"This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs. This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box
A 45 year old man farmer by occupation and He works at the daily farm . His wife works as a farmer as well. His wife was previously admitted for meningitis ? He has 2 children.
He was presented to the casualty with the complaints of :
-Fever since 4 days
-Body pains since 4 days
-Reduced urine output since 3 days
-Vomiting yesterday
-Hematuria since morning
-Black tarry stools since morning
High grade fever , intermittent and not associated with chills and rigors .
H/o 2 episodes of non projectile, non bilious, blood tinged vomiting yesterday
He was taken to an outside hospital where in he received fluids and later the attenders decided to visit to our hospital.
-Hematuria since morning
-1 episode of black tarry stool in the morning
-Reduced urine output since morning
He is an alcoholic since the past 20 years with around 90 ml of whiskey everyday. His last intake of whiskey was 4 days. He smokes around 2 packs of beedi everyday since the past 20 years.
1 year back he presented to our hospital with the complaints of pain abdomen after which he underwent an abdominal surgery.
Reduced urine output since morning
On presentation he is a thin built individual
Subconjunctival hemorrhage +
Icterus+
Pallor +
Images of left eye showing sub conjuctival haemorrhage
Image of right eye showing icterus
Image showing yellowish discolouration of nails and clubbing
Bp - 60 mmHg
PR - 115bpm
RR - 25 cpm
Spo2 - 92% on Room air
Afebrile
Lungs -
Inspiratory crepitations in Bilteral IAA,ISA
Cvs - S1,S2+