70 yr old female with aspiration pneumonia (rt lung consolidation) , acute cva 20 days ago

70 year female brought to casualty in a •unresponsive state which is since one day •no verbal response since 1 day 
•fever since one day

 5 years ago diagnosed with hypertension using Tab.Amlong 5mg OD

20 days ago complaints of giddiness followed by fall in bathroom injury to right 
 lower limb assc with displaced IT fracture

Admitted outside hospital diagnosed with moderate size acute non hemorrhagic infract  in left caudate,lentiform nucleus ,chronic infarct left cerebellar hemisphere
Age related atrophy with small v/s ischemic changes -FAZEKAS GRADE 3

On USG ABDOMEN AND PELVIS - NORMAL STUDY

CAROTID AND VERTEBRAL DOPPLER STUDY — RIGHT CAROTID PARTIALLY CAROTID SMALL PLAQUE (7.5X2 MM)AT BIFURCATION CAUSING NO STENOSIS
IMPRESSION —BILATERAL MILD ATHEROSCLEROTIC CHANGES .NO E/O THROMBOSIS.
NO E/O SIGNIFICANT STENOSIS.

PATIENT CAME TO CASUALTY IN UNRESPONSIVE STAGE WITH NO VERBAL RESPONSE ASSOCIATED WITH FEVER SINCE 1 DAY 
NOT A K/C/O HTN , DM, ASTHMA

GENERAL EXAMINATION: 
No Pallor  , no icterus , cyanosis, clubbing , lymphadenopathy , edema present (non pitting b/l lower limbs)
Temp : 100.5 f
Pr :98 bpm
Bp:130/80 mmhg
Spo2: 56 @ra
Rbs : 212 mg/dl

SYSTEMIC EXAMINATION :
RS : Bilateral air entry present , BILATERAL CREPTS PRESENT
 
P/A : soft , non tender , bowel sounds present
 
CVS : S1 S2 present , no murmurs 
CNS : E1V1M1

INVESTIGATIONS :

Ecg
2D ECHO

OLD INVESTIGATION



TREATMENT : 
1 INJ AUGMENTIN 1.2 GM IV BD DAY 1
2 TAB AZITHROMYCIN 500 MG PO OD DAY 1
3 INJ MIDAZ @ 4 MG/HR 50 ML MIDAZ WITH MICRODIP AT 4 DROPS/MIN
4 INJ ATRACURIUM 4 MEQ / MIN (250 MG + 50 ML NS)
5 IVF NS RL @ 100 ML / HR
6 RT FEEDS 200 ML MILK + 100 ML NS 4 TH HY
7 INJ PAN 40 MG IV OD 
8 INJ ZOFER 4 MG IV BD
9 INJ OPTINEURON 1 AMP + 100 ML NS IV OD
10 TAB ECOSPRIN AV 75 /20 PO H/S
11 TEMP CHARTING 4 TH HRLY
12 TAB DOLO 650 MG TID 
13 INJ NEOMOL 1 GM IV TDS IF > 101 F
14 INJ LASIX 40 MG IV BD (IF SBP>100MMHG)

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