75 year old male who is a washerman by occupation came with the complaints of inability to swallow predominantly liquids and c/o slurring of speech since 3 days
HOPI :
Patient was apparently asymptomatic 4 years ago after which he developed Right sided hemiplegia ( right sided weakness with mouth deviated to left ) and was taken to a local hospital ,took treatment and got completely recovered after a month
1 month ago he again presented to another hospital in miryalguda for the same complaints (they were told that the patient was in semi-unconscious state ,took treatment and was fine(he was able to talk , eat and recognise ) but since then he was bedridden and talking ,eating and recognising people slowly got deteriorated since then and he started passing stools and urine in the bed itself .
15 days ago he became very weak
3 days ago he had difficulty in swallowing predominantly liquids and slurring of speech increased since 3 days
He is hypertensive since 25 years and diabetic since 20 years
He's occassional alcoholic since his young age
General examination :
Patient is in semi conscious state
Temp -afebrile
Bp - 150/110 mmHg
Pr - 114 bpm
GRBS - 421 mg/dl
Spo2 -95 %@RA
Systemic examination :
CVS - S1 S2 +
Rs - bae +
P/a - soft ,nen tender
CNS :
patient is conscious , incoherent
Broca's aphasia +
Gag reflex -
Jaw jerk -
No nasal regurgitation with liquids
Pupils - nsrl
Tone rt. Lt
UL. Increased. Normal
LL. Increased. Increased
Power
UL. 2/5 5/5
LL. 2/5. 5/5
Investigations :
Diagnosis :
Dysphagia secondary to
CVA
Old CVA - right hemiplegia
DM + , HTN +
Treatment :
1.head end elevation
2.RT feeds -2nd hourly (milk with protein powder )
3.inj hai s/c tid before food 8am -1pm -8pm
4.grbs charting 4th hourly
5.i/o charting 4th hourly
6.monitoring of vitals
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