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Duty ReportEmergency Ward27th January 2016Co-Ass on Duty:ColinBayuGeneral Practitioner on Duty:Dr. GeraldDr. DinaPatient RecapitulationMs. S, 61 years old. Hepatitis Mr. DA, 25 years old. Dyspepsia, Pickwickian syndrome Mr. D, 45 years old. Febrile observasionMs. G, 62 years old. Dypsneu e.c CHF Grade 3Ms. J, 59 years old. C.a cervicksPatient IdentityName: Mr. DAMedical Record Number: 010839Date of birth: 9th August 1990Religion: MoslemMarital Status: UnmarriedOccupation: JoblessAddress: Senen, Jakarta UtaraDate of entry: 27th January 2016

AnamnesisAuto & Allo anamnese on 27th January 2016

Current Medical Record:Patient came to emergency ward complaining about his abdominal cramp on whole of abdomen, felt since 5 days before admission, aggravated by cough. Patient also complaints about having both of his legs swollen since 2 weeks before admission. He also complaints of difficulty in urinating for 6 days, defecating for 3 days, and being out of breath, especially at noon, feeling better if he sits or given oxygen and worsen if he sprawl. The patient admits that he needs constant supply of oxygen to relief his shortness of breath, even at home. He also frequently wakes up in the early morning, feeling out of breath. Past Medical History:Heart enlargement

Family Medical History:Heart diseases (-)Pulmonary diseases (-)Hypertension (-)Diabetes (-)Renal diseases (-)

Drug Records:Valsartan 80mgIvabradin 5mgPhysical ExaminationAwareness: Compos MentisBP: 134/77mmHgHR: 107 x/minRR: 31 x/minTemp: 36.8oCWeight: 135 kgHeight: 160 cmIMT: 52.7

Status Generalis

Head: normocephalEye: anemic conjunctivae -/-, icteric sclera -/-Ear: normotia, secretions (-)Nose: septum nasi deviation (-), secretions (-)Throat: tonsil T1-T1, calmMouth: moist oral mucous, cyanosis (-)Neck: JVP 5+0

ThoraxPulmo:Inspection: symmetric hemithorax left and rightPalpation: tactile fremitus left = right (?)Percussion: sonor Auscultation: Vesicular +/+, rhonkhi -/-, wheezing -/-

Cor:Inspection: ictus cordis ()Palpation: palpable ictus cordis Percussion: In normal rangeAuscultation: S1-S2 normal, regular, murmur (-), gallop (-)AbdomenAbdomenInspection: Raised, distension (+)Auscultation: BU (+) normalPalpation: tenderness (+) on hypogastric region, hepar and lien not palpablePercussion: timpanic (?) on whole region of abdomen, CVA -/- Extremity: Warm, CRT < 2 sec, Foot Edema +/+

Problem ListDyspepsia ec. urine retentionPickwickian Syndrome

AssesmentDyspepsia ec. Urine retentionAnamnesa:Abdominal cramping since 5 days before admissionOligouria since 6 days before admissionPhysical examination:Abdominal tenderness (+) on hypogastric region

Patient felt relieved after installation of urinary catheter

Treatment: Urinary catheter

Pickwickian syndromeAnamnesa:Constant shortness of breath, especially at noon Frequently awake at early morning, feeling out of breathPhysical ExaminationIMT of 52.7 (> 30) Foot edema +/+

Treatment:FurosemideEducation on diet and lifestylePrognosis:

Quo ad Vitam: Dubia ad bonamQuo ad Functionam: Dubia ad malamQuo ad Sanationam: Dubia ad malam

Obesity Hypoventilation Syndrome (Pickwickian Syndrome)

OHS is a breathing disorder in obese people that leads to low oxygen levels and too much carbon dioxide in your blood. Low oxygen and high carbon dioxide levels may develop because of a condition called hypoventilation during the day (daytime hypoventilation). Hypoventilation means you are not moving enough air in and out of your lungs very well. With OHS, you may also have difficulty sleeping because of obstructive sleep apnea.

The three main characteristics of OHS are:1) obesity 2) daytime hypoventilation (difficulty getting rid of carbon dioxide)3) sleep disordered breathing (such as obstructive sleep apnea)

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