COMPLAINTS AND DURATION : H/O pain in epigastric region since yesterday evening.

HISTORY OF PRESENTING COMPLAINTS: H/O epigastric pain associated with sweating,palpitations,pain over the right arm&neck. H/O similar episodes since 3 days no h/o cough,vomiting or diarrhea. PAST HISTORY: Known case of APD,no h/o MI,asthma,COPD,TB,Epilepsy jaundice FAMILY HISTORY: No significant family history PERSONAL HISTORY:

Mixed diet,normal sleep,apatite,normal bowel&micturition,known smoker&alcoholic stopped since 10 years.

GENERAL EXAMINATION/VITAL DATA

Anemia(-) Icterus(-) Cyanosis(-) Clubbing(-) Lymph nodes(-) Peripheral nerves(-) Skin(-) Thyroid(-) Oedema(-) Others Pulse:78/min B.P:130/80mm.hg R.R:18/min

SYSTEMIC EXAMINATION: C.V.S:

S1, S2 (+) loud p2

R.S:
NVBS (normal vascular breath sounds)

GIT:
F/A soft

CNS:
NAD

PROVISINAL DIAGNOSIS:
Acid peptic disease

PROGRESS AND TREATMENT

1ST DAY A 60 yrs old male known diabetic on irregular Medication,non-hypertensive presented with c/o -Epigastric pain since yesterday evening -Associated with sweating,palpitations -Pain over the right arm&neck -H/O similar episodes since 3 days -No H/O cough,fever etc -No H/O vomiting,diarrhea PAST -known case of APD gastric ulcer(not documented) -No H/O MI,but asthma,drug allergy etc

PERSONAL -known smoker,alcoholic stopped since 10 yrs FAMILY -not relevant GENERAL EXAMINATION: Pallar-No Icterus-No Cyanosis-No Clubbing-No Pedal oedema-No SYSTEMIC EXAMINATION: C.V.S-S1 S2(+) ,Loud P2 Lungs clear B.P-130/80 mm/Hg P.R-78/min

P/Asoft CNS-NAD

2nd day
GERD Ischemia Candemyopathy 2tsp(TID)1-1-1 (1) T.Omez-D/O.D (2)Syp.sucral fate (3)T-Zincovit(O.D)0-1-0

GERD,ischemia candiopathy? c/o headache P.R-78/MIN B.P-130/80 mm/Hg C.V.S-S1 S2(+) Lungs-clear (1)T.Dolo650mg (2)Syp-sucral fate 2tsp TIR (3)t-Zincovit/O.D (4)Inj.Pantop/ ampluster

[PANTOPRAZOL] (5)T.OMEZ-D/O.D [OMEPRAZOLE] (6)Inj.Lasix 20mg [FURESIMIDE] (7)T.Cloptitab 75mg/O.D [CLOPIDOGREL] (8)T.Glycomet/B.D [METFORMIN] (9)T.Sarbitrate/T.I.D [ISOSORBID DINITRATE] 3 day B.P-130/80mm.Hg Pulse-73/min (1)T.Dolo650mg
rd

C.V.S-S1,S2(+) C.N.S-NAD

[PARACETMOL] (2)SYP.Sucralfate 2tsp/TID

Lungs-clear,NVBS(3)T.Zincovit/O.D (4)T.Omezon-d/O,D (5)T.Clopitab75mg/O.D (6)T.GlycometGp2 B.D 4th day B.P-130/80mm.Hg Pulse-72/min C.V.S-S1,S2(+) C.N.S-NAD (1)T.Dolo(sos) (2)SYP.Sucralfate2tsp/ TID

Lungs- Clear,NVBS (3)T.Zincovit O.D (4)T.Omez O.D (5)T.Clopitab 5mg/O.D

(6)T.Glycomet Gp2/B.D (7)inj.Lasix 40mg (8)inj-Augmentin 1.2gm

[AMOXICILLIN+CLAVULINCACID] 5TH day