CLINICAL MEET - Kamineni Institute of Medical …...2017/12/21  · INTRA OPERATIVE BP - fell down...

CLINICAL MEET 21ST DECEMBER

Department of Medicine Chaired by

Dr. Rakesh Biswas Professor of General medicine

Dr. Sarat

Marriage (1993)

Divorce (1994)

Worked at HYD (1997-2007)

Schizophrenia diagnosed (2009)

Menopause (2013)

Diabetes (2014)

Abdominal distension (2017)

EVENTS BEFORE HOSPITALIZATION

Birth 1968

25Y

26Y

28 to 38Y

41Y

45Y

46Y

50Y

EVEN

TS

O

F

LIF

E

AGE AND YEARS Dr. Azra

Dr. Spandana

Dr. Spandana

Dr. Spandana

Dr. Spandana

Risk of malignancy indices(RMI) in preoperative evaluation of adnexal

masses

Dr. Sahithi

Dr. Sahithi

GENERAL PHYSICIAN CALL FOR HYPOTENSION ON DAY 4 OF ADMISSION

DAY 1 ADMISSION BP – 90/60 mmHg

DAY 4 ADMISSION BP- 70/50mmHg. Complaints of diarrhea

Signs of dehydration present ? HYPOVOLEMIA

TREATMENT: INTRAVENOUS FLUIDS GIVEN

Dr. Siphora

• PRE OPERATIVE BP- 90/60mmHg

• INTRA OPERATIVE BP -fell down to 60/40mm Hg

• Inotropes- nor adrenaline and central line was secured and 1 unit of whole blood was transfused

• POSTOPERATIVE DAY - 1 BP -120/70 mmHg on inotropes

• Inotropes was weaned off on pod-2

• CVP not mentioned

Dr. Siphora

GENERAL PHYSICIAN CALL FOR HYPOTENSION WITH BP 80/50

mmHg POD 3

• CENTRAL VENOUS PRESSURE WAS 4CM OF WATER

• TREATED AS HYPOVOLEMIA:

INTRAVENOUS FLUIDS GIVEN WITH CVP MONITORING

• PATIENT DISCHARGED WITH BP -100/60

mmHg

Dr. Siphora

PATIENT SECOND VISIT AFTER 2 MONTHS FOR TOTAL HYSTERECTOMY WITH SALPINGO-

OOPHORECTOMY TO SURGERY DEPARTMENT

• C/O Weight loss and loss of appetite • With BP-70/50mmHg and was put on central

line. Fluids and inotropes were started

Dr. Siphora

GENERAL PHYSICIAN CALL FOR HYPOTENSION DAY 2

• Inotropes were weaned off • CVP -3cm of water and IVC diameter 1.3cm • Continuous CVP monitoring and IV FLUIDS

accordingly given. • Patient was taken up for surgery with BP – 90/60

mmHg

Dr. Siphora

• INTRA OPERATIVE BP -90/60mm Hg was maintained with IV fluids.

• POST OPERATIVE BP – 90/60 mmHg

• PATIENT DISCHARGED BP – 100/60 mmHg

Dr. Siphora

Dr. Babji

Dr. Babji

Dr. Shweta

Dr. Shweta

5453/17

Dr. Shweta

How does body react to stress? • Behavioural sensitization to

stress.

• Biological mechanisms : 1.HPA axis dysregulation 2.Dopamine dysregulation

Dr. Afeen

MANAGEMENT OF OVARIAN TUMOR

STAGE 1 A [CLEAR CELL CA OF OVARY] TAH + BSO NO NEED OF CHEMOTHERAPY MONITORING WITH CA125 VALUES

Dr. Sahithi