COPD with Acute Coronary Syndrome SENARIO Here is a 65years old male hospitalized for 5 days Chief complaints Case of chest pain since 3days History of present illness Patient was apparently normal then he developed chest pain which was radiating towards neck and jaw ID: 1015742
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1. THERAPEUTICS MINOR CASE PRESENTATION COPD with Acute Coronary Syndrome
2. SENARIO: Here is a 65years old male hospitalized for 5 days.Chief complaints: Case of chest pain since 3days.History of present illness:Patient was apparently normal then he developed chest pain which was radiating towards neck and jaw.Past Medical history:K/c/o COPD since 4years.
3. Personal History:Smoking since 25years. Laboratory investigations:testdaysCPKMB65Troponin-TPositiveWBC16,000Neutrophils79Heamoglobin11MCH20.6MCHC29ESR20
4. General Physical examination:Percursion:Resonant note heard on left mammary area.Auscultation:Bronchial breath sounds heardCrepts –positiveRhonchi-positiveTenderness –positive
5. SOAP note:Subjective:Here is a 65years old male hospitalized with complaints of chest pain since 3days.Objective:CPKMB values are increased: This indicates tissue necrosis.Troponin-T +ve value increased :This indicates tissue necrosis.Neutrophils are increased: This indicates infection.WBC’s are increased: This indicates Tissue necrosis
6. Hb values are decreased: This indicates anemia.The MCH & MCHC values are decreased: this indicates hypochromia.The ESR values are increased:- This indicates tissue necrosis.DIAGNOSIS:COPD with Acute coronary syndrome.ASSESSMENT:Problem list:1.Chest pain:- It occurs due to ischaemia caused by coronary artery spasm.
7. 2.COPD:-It is a chronic disease of the airways characterized by gradual and progressive loss of lung function.There will be airflow limitation associated with abnormal inflammatory response of lung.3.Acute coronory syndrome:-It occurs due to ischemia of heasrt muscles caused due to coronary artery occlusion or spasm.
8. ProblemGoals of treatmentDRUGS & MOADosage1.COPD2.Acute coronary syndrome1.Prevent /minimize progression.2.Relieve symptoms3.Minimal risks/side-effect from therapy1.Early restoration of blood flow to occluded artery.2.Relief of ischemic chest discomfort.1.SABA:Salbutamol: They areBeta agonista.they cause bronchodilation.2.LABA: formeterol3.Effcorlin1.Apirin: Inhibits release of ADP & prevent sticking of platelets.2.Heparin:Inactivates clotting factors.3.Nitrates:They reduce pre & after load 10μgm100μgm100-200mg75-150mg0.6Iu/day10-40mg
9. Plan:S.noGeneric nameBrand nameindicationdoseday123451.T.Sorbitrate1-1-1Isosorbide dinitrateACS10mg YY2.T.Clopitab0-1-0clopidogrel75mgYYYYY3.T.Azitor0-0-1Atorvastain10mgYYYYY4.T .deriphylline1-0-1theophylline+ etiophyllineCopd150mgY5.INJ.pan1-0-0PantoprazoleppI40mgYYYYY6.INJ.Cefara1-0-1Ceftriaxoneprophylaxis1.5gmYYYYY7.INJ.graniforce1-0-1GranisetranProphylaxis1ampY8.INJ.lupinox1-0-1EnoxaparinACS0.6mlYYYYY9.T.RamaceRamiprilACS2.5mgY
10. S.noGeneric nameBrand nameIndicationDosageDay1234510.INJ.lasix1-0-0FurosemideDiuretic2ampY11.INJ.dobutamine ACS2ampYYY12.T .Cytogard1-1-1Trimetazidine HclACS20mgYYYY13.Duolin neb1-1-1salbutamol+ ipratopiumCOPDYYYY