60 M with altered sensorium secondary to ? fat embolism
60 year old male with loss of consciousness
A 60 years old male patient came to casuality with loss of consciousness at 2 Am
HOPI :
Patient was apparently alright and asymptomatic 12 days and then he experienced slip and fall on 15/4/24 and was taken to government hospital there he was diagnosed as intertrochanteric hip fracture and then shifted to ot there they have undergone surgery .
On 17/4/24 patient developed altered sensorium and is so irritable and for further four days he is under observation of doctors and the concerned doctors did not inform the accurate cause to the patient attenders and then he was discharged
After discharge patient was at home with same irritable condition and altered sensorium for four days and again on 24/4/24 he suddenly developed SOB and then the patient attenders admitted him to hospital there he had undergone CT brain suggested age related changes and for SOB they followed conservative treatment and altered sensorium is present
And on Saturday at 2 Am patient loss consciousness so they shifted to our causality around 5pm
History of past illness
N/k/c/o HTN , DMII , TB , Epilepsy , Asthma , CAD
Personal history :
Occupation :
Patient is married
Patient takes mixed diet
Bowel and bladder movements regular
Micturition normal
No known allergies
Regular consumption of alcohol and tobacco since 30 years 1 Beedi pack / day last consumption of alcohol was on 14/4/24
No drug use
Family history : normal
General examination :
Bp: 110/60mm/Hg
Spo2: 98%
GRBS : 116mg/dl
RR: 20cpm
PR: 116bpm
Pallor , icterus , cyanosis , clubbing , lymphadenopathy , pedal edema absent
SYSTEMIC EXAMINATION :
CVS : S1 & S 2 heard , no murmurs , no thrills
Respiratory system : Dyspnea present
Wheeze absent
Position of trachea central
Vesicular breath sounds
P/A : On inspection : shape of abdomen : scaphoid
No tenderness or palapable mass
Hernial orifices normal
Bowel sounds present
No free fluid , bruits
Liver , spleen not palpable
Genitals, speculum examination normal
CNS EXAMINATION : Higher mental functions ; unconscious
Speech no response
Signs of meningeal irritation :
Neck stiffness : no
Kernigs sign : no
On admission
Glasgow coma scale E1 V1 M2
Reflexes : Right left
Biceps 2+
Triceps -
Supinator -
Knee -
Ankle -
Plantar - flexor ( b/l)
Provisional diagnosis : Altered sensorium secondary to delirium ? metabolic encephalopathy( hypoxia)
Investigations :
Investigations :
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