68y/M with Malunited IT# with AVN of left hip

ICU BED - 1
DOA: 03/04/2022

Chief complaints:

A 68y old male patient who was living alone was brought to casualty with h/o slip & fall 4 days back f/b inability to walk due to b/l hip pain since 4days.

HOPI:

Pt was apparently asymptomatic 1 year back,
had h/o fall 1 yr back for which he got an X-ray which showed Left IT fracture. Pt underwent quack treatment and then started weight bearing with the help of a walker.
Pt had h/o slip and fall @ home 4 days back then developed c/o LBA & pain in b/l hip joint and inability to bear weight in Left lower limb.pain in Left hip,constant,non radiating,not relieved with rest but worsens with movements.
Loss of appetite+ & not taking food since 4 days.
No h/o fever,headache,vomiting
No h/o head injury/ENT bleed

Past History:

No h/o DM/HTN/Asthma/Epilepsy/CAD/TB

H/o trauma (fall) f/b ?paraplegia 7 yrs back - recovered in a month with conservative management

Personal History:

Loss of appetite+
Occupation: Agricultural labourer
Chronic alcoholic since 30yrs. Daily alcohol consumption of about 90mL x 4.
Last alcohol consumption: 4 days back(30/03/2022)
No h/o smoking or tobacco consumption.

General Examination:

Pt is Conscious/Coherent/Cooperative
Signs of dehydration+(dry tongue,sunken eyes)
Pallor+
No Icterus/Cyanosis/Clubbing/Koilonychia/Lymphadenopathy/Edema



Vitals on Admission:

BP:90/50mmHg
HR:82bpm
RR:13cpm
Temp:102F
SpO2:99% on RA
GRBS: 137mg/dL

Local Examination:

Skin:Normal
Shortening of limb by 2cm
Limb externally rotated
Tenderness in groin present
Range Of Motion: painful and restricted
Distal pulses present
No neurological deficits

Systemic Examination:

CVS:S1S2 heard, No murmurs
RS: BAE present, No adventitious sounds
P/A:Soft, Non tender
CNS:NAD

Provisional Diagnosis: 

-1 yr old malunited left IT fracture with Inferior pubic ramus # with AVN of Left hip
-Hypo-osmolar Hypovolemic Hyponatremia
-Anemia of chronic illness(malnutrition)
-Mild thrombocytopenia
-Alcoholic liver disease
-Hypoalbuminemia

Treatment:

-Inj.PCM 1gm IV / STAT over 30 min
-IV Fluids NS @ 150mL/hr - continuous infusion
-Inj. PAN 40mg IV / OD
-Inj. ZOFER 4mg IV /SOS
-Inj. THIAMINE 1 Amp in 100 mL NS IV/ TID
-Inj. OPTINEURON 1 Amp in 100 mL NS IV/OD
-Tab. ULTRACET 1/2 Tab QID
-3-4 egg whites/day
-Strict I/O charting
-Monitor vitals

Reports & Radiology images:

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