32 year old female - seizures under evaluation

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This is an online E-log book to discuss our patient de-identified health data shared after taking his/ her guardians sign informed consent

Here we discuss our individual patient problems through series of inputs from available Global online community of experts with an aim to solve those patient clinical problem with collective current best evidence based inputs.

This E-log also reflects my patient centered online learning portfolio.

Your valuable inputs on comment box are welcome

Name: Dr Sreshta J

Complaints of involuntary movements of both upper and lower limbs 2 hours ago

Timeline of events:
Hopi:
Patient was apparently asymptomatic 2 hours ago then she had involuntary movements of both upper and lower limbs that lasted for 5 minutes.
Frothing present
No tongue bite
No loss of consciousness
Post ictal confusion present
No involuntary urination or defecation

2 episodes of active seizures after coming to casualty which lasted for 5 minutes, 1 hour apart 

Past illness:
Known case of epilepsy since 12 years. Was on medication till 3 years ago
Not a known case of DM, Htn, asthma
H/o 2 LSCS 21 and 19 years ago
No h/o blood transfusions

Personal history:
Appetite - normal
Diet- mixed
Bowel and bladder movements- regular
Sleep- adequate
No addictions

General examination:
Pallor no
Icterus no
Cyanosis no
Clubbing no
Lymphadenopathy no
Generalised edema no
Malnutrition no

Temp- 98.7F
Bp- 140/80 mmHg
Pr- 112bpm
Rr- 33cpm
Spo2- 99% @RA
GRBS- 105mg/dl
 
Cardiovascular System : S1, S2 heard, no murmurs

Respiratory System : Bilateral air entry present.Normal vesicular breath sounds heard.Position of trachea central.

Central Nervous System: patient is drowsy. GCS- 13/15 

Per abdomen : soft, non tender.

Investigations:
ECG -
USG abdomen-
Chest Xray-
Treatment:
Inj loraz 2cc iv stat
Inj levipil 1000mg in 100ml NS iv stat 
Tab levipil 500mg PO BD
Monitor vitals
Watch for seizure activity 

23/12/22 SOAP NOTES
32 year old female
GM unit 4 
ICU bed- 6
Day - 1

S
1 episode of bilious vomiting

O
Patient is drowsy 
Temp- 98.4F
Bp- 140/90mmHg
Pr- 81bpm
RR- 21cpm
Cvs-S1 S2+
Rs- BAE+
CNS- cannot be evaluated as patient is drowsy GCS - 13/15
P/a- soft, non tender

A
Seizures under evaluation 

P
Inj lorazepam 2cc iv stat
Tab levipil 500mg po bd
Inj zofer 4mg iv bd
Monitor vitals and watch for seizure activity

USG abdomen on 22/12/22 left renal calculi
Review USG on 23/12/22- appendix not visualised
No echogenecity of any inflammatory changes in right iliac fossa

Advice at discharge:
T Levipil 500 mg PO BD
T Zofer 4mg PO BD SOS
T MVT PO OD x15days

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