: \r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER:142MG/DL\r\nFBS:182MG/DL\r\nBP: 110/60MM HG\r\nCASE PLAN : RPT HB,TC,ELECTROLYTES\r\nContinue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaint\r\nPAIN SCORE: 2/5\r\nBLOOD SUGARS : \r\nPREDINNER: 178 MG/DL\r\nFBS: 132 MG/DL\r\nBP: 150/80 MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.BHat.\r\nContinue trt.\r\n\nSeen by DRA.K.Bhat.\r\nDRessings changed.Suture line clean.\r\nAdv:Review FRiday 25th Nov..Oral FAronem 5 days.'}, {'role': 'model', 'content': '\nIP Number: 8453\n\nPatient Number: 42733\n\nAdmission Date: 02-11-2018\n\nDischarge Date: 20-11-2018\n\nDiagnosis: S/p Tarsometatarsal amputataion of the mid foot - 24/04/2018\r\nS/p SSG left foot - 18/07/2018\r\nSSG loss,Infected Raw area left foot - slough excision on 19/9/18\r\nBone nibbing and fasciotomy-7/11/2018\r\nLeft below knee amputation-13/11/2018\n\nClinical Exam(With BP): nan\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: Doppler Study of Carotid Arteries\r\n Mild b/l intima medial thickening noted in b/l carotids(R.>L).Few calcified and non calcified eccenteric plaques noted in b/l carotid bulb & ICA junction (R>L)occluding 65-70% of lumen on right side and appox 40% of lumen on left side.\r\n\r\n\n\nXray findings: Conscious,oriented\r\nVitals stable\r\nchest clear\r\nLeft foot-Infected Raw area\n\nDiscussion: Mr.Raju L 67year old male k/c/o Type 2DM,HTN with non-healing amputated stump (left leg) was admitted with general weakness and h/o two episodes of syncope.All blood investigations were done.His Total counts were elevated and were started on IV antibiotics and Basal bolus insulin regimen.Doppler study of carotids showed occluding 65-70% of lumen on right side and 40% occluding on left side carotid arteries..MRI scan of brain report showed multi-infarct state . Neurology opinion was also taken and medicines were given.Podiatry consultation was done and taken up for bone nibbing and fasciotomy under regional block(7/11/2018).Due to bad progessing of infection he was taken up for Left below knee amputation under SA(13/11/2018). According to bone culture sensitive antibiotics were started.Alternate dressing were done and wound better.He clinically improved and being discharged in stable condition.\n\nDiet: nan\n\nRemarks: Report SOS incase of fever and discharge \r\nReview on Friday 25th Nov,2018\r\n\r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\n'}] |
8,544 | [{'role': 'user', 'content': '\nIP Number: 8544\n\nPatient Number: 39738\n\nPatient Name: SALEEMA YOUSAF\n\nGender: F\n\nDate of Birth: 25-10-1953\n\nAddress: KALLARAKKAL HOUSE\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 03-12-2018\n\nDischarge Date: 17-12-2018\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: patient concious and cooperative \r\nanxious \r\nvitals stable \r\nleft leg - pitting edema , redness \n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by DRA.K.BHat.\r\nLeft foot&leg ?necrotising fasciitis.Focus from ?dorsum skin lesion/severe intertrigo.\r\nAdv:IV ABx.BBact 1-0-1-0 & Candid cream 0-1-0-1.Leg elevation.\nSEEN BY DR.Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Headache and pin over Lt leg\r\nPAIN SCORE:3/5\r\nBLOOD SUGARS : \r\nPREDINNER:215 MG/DL\r\nFBS:150 MG/DL\r\nBP: 140/90 MM HG\r\nCASE PLAN :\r\nInj.Clexane 0.6s/ OD\r\nTab.Acuvin 1-0-1\r\nInj.Dalacin 600mg 1-1-1\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.BHat,.\r\nContinue trt.\r\n\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Pain left leg\r\nPAIN SCORE: 2/5\r\nBLOOD SUGARS : \r\nPREDINNER: 131 MG/DL\r\nFBS: 158 MG/DL\r\nBP: 150/90 MM HG\r\nCASE PLAN : Continue same, venous doppler, blood culture\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.Bhat.\r\nTenderness/induration esp.posterior leg,blisters-necrotising fasciitis.\r\nSuggested FASCIOTOMY -but patient not willing for operation.\r\nContinue trt.\r\n\nSEEN BY DR.Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:pain\r\nPAIN SCORE:3/5\r\nBLOOD SUGARS : \r\nPREDINNER: 174MG/DL\r\nFBS:147MG/DL\r\nBP: 140/80 MM HG\r\nCASE PLAN :\r\nToday Fasciotomy today under SA\r\nApply Rupatch after surgery\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Pain right leg\r\nPAIN SCORE: 3/5\r\nBLOOD SUGARS : \r\nPREDINNER: 144 MG/DL\r\nFBS: 155 MG/DL\r\nBP: 150/80 MM HG\r\nCASE PLAN : Check CBC, if Hb 8 or below, tranfuse PRBC, Pactiv TID\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSeen by DRA.K.BHAT.\r\nCONTINUE TRT.For C&D under IV Sedation on Monday.\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaint\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 212 MG/DL\r\nFBS: 215 MG/DL\r\nBP: 150/80 MM HG\r\nCASE PLAN Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.B.\r\nFor C&D under IV SEdation on Monday 10th DEc.1.30pm.Preop:NIl oral.Consent.\r\n\nSeen by DRA.K.BHAT.\r\nDressings changed.Multiple large raw areas left leg&thigh.Mostly clean.Posterior skin bridge looks unhealthy and needs observation.\r\nPostop:NIL oral 2 hours.Oral diet once fully conscious.\r\n\nSEEN BY DR.Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Fever\r\nPAIN SCORE:3/5\r\nBLOOD SUGARS : \r\nPREDINNER: 258 MG/DL\r\nFBS: 215 MG/DL\r\nBP: 150/80 MM HG\r\nCASE PLAN : continue same treatment \r\nUrine RE\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Pain left leg\r\nPAIN SCORE: 3/5\r\nBLOOD SUGARS : \r\nPREDINNER: 204 MG/DL\r\nFBS: 213 MG/DL\r\nBP: 140/90 MM HG\r\nCASE PLAN : Dressing today, apply Rupatch, Tramadol 1 hour before dressing, blood transfusion 1 PRBC\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.BHat.\r\nC&D tomorrow.\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: \r\nPAIN SCORE: 2/5\r\nBLOOD SUGARS : \r\nPREDINNER: 175 MG/DL\r\nFBS: 186 MG/DL\r\nBP: 110/70 MM HG\r\nCASE PLAN : Dressing today\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.Bhat.\r\nDressings changed.Large raw areas clean.Posterior skin flap leg looks dusky-needs observation.StOP Clexane.Cap.Camyda 300 mg 1-1-1 .Cap,.Yogut 1-0-1.\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN : Meformin 500 mg BD\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.BHat.\r\nContinue trt.??Plan fr D/C tmrw.\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:pain over left leg ,oozing present\r\nPAIN SCORE:3/5\r\nBLOOD SUGARS : \r\nPREDINNER:155 MG/DL\r\nFBS:182MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN :\r\nCST\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\nSeen by DRA.K.BhAt.\r\nDRessings changed.Clean large raw areas left leg.\nSeen by DRA.K.Bhat.\r\nAdv:Dressings once in 2 days-Betadine,Jelonet.Oral Dalacin 1week.Review OP 10 days.'}, {'role': 'model', 'content': '\nIP Number: 8544\n\nPatient Number: 39738\n\nAdmission Date: 03-12-2018\n\nDischarge Date: 17-12-2018\n\nDiagnosis: Extensive Necrotising fasciitis left lower limb\r\nP/s Fasciotomy\r\n\r\n\r\n\r\n\r\n\n\nClinical Exam(With BP): nan\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: ECG:SR No significant ST/T Changes\t\r\nECHO:NO RWMA Good LVEF Normal Valves\r\n\r\n\r\n\n\nXray findings: Concious and cooperative \r\nAnxious \r\nvitals stable \r\nLeft leg - pitting edema , redness + (necrotizing fascitis)\r\nS1Nl S2Nl Split No S3/S4/Murmurs\r\nChest clear , AEBE\r\n\r\n\n\nDiscussion: Mrs, Saleema Yousaf, 65 year old lady with h/o Type 2 DM presented with complaints of swelling and redness of left leg. She was found to have cellulitis with early necrotizing fascitis of the left leg.She was admitted and started on IV antibiotics.Podiatry consultation was obtained and fasciotomy was done under Regional block on 6/12/18.Her blood sugars were controlled with basal bolus insulin regimen.Regular dressings were given.Wound healing is good.She is clinicaly better and is discharged in a stable condition.\n\nDiet: nan\n\nRemarks: To report SOS in case of discharge, bleeding from the wound site,swelling of the foot/limb or in case of fever.\r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\nDressings once in 2 days-Betadine,Jelonet.\r\nReview after 2 week in Endo/Podiatry OP with PPBS'}] |
8,593 | [{'role': 'user', 'content': "\nIP Number: 8593\n\nPatient Number: 46370\n\nPatient Name: P K MOIDHEEN\n\nGender: M\n\nDate of Birth: 22-10-1955\n\nAddress: PARAMBATHKANDY\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 19-12-2018\n\nDischarge Date: 07-01-2019\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: Conscious,oriented,febrile\r\nchest clear\r\nCNS - NFND\r\nInfective gangrene right big toe,extending deep into plantar,dorsum,intermetatarsal regions of foot.\r\nMaggots.POVD.Cellulitis foot.\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by DRA.K.Bhat.\r\nInfective gangrene rt big toe,extending deep into plantar,dorsum,intermetatarsal regions of foot.Deep pus-C/S taken.Maggots.POVD.Cellulitis foot.\r\nAdv:Betadine dressings.IV ABx.Medical review.\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 121 MG/DL\r\nFBS: 105 MG/DL\r\nBP: 146/70 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.BHat.\r\nDeep infection,pus rt foot.gangrene big toe.Continue trt.\r\nDiscussion:1)Earlier 2 months ago vascular opinion taken-no benefit from revascular angioplasty-explained..\r\n2)Big toe amputation/deroofing metatarsal space-proceed-depending on healing-revascularisation-high risk of nonhealing,risk of BKA explained.\r\n--------------------\r\nPlan for Right big toe amputation,I&D under SA, 21st DEc.\r\nPreop:\r\nGet informed consent.\r\nNil oral as per Anesthetist advice.\r\nClean&dress area on morning of operation.\r\nIV antibiotics.\r\nMedical &Anesthetic fitness for the procedure.\r\nInform OT and anesthetist.\r\n-----------------------\r\nInformed Consent.\r\nTwo months ago there was big oe gangrene-Vascular opinion taken that time with no benefit of any vascular intervention is opinion.There is History of Diabetes,coronary artery disease.\r\nNow there is severe spreading infection of right big toe including bone and other tissues with pus collection deep.There is spreading gangrene(dead tissues) of big toe.This needs removal of infected dead tissues of the big toe-amputation of the big toe.Also deep spreading pus will be drained..The extent of tissue removal will depend on the finding during surgery.In diabetes the surface wound may look small,but the extent of infection on the deeper aspect will be wider in area,so there will be wide multiple wounds after operation.Due to neuropathy&diabetes& decreased blood supply, the control of infection and wound healing needs close observation.Infection control&Wound healing will be delayed. There is possibility that the nonhealing wound may worsen.Having understood the above,consent for operation under anesthesia is given.\r\n------------------------------------------\r\n\r\n\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:pain ,basal creps +\r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nPREDINNER: 211 MG/DL\r\nFBS: 315 MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN :BT today\r\nTab.Dytor 10mg 1/2-0-0\r\nInj.Meropenam 1gm 1-1-1\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\r\n\nPatient's Trop T showed positive\r\ncardiology consultation taken\r\nAdvice\r\nTab.Ecospirin 300mg stat\r\nTab.Deplatt 75mg X4stat\r\nTab.Nebistar 45mg 1-0-1\r\nInj.Clexane 0.4mg s/c BD\r\nTab.GTN sorbitrate 2.6 1-0-1 (8am-3pm)\r\nTab.Dytor 10 1-0-0.\r\nSeen by DRA.K.Bhat.\r\nDressings changed.Extensive residual infection bone/joint at tarsometarsal/ankle level.?Plan for Below knee amputation under Epidural on Wednesday.\nSeen by DRA.K.Bhat.\r\nDressings changed.\r\nPLAN Options given:\r\n1)Wait.\r\n2)Deep repeat debridement/bone nibbling and staged reconstruction with multiple risks.\r\n3) Below knee amputation.\r\n--------------\r\nPosted for right below knee amputation under SA on 26th DEcember.\r\nPreoperative Instructions:\r\nRepeat HB,TC,Urea,Creat,Na,K,FBS tomorrow.\r\nGet informed consent.\r\nNil oral as per Anesthetist advice.\r\nShave and betadine scrub right leg,morning of operation.\r\nIV antibiotics.\r\nMedical &Anesthetic fitness for the procedure.\r\nInform OT and anesthetist.\r\nArrange one unit packed cells.\r\n--------------------------\r\nInformed consent:\r\nThere is extensive bone,joint and soft tissue infection of right foot, ankle with infection extending leg region.Pus extending to tarsal and ankle joints.There is diabetes and neuropathy and cardiac illness and septicemia.There is reduced circulation of leg.The extensive and severe nature of infection makes any form of limb saving operation useless and continued risks for developing recurrence of infection and nonhelaing.Discussion regarding all options of treatment explained. 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.Also close medical followup is essential. The above points have been explained and understood and full high risk consent for anesthesia and operation is given.\r\n-------------------------------\r\n\r\nSIGNED.\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Post op day-1,Stable condition\r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nPREDINNER:210 MG/DL\r\nFBS: 159MG/DL\r\nBP: 156/90 MM HG\r\nCASE PLAN :Shifted to room\r\n Start Inj.Clexane and stop INJ.Dalacin\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Constipation\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 187 MG/DL\r\nFBS: 164 MG/DL\r\nBP: 150/100 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.BHat.\r\nContinue trt.\r\n\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Pain right leg\r\nPAIN SCORE: 3/5\r\nBLOOD SUGARS : \r\nPREDINNER: 192 MG/DL\r\nFBS: 170 MG/DL\r\nBP: 130/70 MM HG\r\nCASE PLAN : Dressing today\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by Dr.A.K.B.\r\nDRessings changed.Clean.Oral ABx-Cefixime.\r\n\nSEEN BY DR.Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: \r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nPREDINNER:166MG/DL\r\nFBS:152 MG/DL\r\nBP: 140/90 MM HG\r\nCASE PLAN : Hb\r\nContinue same treatment\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 140/90 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR.Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:Basal creps+\r\nPAIN SCORE:2/5\r\nBLOOD SUGARS : \r\nPREDINNER:197MG/DL\r\nFBS:183 MG/DL\r\nBP: 130/70 MM HG\r\nCASE PLAN :\r\nTab.Galvus Met 50/500 1-0-1\r\nLFT,TC\r\nAdvice Spiroball Excerise\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 154 MG/DL\r\nFBS: 155 MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaint\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 139 MG/DL\r\nFBS: 161 MG/DL\r\nBP: MM HG\r\nCASE PLAN : TC, Hb, Creat, Cardio review tomorrow\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.B.\r\nC&D.Clean.Continue trt.Plan for D/C on Monday 7th Jan.\r\n\nSEEN BY DR.Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:No fresh complaints\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 140/80 MM HG\r\nCASE PLAN :Continue same treatment\r\nVit D,Ca,Ph and GGT\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.Bhat.\r\nContinue trt.\r\n\nSeen by DRA.K.BHat.\r\nContinue trt.DRessings changed,.Suture line clean.STOP ABx.Plan fr D/C Monday.PHYSIOTHERAPY.\nSEEN BY DR. Karthik &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:nil\r\nPAIN SCORE:1/5\r\nBLOOD SUGARS : \r\nPREDINNER:123MG/DL\r\nFBS:102MG/DL\r\nBP: 150/90 MM HG\r\nCASE PLAN :Continue same treatment\r\nPlanning for discharge\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.B.\r\nContinue trt.\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaint\r\nPAIN SCORE: 2/5\r\nBLOOD SUGARS : \r\nPREDINNER: 125 MG/DL\r\nFBS: 109 MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN : Discharge today\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DR.A.K.Bhat.\r\nSR done.Healed.\r\nAdv:Protective betadine dressings once in 2 days,crepe bandage.Muscle strengthening Exercises.Walker training..REview OP 2 weeks.Diafoot cream.Footcare."}, {'role': 'model', 'content': '\nIP Number: 8593\n\nPatient Number: 46370\n\nAdmission Date: 19-12-2018\n\nDischarge Date: 07-01-2019\n\nDiagnosis: Infective gangrene Right Big Toe,extending deep into plantar,dorsum and intermetatarsal regions of foot\r\n S/P Amputation at MTP of Right big toe 21/12/2018\r\n S/P Right below knee amputation 26/12/2018\r\nACS-NSTEMI \r\nVitamin D Deficiency\r\nAnaemia-?due to chronic infection\n\nClinical Exam(With BP): nan\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: Echo: Mild Concentric LVH.Good LV Systolic Function Stage 1diastolic dysfunction.Aortic valve calcific,Mild MR.\r\n\n\nXray findings: Conscious,oriented,febrile\r\nChest clear\r\nCNS - NFND\r\nInfective gangrene right big toe,extending deep into plantar,dorsum,intermetatarsal regions of foot.\r\nMaggots +\n\nDiscussion: Mr. P.K Moideen 63year/old male,k/c/o CAD and type2 DM with POVD admitted with infective gangrene over right big toe,deeply extending to foot. He was admitted here 2 months back with gangrene of the big toe and was evaluated.Peripheral angio was done which showed long segment occlusion of the Ant Tibial Artery (opinion from Vascular team was taken).He had gone for naturopathy treatment and the condition of the toe and foot became worse.He was in sepsis on admission here.All blood routinue was done and showed elevated leucocyte counts and low haemoglobin.He was started on IV anitibiotics(Piperacillin+Tazobactum and later changed to Meropenem) and Basal bolus insulin regimen.Podiatry consultation was taken immediately.He was taken up for amputaion at MTP of right big toe.After all preop work including ECHO and cardiology consult he was taken up for surgery under regional block on 21/12/2018.During the post operative period he developed pulomnary edema and the Trop T was positive.He was treated with Diuretics ,Clexane,Nitrates,Beta-blocker and Antiplatelets.Alternate day dressings were given. Since the wound healing was not satisfactory, our Podiatry Surgeon adviced BKA (in view of the extensive residual infection of bones/joints at tarsometarsal/ankle level).After explaining to patients relatives about bad progressing of infection, he was taken up for surgery..On 26/12/2018 surgery done under spinal anaesthesia. Intra and post Operative period was uneventfull.2 units of PRBC was transfused.He was given dressings and the amputation site is healed.Hwe was given physio .He is clinically better .His insulin regimen is changed to Twice daily Ryzodeg.He is discharged in a stable condition and advised to physio at home.\n\nDiet: nan\n\nRemarks: REview OP 2 weeks.\r\nReport sos incase of fever,discharge or bleeding from surgery site.\r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\n\r\nReview in Podiatry/Diabetology OP\r\nCBC/PPBS during review\r\nTo bring LOGBOOK during review'}] |
8,884 | [{'role': 'user', 'content': '\nIP Number: 8884\n\nPatient Number: 49901\n\nPatient Name: BABU AUGUSTINE\n\nGender: M\n\nDate of Birth: 10-04-1960\n\nAddress: ARACKAL HOUSE\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 22-04-2019\n\nDischarge Date: 06-05-2019\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: Seen by DRA.K.B.\r\nArterial Doppler left leg..\nSeen by DR.AK.B.\r\nContinue trt.For slough excision and proceed left big toe amputation under regional block on 24th APr.8 am.\r\nPreop:\r\nGet informed consent.\r\nNil oral as per Anesthetist advice.\r\nClean&dress area on morning of operation.\r\nIV antibiotics.\r\nMedical &Anesthetic fitness for the procedure.\r\nInform OT and anesthetist.\r\n--------------------------\r\nInformed consent-\r\nThere is severe gangrenous infection of left big toe including bone/joint and other tissues with pus collection,extending to both plantar and dorsum surfaces of foot and close to 2nd toe joints..Previous operations have been done elsewhere since 1 month,but no relief.There is diabetes and neuropathy.The infection gangrene needs bone nibbling and shortening of the left big toe, to control the infection.During operation all the infected unhealthy bone and skin and soft tissues will be removed.The amount and length of shortening(amputation) of the big toe and amount of skin and soft tissue removal ,will depend on the findings during operation. Due to neuropathy&diabetes&decreased blood circulation and severity and extent of infection, the control of infection and wound healing needs close observation.Wound healing will be delayed. Repeat operations may be needed for wound healing.Having understood the above,consent for operation under anesthesia is given.\r\n======================\r\n\nSeen by DRA.K.B.\r\nContinue trt.\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaints\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: MM HG\r\nCASE PLAN : Continue IV antibiotics, Opthal consultation, sent urine ACR\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Pain left leg\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 185 MG/DL\r\nFBS: 150 MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN : PBF, iron studies\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.B.\r\nContinue trt.\r\n\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 165 MG/DL\r\nFBS: 123 MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.B.\r\nDRessings changed.Clean.Plan fr D/C on Monday.Tab.Ziprax 200 mg 1-0-1.Cap.Yogut.\r\n\nSeen by DRA.K.B.\r\nContinue trt.Plan fr D/C tmrw.\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaints\r\nPAIN SCORE: 0/5\r\nBLOOD SUGARS : \r\nPREDINNER: 123 MG/DL\r\nFBS: 109 MG/DL\r\nBP: 120/80 MM HG\r\nCASE PLAN : Continue same treatment, continue dressing as per Dr. Bhat, GRBS checking once daily, Opthal consultation tomorrow\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.B.\r\nDressings changed.Clean.Continue trt.\r\n\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.B.\r\nDRessings changed.Clean.Continue trt.\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.B.\r\nContinue trt.\r\n\nSEEN BY DR. MANOJ &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 151 MG/DL\r\nFBS: 138 MG/DL\r\nBP: 120/90 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\nSeen by DRA.K.B.\r\nContinue trt.\nSEEN BY DR. Tom &TEAM\r\nNo specific complaints\r\nBLOOD SUGARS : \r\nPREDINNER: 214 MG/DL\r\nFBS: 111 MG/DL\r\nBP: 120/80 MM HG\r\nCASE PLAN : continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.B\r\nPlan fr D/C on MOnday.\r\n'}, {'role': 'model', 'content': '\nIP Number: 8884\n\nPatient Number: 49901\n\nAdmission Date: 22-04-2019\n\nDischarge Date: 06-05-2019\n\nDiagnosis: Left big toe gangrene\r\ns/p Left Big Toe amputation & Slough excision under Regional Block (24/04/29)\n\nClinical Exam(With BP): Provisonal Diagnosis : Diabetic foot - ?Gangrene left big toe\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: \r\n\r\n\n\nXray findings: Patient conscious and cooperative \r\nVitals stable \r\nChest clear \r\nLocal Examination: Large infected unhealthy ulcer left foot - Gangrene left big toe - slough dorsum,1st web\r\nPlantar DP feeble.\n\nDiscussion: Mr Babu Augustine, 59 year old male patient presented with large infected ulcer left foot with gangrene of the big toe to the podiatry OP. He had underwent sugical procedures in an outside hospital earlier following which he developed gangrene of the big toe. On admission all routine blood investigations were send, x-ray left foot, chest x-ray were taken and ECG (normal ) done. Pus culture showed Serratia marcescens. Left arterial doppler done and showed normal vascularity of the arteries. After all pre operative workup, patient was taken up for slough excision and big toe amputation under regional block. His blood sugar values were controlled with basal bolus insulin regimen in the beginning and later switched over to pre-mix insulin twice daily and OHAs. His intraop and post op period were uneventful. Regular dressing and oral antibiotics were continued. Ophthal consultation was done to rule out retinopathy. His condition is stable and is being discharged.\n\nDiet: nan\n\nRemarks: If You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\nReview on 13/5/19 in Ppdiatry /Diabetology OP\r\nPPBS/CBC during review'}] |
9,070 | [{'role': 'user', 'content': '\nIP Number: 9070\n\nPatient Number: 23487\n\nPatient Name: LISSY JOY\n\nGender: F\n\nDate of Birth: 09-04-1960\n\nAddress: THANNIKOTTU H, PANAMKUZHY\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 01-07-2019\n\nDischarge Date: 18-07-2019\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: Seen by DRA.K.B.\r\nC&D done.Blisters deroofed.Large infective eschar posterior lower leg.Continue trt.\nSeen by DR.A.K.B.\r\nContinue trt.\r\nPosted for I&D fasciotomy rt leg on 4th JUly 3pm under SA.\r\nPreoperative Instructions:\r\nGet informed consent.\r\nNil oral as per Anesthetist advice.\r\nClean&dress area on morning of operation.\r\nIV antibiotics.\r\nMedical &Anesthetic fitness for the procedure.\r\nInform OT and anesthetist.\r\nPreop. tests.\r\nArrange one unit packed cells.\r\n------------------\r\nInformed consent.\r\nThere is pus filled infection of right foot and leg extending to thigh region.This pus infection is extending deep to deeper tissues like fascia.There are multiple pus filled blisters in these regions.There is Diabetes,decreased circulation of leg.The infection needs incision and drainage and fasciotomy under anesthesia.During operation the spreading infection will be opened up in multiple areas and pus will be drained.In necrotising fasciitis there will be infection more extensive than what is seen on the surface.Infected skin and soft tissues need to be removed.Due to extending nature of infection, after surgery the wounds will be large and control of infection and healing will be delayed.Due to Diabetes and decreased circulation, infection control&healing will be delayed.The healing and circulatory condition of wounds will need observation.Repeat surgery may be needed.Understanding the above consent for anesthesia and operation is given.\r\n---------------------\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 150/100 MM HG\r\nCASE PLAN : Stop T. Telmisartan, start Cilacar, IV fluid 1 pint NS with kcl 70 ml/hour, insulin infusion 4 ml/hour\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Pain right leg\r\nPAIN SCORE: 3/5\r\nBLOOD SUGARS : \r\nPREDINNER: 223 MG/DL\r\nFBS: 193 MG/DL\r\nBP: 140/90 MM HG\r\nCASE PLAN : IV fluid maintainance 500 ml NS 75 ml/hr, Rupatch. Sent Hb, TC, creat, Electrolytes tomorrow\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.B.\r\nContinue trt.\r\n\nSeen by DRA.K.B.\r\nContinue trt.C&D tomorrow.\nSeen by DRA.K.B.\r\nDressings changed. Large raw areas leg&thigh-exposing bare tendoachilles-needs observation.AK POP slab given.Continue trt.\nSeen by DRA.K.B.\r\nRash posterior thoracic spine region.Tab.Allegra.Continue trt.\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Generalized pain, itchy erythema over the back\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 138 MG/DL\r\nFBS: 105 MG/DL\r\nBP: 150/90 MM HG\r\nCASE PLAN : Sent stool for occult blood, Hb, TC,\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaint\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 169 MG/DL\r\nFBS: 165 MG/DL\r\nBP: 170/100 MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.B.\r\nContinue trt.Enema SOS.Inj.Pansec IV bd.\r\n\nSEEN BY DR. MANOJ &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: bladder distention and no urine output from evening onwards.catheter removed(blocked by pus)\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 212 MG/DL\r\nFBS: 104 MG/DL\r\nBP: 150/90 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.B.\r\nDressings changed.Large clean raw area,but exposing bare tendoachilles.Stop IV ABx.Start Cap.Dalacin 300mg 1-1-1.\r\n\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: \r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: MG/DL\r\nBP: 150/90 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaint\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 136 MG/DL\r\nFBS: 130 MG/DL\r\nBP: 140/90 MM HG\r\nCASE PLAN : Stop Allegra, Atarax, Pan\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.B.\r\nContinue trt.C&D in ICU tmrw.\r\n\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaint\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 129 MG/DL\r\nFBS: 201 MG/DL\r\nBP: 150/90 MM HG\r\nCASE PLAN : Continue same. Dressing today\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\nSeen by DRA.K.B.\r\nDressings changed.Large raw areas rt leg exposing bare tendoachilles.I&D done under LA, to decompress edema mid calf region.Continue trt.\nSeen by DRA.K.B.\r\nContinue trt.DRessings to be changed on Monday in ICU.\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaints.\r\nPain better. URE normal. Stool occult negative.\r\nPAIN SCORE:\r\nBLOOD SUGARS :\r\nFBS: 141 MG/DL\r\nBP: 170/100 MM HG\r\nCASE PLAN : Dressing change today, T. Telma OD\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Sugar controlled. No specific complaints\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: MG/DL\r\nFBS: 122 MG/DL\r\nBP: 140/90 MM HG\r\nCASE PLAN : Dressing change today\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.B.\r\nDressings changed.Plan fr D/C tmrw.\r\n\nSeen by DRA.K.B.\r\nD/C advice:DRessings betadine,debrin,jelonet once in 2 days.Oral ABx 1 week.Review OP 1 week.'}, {'role': 'model', 'content': '\nIP Number: 9070\n\nPatient Number: 23487\n\nAdmission Date: 01-07-2019\n\nDischarge Date: 18-07-2019\n\nDiagnosis: Severe extensive necrotising fascitis, blistering along with cellulitis of whole right lower limb\r\n s/P Fasciotomy and I&D of right lower limb.\r\n s/P amputation of right big toe (done in the past).\n\nClinical Exam(With BP): nan\n\nSystolic BP: 153.0\n\nDiastolic BP: 93.0\n\nPhysical examination: ECG: SR No significant ST/T Changes\t\r\nECHO: No RWMA Good LVEF Normal Valves\n\nXray findings: General Examination: Conscious and oriented\r\nChest clear \r\nLocal Examination: Rt leg achilles region, severe extensive necrotising fascitis - blistering. Cellulitis of the whole right foot & leg.\n\nDiscussion: Mrs. Lissy Joy 59 years old female, a k/c/o diabetic was admitted with severe extensive necrotising fascitis, blistering along with cellulitis of whole right lower limb. On admission, she had raised blood sugar level (375mg/dl) and elevated total counts(16800). She was started on IV antibiotics, analgesics and basal bolus insulin regimen. Podiatry surgeon was consulted and advised faciotomy. After all preop workups, on 4/7/2019, fasciotomy under SA was done. Specimen was sent HPE. Intra and postoperative period was uneventfull. On 12/7/2019, I&D done under LA to decompress edema mid calf region. She got symptomatically better and blood sugar level was brought into control. Regular dressings were given. She is discharged in a stable condition.\n\nDiet: nan\n\nRemarks: To report SOS in case of discharge, bleeding from the wound site,swelling of the foot/limb or in case of fever.\r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness. Immediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\n\r\nReview after 1 week with PPBS at Podiatry and Endo OP'}] |
9,294 | [{'role': 'user', 'content': '\nIP Number: 9294\n\nPatient Number: 42745\n\nPatient Name: BASHEER K S\n\nGender: M\n\nDate of Birth: 10-04-1969\n\nAddress: KARUKUNNATHU H\n\nPincode: nan\n\nPhNo: 9562888836\n\nAdmission Date: 24-09-2019\n\nDischarge Date: 12-10-2019\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: o/e bp=130/80\r\npr=88\r\nt=n\r\npallor +\r\nconcious corperative \r\nchest clear\r\ncvs s1s2 heard\n\nPrecautions to be taken while treating the patient: k/c/o DM\n\nRemarks: Seen by DRA.K.B.\r\nSevere extensive limb life threatening necrotising gangrenous diabetic foot infection whole of left foot, heel. Full thickness skin, soft tissue deep fascial tendinous bone/joint infection. Foul smelling discharge from all layers. Large multiple necrotic raw areas of foot, heel. Severe swelling of foot and leg. Ascending infection. Neuropathy&vasculopathy,.\r\nPlan for BK amputation. Patient wants conservative medical treatment. \r\nAdv: Daily dressings. IV Abx. Transfuse packed cell. IV fluids. XRay left foot AP, Oblique. Arterial Doppler.\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Weakness, loss of appetite, dryness of mouth\r\nDoctors Note: Patient admitted with sepsis secondary to diabetic foot (left)\r\nHe was advised amputation 4 months back at Amritha. Patient went to Palakad and took treatment from there.\r\nPAIN SCORE: 1/5\r\nBLOOD SUGARS : \r\nPREDINNER: 187 MG/DL\r\nFBS: 148 MG/DL\r\nBP: 98/58 MM HG\r\nCASE PLAN : IV fluid 500 ml NS 150 ml/hr. Arrange and transfuse blood.\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSeen by DR.A.K.B.\r\nTransfuse packed cells.& FFP. Daily dressings. Continue trt.\n1.15pm 26/9/19\r\nblood crossmatched ready for infusion \r\ninj avil 1cc stat\r\nunit no 57767/pc\r\ngroop A+\r\nPACKED RED BLOOD CELL\r\ncollection date 31/8/19\r\nexpiry date 12/10 19\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:better,no pain\r\nDr.Bhatt to see,Arterial Doppler to see.\r\nPAIN SCORE:2/10\r\nBLOOD SUGARS : \r\nPREDINNER: 110 MG/DL\r\nFBS: 146 MG/DL\r\nBP: 128/70 MM HG\r\nCASE PLAN :\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DR.A.K.B.\r\nPlan for BKA.Patient not willing for any surgical procedure. Adv:Daily dressings.IV antibiotics.\ncase seen by Dr.SruthySathya\r\nOozing from the wound+\r\nAfebrile,GC good\nSEEN BY DR. TOM &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O:ITCHINGA ND PAIN ON HE FOOT\r\nPAIN SCORE:4\r\nBLOOD SUGARS : 166\r\nPREDINNER: 219 MG/DL\r\nFBS: MG/DL\r\nBP: 130/80 MM HG\r\nCASE PLAN :PODIATRIC AND DIETECIAN CONSULTATION\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DR.A.K.B.\r\nContinue trt.\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaint\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 209 MG/DL\r\nFBS: 118 MG/DL\r\nBP: 115/60 MM HG\r\nCASE PLAN : Amputation\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\ncase seen by dr.chinmaya\r\ngeneral condition fair\r\nRS- clear\r\nCVS- s1 s2 heard\r\nCNS- nfnd\r\nP/A - soft\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaint\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 227 MG/DL\r\nFBS: 165 MG/DL\r\nBP: 128/75 MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.B.\r\nExplained to patient and bystanders in detail. Plan for Left BKA on Friday(4TH Oct). Preop:Transfuse packed cells&FFP.Two packed cells for day of operation. IV ABx.,Preop. tests.Medical/Anesthetist fitness.\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Pain in left leg\r\nPAIN SCORE:4/10\r\nBLOOD SUGARS : \r\nPREDINNER: 258 MG/DL\r\nFBS: 242 MG/DL\r\nBP: 126/76 MM HG\r\nCASE PLAN : Blood tranfusion today. Cardiac clearance. BKA tomorrow.\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\nSeen by DRA.K.B.\r\nContinue trt.\r\nPosted for left Below knee amputation surgery on 4th Oct.under SA .\r\nPreoperative Instructions:\r\nGet informed consent for Left below knee amputation..\r\nNil oral as per Anesthetist advice.\r\nClean&dress area on morning of operation.\r\nShave and betadine scrub ,morning of operation.\r\nIV antibiotics.\r\nMedical &Anesthetic fitness for the procedure.\r\nInform OT and anesthetist.\r\nArrange packed cells.\r\n---------------------------\r\nThere is extensive bone,joint and soft tissue infection of left ankle and whole foot, 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 anesthesia and operation is given.\r\n----------------------\r\nSIGNED.\ncase seen by Dr.SruthySathya\r\nPosted for surgery today\r\nNo fresh complaints\r\nNPO from morning\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nOozing present\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 139 MG/DL\r\nFBS: 208 MG/DL\r\nBP: 121/72 MM HG\r\nCASE PLAN : BKA today\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\ncase seen by dr.chinmaya, post op day 1.\r\ngeneral condition condition , oriented, afebrile\r\nSpo2- 98%,BP- 120/70, urine output 1500ml,grbs - 185\r\nno fresh complaints\r\nRS - clear\r\nCVS - s1 s2 heard\r\nP/A - soft\r\nCNS - nfnd\r\nSeen by DRA.K.B.\r\nContinue trt.Tab.PCT 1-1-1.\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Itching over the amputation site\r\nPAIN SCORE: 3/10\r\nBLOOD SUGARS : \r\nPREDINNER: 165 MG/DL\r\nFBS: 180 MG/DL\r\nBP: MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\ncase seen by Dr.SruthySathya\r\nMild pain over surgical site ,tolerable\r\nNo other complaints\r\nUrine output good\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaint\r\nPAIN SCORE: 2/10\r\nBLOOD SUGARS : \r\nPREDINNER: 262 MG/DL\r\nFBS: 135 MG/DL\r\nBP: 140/80 MM HG\r\nCASE PLAN : Dressing today. Dr. Bhat to see\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\nSeen by DRA.K.B.\r\nDRessings changed. Drain removed. SL clean. Stop IV ABx.Start Tab. Faronem. Continue trt.\nSeen by DRA.K.B\r\nContinue trt.\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaint\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 163 MG/DL\r\nFBS: 111 MG/DL\r\nBP: 140/80 MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSeen by DRA.K.B.\r\nDRessings changed. Suture line clean. Continue trt.PHYSIO.\ncase seen by Dr.SruthySathya\r\nno fresh complaints\r\nGC good\r\n\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaints\r\nPAIN SCORE: 2/10\r\nBLOOD SUGARS : \r\nPREDINNER: 164 MG/DL\r\nFBS: 110 MG/DL\r\nBP: 122/80 MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaint\r\nBLOOD SUGARS : \r\nPREDINNER: 235 MG/DL\r\nFBS: 242 MG/DL\r\nBP: 121/68 MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\nSeen by DRA.K.B.\r\nContinue trt.Plan fr D/C tmrw. Long term Stiloz, Ecospirin.\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaint\r\nBLOOD SUGARS : \r\nFBS: 223 MG/DL\r\nBP: 120/80 MM HG\r\nCASE PLAN : Discharge today\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n'}, {'role': 'model', 'content': '\nIP Number: 9294\n\nPatient Number: 42745\n\nAdmission Date: 24-09-2019\n\nDischarge Date: 12-10-2019\n\nDiagnosis: Life threathing diabetic foot infection - left foot\r\nS/p Left Leg Below Knee Amputation done on 4/10/19\r\nAnemia\r\nED+\n\nClinical Exam(With BP): He came with life threatening diabetic foot of Lt leg since 4 months.\r\nc/o loss of apitite, tiredness giddiness\n\nSystolic BP: 138.0\n\nDiastolic BP: 70.0\n\nPhysical examination: Chest X-Ray : Within normal limits.\r\n\r\n\n\nXray findings: BP - 130/80 mmHg\r\nPulse - 88/min\r\nPallor +\r\nConcious corperative \r\nChest clear\r\nCVS - s1s2 heard\n\nDiscussion: Mr.Basheer 50 yr old, a k/c/o Type 2 DM, hyperchylomicronaemia presented with life threatening diabetic foot of Lt leg since 4 months, accompanied with loss of appetite, tiredness. He was admitted, all routeine investigations were sent (was suggestive of sepsis) and started on IV antiobiotics. Podiatry consultation was sought and adviced left below knee amputation .After obtaining fitness from cardiology, medicine, pulmonology and anesthesiology, he was takenup for surgery. Below knee amputation done under spinal anesthesia on 04/10/19, intra and post operative periods were uneventful. His condition is better and is being discharged under stable condition with oral antibiotics.\n\nDiet: nan\n\nRemarks: Review on monday opd.\r\nTo report SOS in case of discharge, bleeding from the wound site, in case of fever.\r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness. Immediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\nAlternate day dressing at our podiatry unit as advised by our Podiatry Surgeon.\r\nReview with PPBS after 1 week'}] |
9,577 | [{'role': 'user', 'content': '\nIP Number: 9577\n\nPatient Number: 55326\n\nPatient Name: AL JABRI AWADH AHMED SALIM\n\nGender: M\n\nDate of Birth: 09-11-1967\n\nAddress: OMAN\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 19-01-2020\n\nDischarge Date: 21-02-2020\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: concious, oriented ,alert\r\nBP - 140/90\r\nGRBS- 199\r\nRS- clear\r\nCVS - s1 s2 heard\r\nCNS - nfnf\r\nP/A- soft , non tender\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: SEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Cough\r\nBLOOD SUGARS : \r\nPREDINNER: 105 MG/DL\r\nFBS: 114 MG/DL\r\nBP: 130/70 MM HG\r\nCASE PLAN : Nebulization BD, Sufrecof syp, oral antibiotics\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: Rt shoulder pain. Cough reduced but persists\r\nPAIN SCORE:\r\nBLOOD SUGARS : \r\nPREDINNER: 114 MG/DL\r\nFBS: 107 MG/DL\r\nBP: 130/82 MM HG\r\nCASE PLAN : Physio. Nebulization for today\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaint\r\nPAIN SCORE: 2/10\r\nBLOOD SUGARS :\r\nFBS: 121 MG/DL\r\nBP: 118/72 MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Manoj &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaint\r\nBLOOD SUGARS : \r\nPREDINNER: 102 MG/DL\r\nFBS: 130 MG/DL\r\nBP: 120/94 MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Tom &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaint\r\nBLOOD SUGARS : \r\nFBS: 115 MG/DL\r\nBP: 128/70 MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n\nSEEN BY DR. Lakshmi &TEAM\r\nPATIENTS GENERAL CONDITION STABLE\r\nC/O: No specific complaint\r\nBP: 143/88 MM HG\r\nCASE PLAN : Continue same\r\nPATIENT CONDITION EXPLAINED TO THE BYSTANDERS\r\n\r\n'}, {'role': 'model', 'content': '\nIP Number: 9577\n\nPatient Number: 55326\n\nAdmission Date: 19-01-2020\n\nDischarge Date: 21-02-2020\n\nDiagnosis: Lt leg Charcots arthropathy\n\nClinical Exam(With BP): He presented to us with pain and swelling - left foot since 3yrs which had worsended recently. His gait was becoming abnormal in leiu of the deformity. MRI scan of the Lt foot done else where was suggestive of Charcots Arthropathy.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: \r\n\r\n\n\nXray findings: Concious, oriented ,alert\r\nBP - 140/90\r\nGRBS- 199\r\nRS- clear\r\nCVS - s1 s2 heard\r\nCNS - nfnf\r\nP/A- soft , non tender\r\nLt foot swollen, warm and deformed\n\nDiscussion: Mr Al Jabri Awadh Ahmed Salim 52yrs came in with c/o pain and swelling over the Lt foot since 3yrs with acute worsening. He was admitted here for strict off loading of Lt foot. He was given a bi valve fibre cast which was later changed to a walking cast during the course of hospital stay.His sugars controled by a low caloric diet + SGLT2I + GLP1RA .A weight loss of about 9 kgs was achieved while in hospital. He is symptomaticaly better and being dicharged in stable condition. He is advised to r/w after 2 days (on Monday) for cast removal and initiate footwear.\n\nDiet: nan\n\nRemarks: If You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\nLimited walking as advised by our physiotherapist\r\nTo come for admission on Monday for cast removal \r\n\r\nReview after 2days (24/2/2020) for cast removal and Dr Tom opd'}] |
9,882 | [{'role': 'user', 'content': '\nIP Number: 9882\n\nPatient Number: 57762\n\nPatient Name: PANKAJAKSHI DIVAKARAN\n\nGender: F\n\nDate of Birth: 31-12-1948\n\nAddress: VALLIKUNNATH H\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 16-07-2020\n\nDischarge Date: 30-07-2020\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: Temperature :98.6 °F\r\npulse :120 /min\r\nRespiration :20 /min\r\nBP :110 / 67 mm Hg\r\nGeneral Examination :Infection/Gangrene Left Bigtoe extending to the proximal Foot\r\n\r\n\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by DRA.K.B.\r\nIschemic, infective gangrene left foot-big toe, medial foot. POVD. Pedal pulsations absent.Continue trt.Arterial Doppler.Betadine dressings.\nSeen by DRAK.B.\r\nContinue trt.Doppler-POVD.Vascular opinion.\nSeen by DRAK.B.\r\nExtending infective gangrene left big toe, towards rest of medial&midfoot, reaching heel region. Doppler-POVD.Adviced: Vascular opinion.\r\nPatient bystanders explained about the nature of treatment, that vascular augmentation followed by limb saving procedure-if possible. However they requested belowknee amputation as a definitive procedure.\r\nHence plan for left BKAmputation on Monday-20-7-2020.\r\nPreop: Blood tests. Medical fitness. IV ABx, C&D. Arrange 1 unit packed cell for Monday.\nPosted for left BKAmputation on Monday-20-7-2020 , 12 noon..\r\nPreop: Medical fitness. IV ABx. Arrange 1 unit packed cell for Monday. Shave leg&thigh&betadine scrub. Informed written consent.\r\n------------------\r\nThere is extensive bone,joint and skin&soft tissue gangrenous infection of left foot. Pus extending deep&to region of ankle and foot. Patient is HBsAg positive. There is diabetes and neuropathy and severe vasculopathy.There is reduced circulation of leg as seen in Arterial Doppler report. Initial opinion for revascularisation was suggested. The extensive nature of gangrene infection makes any form of limb saving operation useless until any blood flow has been improved.The patient bystanders however want only an amputation without any attempt for revascularisation..Hence after getting this consent for left below knee amputation under Anesthesia , surgery will be done. .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 will 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 anesthesia and operation is given.\r\n\r\nSIGNED. \r\n----------------------\r\n\nSeen by DRA.K.B.\r\nContinue trt.Inj. Clexane 0.4 SC od for 4 days.\nSeen by DRA.K.B.\r\nNo soakage. Continue trt. REpeat HB, FBS, CReat tomorrow.\nSeen byDRA.K.B.\r\nLeft leg dressings done. Suture line&raw area stump is clean. Stop IV ABx. Start Tab.Moxclav.\nSeen by DRA.K.B.\r\nLeft leg dressings changed. Sutures clean. Raw areas clean.\r\nAdvice: Review Monday 3-8-2020. Oral ABx 1 week.'}, {'role': 'model', 'content': '\nIP Number: 9882\n\nPatient Number: 57762\n\nAdmission Date: 16-07-2020\n\nDischarge Date: 30-07-2020\n\nDiagnosis: Infection/Gangrene Left Bigtoe extending to the proximal Foot\r\ns/p-Left Below Knee amputation (20/07/2020)\n\nClinical Exam(With BP): She presented to us with infective gangrene left big toe extending to the proximal Foot and uncontrolled high sugars. She is a k/co Type 2 DM on treatment.\r\n\n\nSystolic BP: 110.0\n\nDiastolic BP: 67.0\n\nPhysical examination: Chest X-Ray :increased BVM\r\nECG:SR No significant ST/T Changes\t\r\nECHO: No RWMA Good LVEF Normal Valves\r\nArterial Doppler-Left Lower LImb-POAD\r\n\n\nXray findings: Temperature :98.6 °F\r\npulse :120 /min\r\nRespiration :20 /min\r\nBP :110 / 67 mm Hg\r\nLocal Examination :Infection/Gangrene Left big toe extending to the proximal Foot\n\nDiscussion: Mrs. Pankajakshi 71 a yr old female k/c/o Type 2 DM admitted with infective gangrene left big toe extending to the proximal foot and uncontrolled blood sugars. Her labs were sent which showed elevated total count, derranged RFT levels and anaemia. She was started on parentral antibiotics, IV Fluids and other supportive care.Glycemic control was acheived with basal bolus insulin regimen. Arterial Doppler of the lower limb showed atherosclerosis. Podiatry surgeon consultaion was taken and discussed about the opition of Angiogram and revacularisation or Below knee amputation. She and patient party opted for below knee amputation without angiogram. Her HBsAg was positive, but her other liver function tests were normal (given Vitamin K prior to surgery). Fitness for surgery was taken from respective departments prior to the surgery. She was taken up for the procedure on 20/07/2020 under SA. Her anaemia was corrected with 2 units of PRBC prior to the surgery and during the intra-operative period. Her immediate post-op period was uneventful. She was recovering slowly when she developed bleeding from amputation stump third post-operative day. She had Hb drop and was given PRBC. She was taken back for re-exploration by the surgeon and ligated the venous bleeder on 23/07/2020. She was given supportive care and regular dressings. Her general condition improved gradually. Her haemoglobin is holding and the renal parameters are stable. She is hence being discharged in a stable state and advised to review as outpatient.\n\nDiet: nan\n\nRemarks: Report if there is fever,giddiness or bleeding from the surgical site.\r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\nReview on 03/08/2020 at Podiatry/Diabetology OP\r\nwith CBC/RFT/Lipid profile/RBS'}] |
9,934 | [{'role': 'user', 'content': '\nIP Number: 9934\n\nPatient Number: 58194\n\nPatient Name: BASHEER T U\n\nGender: M\n\nDate of Birth: 19-08-1957\n\nAddress: 2/1038\n\nPincode: nan\n\nPhNo: 8086192975\n\nAdmission Date: 24-08-2020\n\nDischarge Date: 07-09-2020\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: Concious, oriented,alert\r\nPulse- /min\r\nBP - mm Hg\r\nChest - clear\r\nCVS - s1 s2 heard\r\nCNS - HMF normal\r\n\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by DRA.K.B.\r\nLeft big toe base near circumferential infecteive necrosis. Partial big toe gangrene.\r\nIf surgical debridement is done, there is high risk of big toe loss-same discussed with patient and bystanders.\r\nDressings,. IV ABx.\nSeen by DRA.K.B.\r\nPosted for SLough excision under ankle block/SA on 26-8-2020.Preop: C&D. Medical fitness. IV ABx. Written informed consent.\r\n---------------------\r\n-------\r\nInformed consent.\r\nThere is pus filled gangrenous infection of left big toe.This pus infection is extending to the region of base of big toe& ,possibly upto bone and joint and to nearby web space and 2nd toe &foot..The big toe is gangrenous due to decreased blood supply due to existing atherosclerosis and infection. Angiography already done, says no vascular intervention needed.There is diabetes.This infection needs incision and drainage and slough excision under anesthesia.During operation, the spreading infection will be opened up and dead and necrotic and infected skin and soft tissues will be removed. There is high risk of deep involvement of toes&loss of circulation which may end up in toe amputation in future-this will be decided in the following days after operation.,.In diabetes, the initial wound will be small,but spreading infection will extend below the skin and hence after surgery, the wound will be larger than the present wound.Due to diabetes control of infection and healing will be delayed.Repeat surgery may be needed.Due to extent of infection, the healing and circulatory condition of toes will need observation. Understanding the above, consent for anesthesia and operation is given.\r\n--------------------\nSeen by DRA.K.B.\r\nDressings changed.. Base ulcer clean. Lateral aspect whole big toe is exposing bare bone/joint.Big toe tip nonviable.\r\nOptions discussed- AMputation big toe Vs Wait a few weeks and then decide.\nSeen by DRA.K.B.\r\nDressings changed.Base of big toe &web space granulating. Distal pulp discolored&Lateral aspect big toe exposes bare flexor/extensor bones-needs observation. \r\nAdviced betadine dressings once in 2 days.\nSeen by DRA.K.B.\r\nFoot dressings changed. Big toe Medial aspect viable. Lateral aspect&pulp nonviable-exposing bare bone&flexor tendon.\nSeen by DRA.K.B.\r\nPosted for big tgoe amputation under SA, on 4-9-2020. Preop: Informed written consent for left big toe amputation. C&D. IV ABx.\nSeen by DRA.K.B.\r\n?Plan fr D/C on MondaY.Tab. Faronem.'}, {'role': 'model', 'content': '\nIP Number: 9934\n\nPatient Number: 58194\n\nAdmission Date: 24-08-2020\n\nDischarge Date: 07-09-2020\n\nDiagnosis: S/P - Slough excsion done under regional block on 26/08/2020.\r\nLeft Big Toe Amputation done under ankle block 5/9/2020\r\nTinea versicolor\r\nPAG- Sluggish Flow in Anterior Tibial Artery in Left\r\nNon Healing Ulcer in Left LIower Limb Big Toe with Gangrene\r\n\n\nClinical Exam(With BP): He presented to us with non- healing ulcer in the left big toe with gangrene. He is a k/c/o Type 2 DM on treatment.\n\nSystolic BP: 142.0\n\nDiastolic BP: 102.0\n\nPhysical examination: \r\n\r\n\n\nXray findings: Concious, oriented,alert\r\nPulse- 62 /min\r\nBP - 110/60 mm Hg\r\nChest - clear\r\nCVS - s1 s2 heard\r\nCNS - HMF normal\r\nL/E - Left big toe base near circumferential infective necrosis, \r\n Partial big toe gangrene +\r\n\r\n\n\nDiscussion: Mr.Basheer a 63 yr old male k/c/o Type 2 DM presented to us with non- healing ulcer in the left big toe with gangrene.He was treated with parentral antibiotics annd supportive care.Arterial Doppler of the lower limb showed POAD.He was sent to an intervetional cardiologist for peripheral angiography and intervetnion if required. PAG which was done showed - sluggish flow in Lt. anterior tibial artery and suggested medical management.He was re-admitted and started on IV antibiotics and analgesics.Podiatry review was taken and slough excision under LA was done on 26/08/2020 after explaining the rsik and prognosis. Due to persisting infection and pain he was taken up for big toe amputation under ankle block on 5/9/2020 with minimal risk.Intra and post operative periods were uneventful.His blood sugars were controlled with basal bolus insulin regimen.Regular dressings were given.Wound is healing and good so being discharged in stable condition with oral antibiotics and is advised proper wound care.\r\n\n\nDiet: nan\n\nRemarks: OFF LOAD LEFT FOOT\r\nTo report SOS in case of discharge, bleeding from the wound site ,swelling of the foot/limb or in case of fever.\r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor\r\nReview in Podiatry/Diabetology OP on 11/09/2020\r\nCBC/RBS--during review'}] |
9,977 | [{'role': 'user', 'content': '\nIP Number: 9977\n\nPatient Number: 23487\n\nPatient Name: LISSY JOY\n\nGender: F\n\nDate of Birth: 09-04-1960\n\nAddress: THANNIKOTTU H, PANAMKUZHY\n\nPincode: nan\n\nPhNo: nan\n\nAdmission Date: 23-09-2020\n\nDischarge Date: 07-10-2020\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: Concious,oriented,febrile\r\nBP- 140/80\r\nSPO2- 95%\r\nPR- 68/min\r\nRS - clear\r\nCVS -s 1 s2 heard\r\nCNS - HMF normal\r\n\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by DRA.K.B.\r\nLeft leg large unhealthy raw area lower 2/3 leg, exposing bare excoriated posterolateral tendons, posterior ankle joint, sluggish pale granulation. POVD. Needs further deep debridement-guarded prognosis regarding limb salvage.. Adviced: ARterial Doppler left leg.\nSeen by DRA.K.B.\r\nPlan for debridement, tendoachilles excision under SA.\nSeen by DRA.K.B.\r\nPlan for Slough/tendoachilles excision under popliteal block. Repeat Blood HB, TC, Creat.\nSeen by DRA.K.B.\r\nPlan for slough/tendoachilles excision under popliteal block on 30-9-2020. Preop: IV ABx. Consent. Explained about the limb&general risks involved. Arrange one unit packed cells for surgery.\nSeen by DRA.K.B.\r\nPlan for slough/tendoachilles excision under popliteal block on 30-9-2020, 7am.. Preop: IV ABx. Consent. Explained about the limb&general risks involved. Arrange one unit packed cells for surgery.\r\n-----------------\r\nInformed consent.\r\nThere is large nonhealing ulcer infection of left leg.This ulcer infection is extending to the region of bone and tendon of the heel&leg area.There is diabetes and neuropathy and decreased circulation of leg.Cardiac disease/lung edema treated earlier.The ulcer infection of leg needs slough excision under anesthesia.During operation the dead and necrotic soft tissues will be removed.Infected tendon tissues and bone will also be removed.The amount of dead tissue removal will be decided during operation findings.In diabetes the initial wound will be small,but spreading infection will extend below the skin and hence after surgery the wound will be larger than the present wound.Due to diabetes and decreased circulation,control of infection and healing will be delayed.Repeat operation may be needed for wound healing. Understanding the above consent for anesthesia and operation is given.\r\n=====================\r\n\nSeen by DRA.K.B.\r\nDressings changed.Large raw area pus/slough reduced.\nSeen by DRA.K.B.\r\nDressings changed. Large raw area left leg is granulating. Calcaneum is exposed bare-needs observation. Continue trt.\nSeen by DRA.K.B.\r\nDRessings changed. Large raw area left leg. Bare calcaneum stands exposed-needs observation. Advice on Discharge.:Dressings once in 2 days. Avoid direct pressure on left heel. Oral Abx 3 Weeks.'}, {'role': 'model', 'content': "\nIP Number: 9977\n\nPatient Number: 23487\n\nAdmission Date: 23-09-2020\n\nDischarge Date: 07-10-2020\n\nDiagnosis: Diabetic Foot-Necrotising infection posterior aspect left heel, with deep ascending infection along tendoachilles.\r\nS/P-Extensive Debridement under SA on 18/09/2020.\r\ns/p-Re-exploration done on 30/09/2020 Under Popliteal Block\r\nIHD- NSTEMI (Trop I positive on 18/09/2020)\r\nUncontrolled Diabetes Mellitus (HbA1c - 13%)\n\nClinical Exam(With BP): She is re-admitted for wound care and glycemic control. She underwent extensive debridement on the left leg on 18/09/2020 under SA. She is a k/c/o Type 2 DM, IHD and Dyslipidemia on treatment.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: ECG - NSR , Poor 'r' wave progression.\r\nECHO (23/09/2020)- No RWMA , normal LV systolic function ,thin layer of PE(+) Laterally (EF- 55%).\r\n\r\n\n\nXray findings: Concious,oriented,pallor +\r\nBP- 140/80\r\nSPO2- 95%\r\nPR- 68/min\r\nno cyanosis , clubbing \r\nRS - clear\r\nCVS -s 1 s2 heard\r\nCNS - HMF normal\n\nDiscussion: Mrs. Lissy 60/F k/c/o Type 2 DM, IHD and Dyslipidemia on treatment.\r\nwas readmitted after CCU care from Medical Trust Hospital following an episode of Acute Pulmonary Edema, for wound care and glycemic control. She had undergone extensive debridement on the left leg on 18/09/2020 under SA. Labs sent were with in normal limit. Culture specific paraentral antibiotic(levoflox) and other supportive treatment was given. Proper wound dressing under aseptic condition was also given by Dr Bhatt(Podiatry) .Re-eploration of the wound was done on 30/09/2020 under popliteal block.Her sugars were controled by basal boulus insulin regimen.Now the wound is better but guarded prognosis has been explained. She is being discharged with proper wound care.\n\nDiet: nan\n\nRemarks: Report SOS in case of pain,swelling or discharge from wound site\r\nIf You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\nReview at Podiatry/Diabetology OPD on 16/10/2020 with CBC/RBS/RFT"}] |
10,012 | [{'role': 'user', 'content': '\nIP Number: 10012\n\nPatient Number: 59168\n\nPatient Name: ANNIES VARGHESE\n\nGender: F\n\nDate of Birth: 23-08-1948\n\nAddress: PARAYIL HOUSE\n\nPincode: nan\n\nPhNo: 9526840636\n\nAdmission Date: 14-10-2020\n\nDischarge Date: 03-11-2020\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: concious corperative \r\nvitals stable \r\nafebrile \r\nchest clear\r\ncvs s1s2 heard\r\nL/E redness +\r\nswelling -\r\ntendernes mild \r\n\n\nPrecautions to be taken while treating the patient: nan\n\nRemarks: Seen by DRA.K.B\r\nContinue trt. Subacute on chronic ischemic gangrene left foot toes, heel pad&lower half leg. Painful, Pulseles&cold leg. Plan to be discussed.\nSeen by DRA.K.B.\r\nIschemic gangrene left foot, heel, toes, patchy ischemic blisters lower leg. Pulseless cold painful foot/leg. \r\nThe option of repeat angioplasty for limb salvage has been adviced. Considering the severity of pain, extensive gangrene, severe POVD, previous angioplasty, a below knee amputation with risks explained is also thought of and discussed with bystanders.\r\nPlan for BKA under SA, on MOnday. Preop: Serology, CXR, PT, INR, Gp, RH. Arrange one unit packed cells. Betadine dressings. Biopiper 8th hrly. Repeat RE, RFT, NA, K, Sugar, TSH, .Medical fitness. Inj. Clexane 0.4 bd.\nSeen by DRA.K.B.\r\nLeft leg/foot ischemic gangrene.\r\nPlan for LEFT BELOW KNEE AMPUTATION UNDER REGIONAL BLOCK ON 19-10-2020. 12-30/1PM.\r\nPreop: Medical fitness. C&D. IV ABX. Informed written consent.\r\n----------------------\r\nINFORMED CONSENT.\r\nThere is extensive infective gangrene left foot, heel, and lower half leg. There is diabetes, peripheral vascular disease. Previous angioplasty done to improve leg circulation, but with no improvement. There is severe pain. .The extensive and chronic nature of gangrene makes any form of limb saving operation useless and continued risks for developing ascending infection&sepsis. 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 will be delayed.The overall recovery and function of the amputated leg will need close observation. The nature of vascular disease is such that the amputation wound may not heal&a higher level amputation may be a possibility.Close medical followup is essential. The above points have been explained and understood and full consent for anesthesia and operation is given.\r\n\r\nSIGNED.\nSeen by DRA.K.B.\r\nFor LEFT BK AMPUTATION UNDER SA, ON 19-10-2020.\r\n\nThanks for referral. \r\nCase seen by Dr Aswin Krishnan Ajit.\r\nH/s/o Delirium, due to multifactorial etiology.\r\nNo persisting memory impairment reported.\r\nOccasional disorientation and confused behavior reported.\r\nSleep is disturbed.\r\nOn Syndopa from rajagiri.\r\n\r\nAdv:\r\n1) Tab QUTAN 25 mg 0-0-1/2\r\n2) Tab NUHENZ 1-0-0\r\n3) Tab ZOLFRESH 5mg HS SOS ( if reduced sleep)\r\n\r\nShall review after 2 days.\nSeen by DRA.K.B.\r\nDressing changed.Drain removed. Suture line clean.Continue trt.\nSeen by DRA.K.B.\r\nContinue trt. PHYSIOTHERAPY.\nSeen by DRA.K.B.\r\nDressings changed. Suture line Some areas of edge necrosis-needs observation. Oral intake inadequate. Maintenance IV fluids.\nSeen by DRA.K.B.\r\nDressings done. Skin flap edge necrosis needs observation.\nSeen by DRA.K.B.\r\nDressings changed. Flap edges esp. medial aspect is nonviable for about 2cm width-allow for spontaneous healing. Cap. Wakcef 500 mg 1-0-1 from tomorrow.\nSeen by DRA.K.B.\r\nDressings changed. Flap edge necrosis for 2 cm- needs observation.Continue trt.\nSeen by DRA.K.B.\r\nLeft leg stump edges nonviable-suggested salvage angioplasty.'}, {'role': 'model', 'content': "\nIP Number: 10012\n\nPatient Number: 59168\n\nAdmission Date: 14-10-2020\n\nDischarge Date: 03-11-2020\n\nDiagnosis: Left Foot Gangrene\r\nS/P - Below Knee Amputation done under SA on 19/10/2020.\r\nPost amputation stump gangrene\n\nClinical Exam(With BP): She presented to us with pain and swelling on the left foot, discoloration of toes and the heel since 1 week. She is a k/c/o Type 2 DM, HTN ,POVD and Dyslipidemia on treatment.\n\nSystolic BP: 0.0\n\nDiastolic BP: 0.0\n\nPhysical examination: ECG:SR No significant ST/T Changes\t\r\nECHO:NO RWMA Good LVEF Normal Valves\r\n\r\n\r\n\n\nXray findings: Concious, oriented, afebrile\r\nBP - 160/70 \r\nChest -clear\r\nCVS- s1s2 heard\r\nL/E - pregangrenous changes of toes and the heel, redness +, swelling +, tendernes+\n\nDiscussion: Mrs.Annies a 72 yr old female k/c/o Type 2 DM, HTN has underwent left lower limb angioplasty from outside hospital 3 months back for non-healing ulcer and POAD. She developed gangrene of left foot since last 1 week. She was admitted and Podiatry surgeon (Dr.Bhatt's ) consultation was taken and was advised parentral antibiotics, analgesics and arterial doppler left leg, which showed peripheral occlusive vascular disease from popliteal downwards. In view of poor blood flow (below popliteal artery) and left foot gangrene, she was advised for left BKA with guarded prognosis. Her condition and risk for the surgery was explained to patient and the patient party clearly. Pre-op medical workups and fitness for surgery was taken prior to the surgery according to the hsopital protocol. Glycemia was well controlled with basal bolus insulin regimen. She was taken up for the procedure on 19 /10/2020 under SA. Intra and post -op periods were uneventful. Her biopsy of left tibial vessel showed arteriosclerosis of left leg. She was given regular dressings by the poditary surgeon. Her post-amputation site showed color change and became necrotic. She requires revision amputation. In view of severe POAD, she is advised to get angiogram/vascular opinion before the surgery. She is hence been referred to Vascular surgeon/Podiatry Surgeon for angiogram and salvage angioplasty if possible.\n\nDiet: nan\n\nRemarks: If You experience palpitations, nervousness, sweating, shivering, shakiness, blurred vision, confusion, unconsciousness.\r\nImmediately eat/drink something that contain direct sugar (glucose tab, ½ glass juice, candies) if symptom continue, call your Doctor.\r\nReferred to Dr.A.K.Bhatt (Podiatry surgeon) at ASTER Medicity."}] |
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