airway management

CASE PRESENTATION

Patient’s Personal Details
Registration Number : HK00033285
 Sex : Male
 Race : Cina
 Age : 76 years old
 Date of Admission : 28.09.12


Chief Complain
Renal function damaged during follow up under Tenom Hospital for 2/7 ago.

History of Present illness
Noted having refractory hyperkalemia secondary to CKD.
 Loss of appetite.
 Headache.
 Weight loss without trying to lose weight.
 No chest pain.
 No SOB (Shortness of Breath)
 No vomiting
 No urinary tract infection


Past Medical History


Patient has Diabetes Mellitus and
Hypertension but under review

Family History and Social History
A few family members has Diabetes
Mellitus and hypertension.
 Social History : Non alcoholic, Non smoker. 

Vital Sign
Blood Pressure : 136/75 mmHg.
 Pulse Rate : 67/min (irregular rhythm)
 Temperature : 37°c
 Respiratory Rate : 21/min
 Pain Score : 2/10


Physical Examination
Cardiovascular System
 DRNM
 Irregular rhythm of pulse
Respiratory System
 Lung clear
 No respiratory distress
 No sign of cyanosis
 No Ronchi

Abdomen
 Soft
 No tenderness
 No swelling
Central Nervous System
 No loss of sensation
 GCS : 15/15
Upper and Lower Limbs
 No pedal oedema
 No deformity seen.
 Capilarry refill normal.

Investigation
BUSE
urea - 28.2 mmol/L ABNORMAL (2.0 - 8.3) chloride – 114.1 mmol/L ABNORMAL (95 - 110) creatinine – 539 umol/L ABNORMAL sodium and potassium NORMAL.
1.

2. LFT
Protein – 62.6 g/L ABNORMAL (66 - 87)

3. VENOUS BLOOD GASES pH – 7.1 ABNORMAL (7.3-7.4)
Total Co2 – 14.2 mmHg ABNORMAL (21-30)
PaO2 – 31.6 mmHg ABNORMAL (80-100)
SPO2 – 48% ABNORMAL (95-100)

4. FBC
RBC – 2.53 ABNORMAL (4 - 6)
Hb – 7.2 g/dL ABNORMAL (13.5 - 18)
Platelet – 122 ABNORMAL (150-400)

Other Ix
Ultrasound
 DXT QID for DM


Management
1.
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7.

Send pt for haemodialisis.
Insert femoral catheter for HD.
DXT qid with