CASE PRESENTATION

Dalena, Karen Bea E.Visayas Community Medical CenterPost-Graduate InternPATIENT CASE PRESENTATION1Patient InformationE.T. 63 year-old married Roman Catholic, retired Civil EngineerCebu CityMaintenance meds:HypertensionLosartan 50 mg/tab tab OD (hypertension)ISM 60 mg/tab 1 tab OD AC lunch (chest pain/angina)Furosemide K 40 mg/tab 1 tab OD (prevent heart failure)Clopidogrel 75 mg/tab 1 tab OD (blood thinner)Aspirin 80 mg/tab 1 tab OD after lunch (blood thinner)Trimetazidine 35 mg/tab 1 tab BID (ischemia)Atorvastatin 80 mg/tab 1 tab OD (cholesterol )Ezetimibe 10 mg/tab tab OD (cholesterol )Psyllium sachet 1 sachet mixed with drinks OD (high fiber, lowers cholesterol and sugar levels)

DiabeticVidagliptin 50 mg/tab, 1 tab BID (diabetes)2Past Medical HistoryDM 15 yearsHPN 3 years (usual 120/90, highest 170/100)Asthmatic - childhoodno previous surgeries.previously admitted for:M.I. (2003)COPD (2010)2014:COPD secondary to CAP-HRHCVD in CHF FC IVC AKI secondary to # 2Maintenance meds:HypertensionLosartan 50 mg/tab tab OD (hypertension)ISM 60 mg/tab 1 tab OD AC lunch (chest pain/angina)Furosemide K 40 mg/tab 1 tab OD (prevent heart failure)Clopidogrel 75 mg/tab 1 tab OD (blood thinner)Aspirin 80 mg/tab 1 tab OD after lunch (blood thinner)Trimetazidine 35 mg/tab 1 tab BID (ischemia)Atorvastatin 80 mg/tab 1 tab OD (cholesterol )Ezetimibe 10 mg/tab tab OD (cholesterol )Psyllium sachet 1 sachet mixed with drinks OD (high fiber, lowers cholesterol and sugar levels)

DiabeticVidagliptin 50 mg/tab, 1 tab BID (diabetes)

M.I. 7 days hospital stay, discharged, improved COPD 22 days hospital stay, discharged, improved COPD sec. to CAP-HR, HCVD in CHF IVC, AKI sec. to #2, DMType 2 ICU, discharged, improved3Personal and Social History38 pack year smokerfrequent alcoholic beverage drinker, consuming 18-20 bottles of beer every other day (stopped 2014).Drinks 1.5-2L/daySalty and sweet foodFamily HistoryDM maternalBronchial asthma paternalHypertension both History of Present Illness1 week PTA, noted cough and dyspnea upon walking two flights of stairs which was relieved by rest. The dyspnea progressed to dyspnea on walking at least 4 meters on a flat floor. (+) 2 pillow orthopnea. 1 day PTA, noted progression of cough (after getting the flu vaccine) and chest pain. Took Isosorbide dinitrate with relief.3 hours PTA, patient was dyspneic, relieved by oxygen inhalation at home. He was also noted to be diaphoretic.Persistence of symptoms prompted admission.> Isosorbide Dinitrate class: nitrates, angina

6At the ERconscious, coherent, cooperative, ambulatory, not in respiratory distress, fairly nourished, afebrile with the following vital signs:BP 140/90 mmHgPR 114 bpmRR 25 cpmTemp 36.8COxygen Saturation 85%Hgt 129 mg/dl Weight 76.5 kgHeight 164 cmBMI 23.32 kg/mBMI: kg/m2

Global guidelines DMT2 2005Advise people with diabetes that maintaining a DCCT-aligned HbA1c below 6.5 % should minimize their risk of developing complications. Target levels CBG: 10> 2CHigh Risk Less SymptomsGOLD 3-4> 2< 100-1DHigh RiskMore SymptomsGOLD 3-4> 2> 10> 2

EXACERBATION of COPDPrecipitating Causes and Strategies to Reduce Frequency of ExacerbationsPatient AssessmentEstablish the severity of the exacerbationEstablish the severity of the preexisting COPD

TREATMENT ACUTE EXACERBATIONBronchodilatorsAntibioticsGlucocorticoidsOxygenMechanical Ventilatory Support