70 yrs old male came with complaints of shortness of breath since morning

 70 yrs old male came with complaints of shortness of breath since morning,cough( with sputum) since 2-3 months decreased with medications.

 patient was apparently asymptomatic till last night when he had alcohol last night, exposed to cold environment, following which he had SOB this morning, not decreased with inhalers, taken to RMP outside where nebulization kept and the symptoms decreased and he returned home, recurrence of symptoms at 5:00 pm, pt shifted here.

No c/o pedal edema, orthopnea, PND 

H/o similar episodic complaints since 5-6 yrs; increased since 1yr on exposure to cold

He is on inhalers ( salbutamol 100mcg/dose) daily use.

Past history:-k/c/o HTN since 5yrs

H/o ?TURP 5 yrs back; for progressive decreased urine output

VITALS

BP- 120/80 mmHg

PR- 122 BPM.

RR-30CPM

Temp- afebrile

Spo2- 85% at RA.

GENERAL EXAMINATION:-

patient is conscious, coherent, cooperative

No signs of Pallor, Icterus, Cyanosis, Clubbing, Lymphadenopathy or Edema.





Systemic examination:-

CVS-S1S2+.

RS- S1S2+, wheeze present on all left side.

P/a - soft,non tender

CNS- NAD

Provisional diagnosis:- acute exacerbation of copd with k/c/o copd

INVESTIGATIONS:-



ECG:


X-ray




Treatment:- 

Inj hydrocortisone 100MG/IV/BD.

Nebulization with budecort,Ipravent 4th hourly.

Bipap intermittently ( over 30 min)

O2 inhalation ( according to spo2)

Inj PAN 40mg IV/OD.

Inj optineuron 1 amp in 100ml NS/IV/OD ( over 30 minutes)

Spo2,HR monitoring hourly.









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