7.Respiratory Failure
History of present illness:
The patient was apparently asymptomatic 12 days ago ( i.e on 23 /11/21 ) Then he consumed excess amount of alcohol ( alcohol intoxication) while he was on duty on his field as a farmer . In altered stage he consumed profenofos ( 100-150ml ) - An Insecticide. He had 3-4 episodes of vomitings on 23/11/21.
He was rushed to Nearby hospital immediately on 23/11/21 @11 am by his wife . He was given gastric lavage. Pralidoxime and Atropine were administered . He was then shifted to navya hospital on 23/11/21 where he went into respiratory failure . He was ET intubated on 24/11/21 @4 pm . Pralidoxime, atropine and symptomatic treatment was given . Due to financial concerns he was shifted to our hospital on 25/11/21 insedated stage on mechanical ventilator . Patient was intubated as was diagnosed with Type 2 Respiratory failure along with Intermediate syndrome ( Muscle weakness and paralysis)
ET tube was changed and tracheostomy was done .
Past history:
Patient had history of high grade fever , vomitings and increased secretions
Patient had history of trauma to his LEFT EAR
1 and 1/2 yr back.
No history of chest pain ,Hypertension palpitations ,
no history of diabetes,epilepsy,TB,tyroid disorder.
Personal history:
Diet-mixed
Appetite- None
Bowel and bladder- Regular
Sleep-normal
Addictions - Alcohol - Every day
Family history:
No history of DM/HTN/TB/ asthma/ thyroid
No similar complaints in the family previously .
General examination:
No pallor or cyanosis Or icterus or clubbing
No lymphadenopathy
No Dehydration or odema
Vitals:
Temp -101 C/F
Pulse rate -120 bpm
Resp ratec-22 cpm
Bp-120/90mm hg
Systemic examination:
1.cvs-inspection-chest wall is bilateral systemically
Palpation -normal
Auscultation-normal with regular heart beat
S1 S2 heard
No murmurs
abdomen
Shape of abdomen is scaphoid
No tenderness
No palpable mass
Liver is palpable
Bowel sounds are heard
Investigation:
Treatment Inj .Pam IV BD
Inj . Glycopyrolax IM BD
Inj . NAC IV BD
Inj . PAN IV OD
Inj . Optinuron IV OD
Inj . Augmentin IV BD
Inj .Metrogy IV TID
Syp Potklos
Inj lasix IV
Questions :
1. What is intermediate syndrome?
2.What is the mechanism of action of atropine ?
3.What is type 2 respiratory failure?
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