A rare cause of Acute Respiratory Distress Syndrome (ARDS) - Mycoplasma pneumonia in a middle aged women Case History A 66-year-old female presented to the Emergency Department of Sri Jayewardenepura General hospital with generalized weakness, faintness, and progressive worsening of difficulty in breathing over a week prior to admission. She also had dry non-productive cough, general malaise with myalgia and a low grade fever. She had consulted a GP and treated with salbutamol and steroid inhalers on outpatient basis. However, since her symptoms became more and more troublesome, she was admitted to the hospital. She is a diagnosed patient with type 2 diabetes mellitus for last 10 years and was taking oral metformin for the control.
DOI: 3/24/2010. The patient is a 55-year-old male machine shop lead who sustained back, neck, right shoulder and internal injuries due to repetitive work. As per medical report dated 04/27/16, the patient has a history of a spinal cord injury secondary to cervical stenosis. He underwent emergent decompressive cervical laminectomy on 3/26/10. The patient has ongoing neurogenic bowel, ongoing neurogenic bladder, severe depression and pain.
Range of motion was restricted inflexion and extension due to pain. Patient was diagnosed with impaired vision, cervical spine sprain/strain/herniated cervical discs, lumbar spine sprain/strain/herniated lumbar disc at L4-5 and L5-S1, right shoulder sprain, right elbow sprain and right hand sprain/strain rule out tendonitis and carpal tunnel syndrome. Treatment plan includes to start chiropractic treatments for 2 x 5 weeks for the cervical and lumbar spine to improve range of motion, improve function and decrease pain and spasms; cervical spine ESI at C5/C6 and C6/C7 and lumbar ESI at L4-5 and L5-S1 to attempt to reduce pain, decrease medication intake and increase functional capabilities. He was given a refill prescription for topical creams, Norco 10/325 mg 1 tablet every 4-6 hours #90, Ultram extended release 150 mg 1 tablet twice daily #60, Celebrex 200 mg 1 capsule daily #30, Protonix 20 mg 1 capsule twice daily #60 and Fexmid 7.5 mg 1 tablet three times a day #120. Per verification from the provider’s office, the IW has not had a previous cervical ESI and this is an initial
The radiograph depicts Legg-Calvé-Perthes disease (LCPD) of the left hip. The right hip is not affected. This childhood hip disorder is a result of idiopathic avascular necrosis of the growing bony epiphysis of the femoral head, with boys affected four times more that girls (Texas Scottish Rite Hospital for Children, n.d.). This interruption in blood supply to the bone results in necrosis, and the femoral head become flattened due to weight and pressure placed on the bone during normal physical activity (Texas Scottish Rite Hospital for Children, n.d.). View: This is an Anterioposterior view demonstrating the entire pelvis, sacrum, the lumbosacral articulation, both proximal femurs and hip joints.
Laboratory tests and lumbar puncture are also recommended. Direct tissue biopsy is rarely performed due to the technically difficult and potentially harmful approach to the cavernous sinus. The specific diagnostic criteria recommended by the International Headache Society are summarized: ●Unilateral headache ●Granulomatous inflammation of the cavernous sinus, superior orbital fissure or orbit, demonstrated by MRI or biopsy ●Paresis of one or more of the ipsilateral third, fourth, and/or sixth cranial nerves ●Evidence of causation demonstrated by both: •Headache has preceded oculomotor paresis by <2 weeks or developed with
It was also noted that the office will give a new lap slip. It was also noted that the patient is scheduled for a repeat caudal epidural steroid injection. Physical examination revealed that the cervical spine has decreased range of motion; tenderness to palpation at the paraspinal muscle; spasm at the bilateral cervical trigger point, bilateral trapezius rigger point, and bilateral rhomboid trigger point. There is also bilateral tenderness to palpation of facet joints C5-C7, positive Spurling’s test, foraminal compression test. Physical examination of the lumbar spine revealed decreased range of motion on all planes; tenderness to palpation at the lumbar paraspinous area; tenderness to palpation over the lumbar spine; bilateral straight leg raise; bilateral knee extension weakness, bilateral lumbar radicular sign, and spasm noted.
Patient 1 Medication History Patient Initials: M.K Reason for Physical Therapy: 62 years male Three weeks post right (Rt) CVA, Pain on leftshoulder, left shoulder subluxation, Lt side weakness inability to perform functional ADL. Diabetic, Unstablehighblood pressure,______________________ ___________________________ PT Treatment Plan (Specific Interventions, Frequency, and Duration): 1hour program 3 times weekly, Increase PROM-10mins Lt UE/LE strengthening muscles of (Lt) shoulder. Lt side muscles-30mins, relieve pain on the Lt shoulder, IRR to the Lt shoulder-10mins STM ( Lt) UE/LE, Balance training in all postures 10mins Sitting-standing reducation-10mins Trade Name Generic Name Prescribed for: Dosage Rehab Implications Prisolec Omeprazole
Figure 4 Histological findings show a subchondral fracture of the femoral head and no evidence of antecedent osteonecrosis. (A) Mid-coronal cut section of the resected left femoral head shows a linear fracture line paralleling the subchondral bone endplate. (B) The photomicrograph obtained from the subchondral fractured lesion shows marked fracture callus and vascular rich granulation tissue (hematoxylin and eosin, ×100). Learning points Preventing post-traumatic osteoarthritis is a challenging problem in patients with acetabular
Air confined only to the cochlea was seldom reported.2,5 The mean age at presentation was 25 years with male preponderance.1 CT imaging is a valuable tool to diagnose traumatic pneumolabyrinth. Since the absence of a temporal bone fracture on the initial CT doses not necessarily eliminate a vestibular, cochlear or ossicular chain involvement, a millimeter-scale slices directed towards the temporal bone is recommended.9 In our patient, pneumolabyrinth might have been detected earlier with the use of a high-resolution CT scan centered towards the temporal bone with a bone window in the axial and coronal planes. Vestibular symptoms usually have more favorable prognosis after treatment. Whereas, hearing recovery outcome after traumatic pneumolabyrinth is assumed to be influenced by the following factors: the interval until surgery, the presence of stapes lesions and air location on CT. With longer interval until surgery, hearing recovery was reduced. 54% of Patients receiving surgery with an injury to surgery interval less than 2 weeks demonstrated an improved
Subjective CC/HPI: Patient is a 26 year-old female who presents with frequent shortness of breath and wheezing. She reports experiencing shortness of breath 4 times a week and experiences nighttime awakenings twice a month due to her symptoms. Patient claims to use her Flovent inhaler one puff twice a day, less than her prescribed dose due to cost issues, and her rescue inhaler 3 times a week for when her wheezing is severe. Patient also presented with a persistent runny nose and itchy eyes starting 5 weeks prior. Her inhaler technique was assessed and deemed correct.
The doctors also examined plaintiff’s cervical spine, which revealed a normal alignment. Although, there was some straightening of the curvature suggesting a muscle spasm. In September of 1985, the plaintiff was rear ended. She suffered a sore neck and soreness in the right shoulder. In April of 1992, the plaintiff was in a motor vehicle accident suffering right leg and groin pain.