CURRENT UNIT 6 PATIENTS SOAP UPDATES
total 9 cases : 1 icu and 1 AMC 5 in ward 2 in superspeciality female ward patients 1) 45/f S- no fresh complaints backache - subsided sob - subsided fatiguability - subsided o- pr-84 bpm bp-110/80 mm hg cvs - s1,s2 + rs- nvbs + p/a - soft non tender a- anemia under evaluation ? IDA P- 1.TAB PANTOP 40MG PO/OD 2.INJ BUSCAPAN 1AMP /IV /SOS 3.PLAN FOR BLOOD TRANSFUSION 4. SYP CREMAFFIN 15ML PO/HS 2) 60/f S: no fresh complaints . vomitings-subsided loose stools-subsided pain in abdomen- subsiding O: Dry tongue+. Pallor+. Temp: afebrile PR :84 bpm BP:100/70 mmhg RR: 18cpm P/A: soft, tenderness noted in epigastric region. CVS: S1,S2 heard, no murmurs RS: BAE+, NVBS heard. CNS: NAD. A- Acute gastroenteritis. P- 1.IV FLUIDS 2NS, 1 DNS, 1 RL @ 100ml/hr. 2.INJ. PANTOP 40 mg /po/OD.. 3. INJ.ZOFER 4 mg/IV/TID 4. TAB. SPOROLAC -DS PO/TID. 5. ORS SACHETS 1 PACKET IN 1 LITRE , 200ML AFTER EACH STOOL. 6 INJ. BUSCOPAN 1 IV /SOS 7. TAB. CIFLOX 500MG PO/BD 8. INJ. METROGYL 500 MG