Haemopoiesis Clinical application Dr. Tariq M. Roshan Department of Hematology PPSP.
Supervisor :Dr TARIQ ALMOFLEHI prepared by: Dr A.AZiZ Aonallah
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Transcript of Supervisor :Dr TARIQ ALMOFLEHI prepared by: Dr A.AZiZ Aonallah
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Supervisor :Dr TARIQ ALMOFLEHI
prepared by: Dr A.AZiZ Aonallah
Case Presentation
8/5/2014
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Personal Information
Name : Abdulkareem Mohammed Hassen
Age : 65 years old
Residence: Sana’a
Martial status: Married & has 8 offspring
Occupation: solider
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Special habits :Irregular Qat chewing
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Date of admission :23th march 2013
Source of History The patient himself
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Chief Complain
Chest pain for three hours
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The Condition of pt started two days PTA
as recurrent chest discomfort
lasted for about 15 min. increased by exertion
relived by rest
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Three hours before admission the pateint developed in-tense continuous chest pain
Sudden onsetRetrosternal Radiated to his lt. shoulderHeaviness in nature Associated with sweating
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No history of shortness of breath , palpitation nor synco-
pal attack. Also no fever nor LL edema.
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Review Of Other Systems
Respiratory: NAD
Abdomen : NAD
Renal :NAD
Endocrine: NAD
CNS: NAD
Hematology: NAD
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Past History
Medical Hx.: No Hx. Of DM, HTN
Surgical Hx. :None
Drug Hx. : None
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Family History
No Hx. Of DM, HTN
No Hx. Of CAD
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On Examination
pt was conscious, oriented and coopera-tivethere was no jaundice no cyanosis nor pallor.
JVP is not rised, no lymph node enlarge-ment
No lower limb edema
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Vi-tal signs • BP= 150/110 mmhg• PR=76 b/m• T=37.3 c• RR=16 c/m
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Ex-amination
Heart= S1+S2+0Chest=ClearAbdomen= Soft, no organomegly
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ECG
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ECG
• ST segment elevation from V1 to V4 and in I &
AVL.• T inverted in lead III ,AVF
and V6
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Lab Investigations:CBC: WBC=14.17Hb=17 g/dlPLT=219CK-MB= 33Serum creatinine= 0.9 mg/dlSerum K=3.9
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• The case was diagnosed as
Antero septo lateral Myocardial Infarction
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Initial Manage-ment in ER:
• General :Complete bed rest. Inform CCU doctor Close monitoringMorphine 3 mg +plasil IV STATO2 inhalationAspirin 100 mg 3 tab chewable Plavix 75 mg 4 tab STAT Cardiology consultation (Dr Fikri ,Dr Abdulmalek and The visitor Saudian
team)
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The decision was to prepare the patient for
PRIMARY PCI
Within 35 minutes the patient was ready
in CATH LAB
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FROM CATH LAB
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After discussion the decision was to send the patient for
thrombolytic then control CAG
and surgical consultation.
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The patient shifted to CCU and received
Actylase 15 mg IV bolusthen 50 mg IVI over 30 minutes
then 35 mg IVI over 1 hour.
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• Stabilization in CCU.• cardio surgical consultation done by Dr Yahia Rajeh with advice to
transfer the patient to the surgical ward and to prepare him for CABG next week.
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• During admission in surgical ward the patient refuse CABG .
• Consultation by Dr Tariq done with advice to prepare the patient for PCI to LM and total LAD.
• Reevaluation and preparation by Dr Tariq,• confirm the date of Intervention
2/4/2014
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One day before the intervention every thing was ready (patient fit ,
cardio-surgical pack up and OT with (6 units of plasma,6 units of PLT and 6 units of blood AB nega-tive) for possible complication ,
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Next day the patient sent to CATH LAB with high risk consent
for
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PCI to LM and total ostial LADfor first time in YEMEN
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FROM CATH LAB
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ECG post PCI
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Observation in CCU post PCI
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Patient shifted to the ward for observation and follow up
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Then the patient discharged with good general condition
by Dr Areej
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Thank you