ALTERED SENSORIUM UNDER EVALUATION WITH BED SORE GRADE 2 AND RIGHT UPPER LOBE CONSOLIDATION

A 90 years old female  came with chief  complaints of decreased response  since morning
HISTORY OF PRESENT ILLNESS :- 
patient was apparently asymptomatic  
 20 days before.then she gradually reduced doing her regular works, and  few days  later  she bed ridden and used to eat food when attenders feed her.once suddenly when the patient attenders giving bath to  her  noticed a ulcer on the right hip region  which is circular in shape , margins are irregular. when they noticed the ulcer called a rmp doctor he  advised a  local application which is a powder, and daily they are applying that powder and staying at home.
on the day 13/2/22   she ate 2 spoons of feeding  at night, and she spoken to the attenders as usual
on the day 14 /2/22 when they are supposed to    feed  her with bread slices with milk  she refused to eat  as she is having bitter taste..and then after she  became semi consciousness and  rolled her eyes upwards, then the attenders brought her to the hospital .
HISTORY OF PAST ILLNESS 
not a known case of  htn, dm, asthma, epilepsy
PERSONAL HISTORY :- 
appetite - reduced 
diet - vegeterian
sleep - adeqaute 
bowel and bladder - irregular 
no addictions 
FAMILY HISTORY :- 
not significant 
ON EXAMINATION
patient is semi conscious , non coherent ,non coperative 

vitals :- 
temp : afebrile 
bp : 120 systole 
PR :  78 bpm
RR : 35 cpm
spo2: 99%

SYSTEMIC EXAMINATION:- 
RS :- bilateral air present 
cvs :- s1 , s2 hears 
CNS :- 
cns examination : 
level of consciousness : drowsy
speech incoherent 
brudinzke positive 
motor system :- 
power : not coperative 
tone  :                       right.              Left 
upper limb         decreased.        decreased 
 lower limb          increased        increased 
 gcs : E3V2M4 
p/a :- soft non tender
INVESTIGATIONS 
Chest x ray

ABG 
PH 7.3 
Pco2. 18.4 
Po2 104 
Hco3 8.8 
Spo2 95.3 
A gap 28 
Hemogram 
HB 8.4 
TLC 10,800
N/l/e/m/b. 90/4/2/4/0
Pcv 24.5 
Mcv 78.2 
Plt count 1.35 
Normocytic normochromic 

Rft 
Cr 1.1
Urea 81 
Na+ 134 
K+ 4.0 
Cl _ 97 

RBS 113 

Lft 

Tb 1.20 
Db. 0.75 
Ast  43 
Alt  49 
Alk phosphate  590 
Total protein. 4.4 
Alb. 2.01

CUE 
COLOUR :- reddish 
Appearance - cloudy 
Reaction  - acidic 
Albumin  ++ 
Puscells. 4-6 
Epithelial cells 2- 3
RBC cells. 2-4

TREATMENT :- 
1) IVF ns Rl dns  @ 100 ml / HR 
2) inj piptaz 4.5 gm IV / stat 
3 ) inj clindamycin 600 mg iv /bd
4 ) inj pantop 40 mg iv/od 
5) inj zofer 4 mg iv /sos 
6 ) inj neomol 100 ml iv/sos 
7) neosporin powder for bed sore

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