This is an online E log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent.
Diagnosis
1)RTA TRAUMATIC BRAIN INJURY (20/03/23) WITH INTRA VENTRICULAR HEMORRHAGE
(RESOLVED) WITH FRONTAL BONE FRACTURE S/P RIGHT FRONTAL LACERATION WITH SOFT TISSUE REPAIR WAS DONE ON 21/03/23
2) POST CPR HIE
3)S/P TRACHEOSTOMY 29/3/23)EXTUBATED ON (30/3/23) AT 8PM
4)HFMEF 50% ANTERIOR WALL MI
5) GRADE 2 BEDSORE
6) VENTILATOR ASSOCIATED PNEUMONIA (RESOLVING WITH BILATERAL PLEURAL
Case History and Clinical Findings
CHEIF COMPLAINTS
PATIENT ALLEGED TO FALL FROM BIKE UNDER ALCOHOL INFLUENCE ON 20/03/13
HOPI
PATIENT HAD A FALL FROM BIKE UNDER ALCOHOL INFLUENCE AT 9.30PM NEAR HALIYA ON 20/03/23 THEN WAS TAKEN TO A HOSPITAL FOR FURTHER MANAGEMENT, PATIENT WAS INVESTIGATED AND DIAGNOSED TO HAVE RTA TRAUMATIC BRAIN INJURY WITH INTRA VENTRICULAR HEMORRHAGE WITH FRONTAL BONE FRACTURE WITH ASPIRATION PNEUMONIA AND RIGHT FRONTAL LACERATION WITH SOFT TISSE REPAIR AND DEBRIDEMENT WAS DONE ON 21/03/23 PATIENT WAS INTUBATED ON 20/03/23 I/VIO POOR GCS AND EXTUBATED ON 21/02/23 PATIENT HAD SUDDEN CARDIAC ARREST AT 7.30AM ON 25/03/23 AND WAS AGAIN REIN TUBATED AFTER 2 CYCLES OF CPR, ROSC ACHEIVED AND IS CONNECTED TO MECHANICAL VENTILATOR WITH FI02 100% PATIENT HAD FOCAL SEIZURES S/O HIE WITH STRESS MYOCARDITIS AND IS ON IONOTROPES SUPPORT ET CULTURE SHOWED (21/02/23) KLEBSIELLA WITH INTERMEDIATE SENSITIVITY TO INJ AZTREONEMPATIENT WAS SHIFTED TO OUR HOSPITAL FOR FURTHER MANAGEMENT.
PAST HISTORY
NOTA K/C/O HTN/DM/TB/CVA/CAD/EPILEPSY/THYROID DISORDER
PERSONAL HISTORY:
DIET MIXED
APPETITE NORMAL
SLEEP NORMAL
BOWEL AND BLADDER REGULAR ADDICTIONS OCCASIONAL ALCOHOL CONSUMPTION
NO ALLERGIES
FAMILY HISTORY INSIGNIFICANT
GENERAL EXAMINATION
PATIENTIS CONSCIOUS COHERENT AND COOPERATIVE
MODERATELY BUILT AND NOURISHED NO SIGNS OF PALLOR ICTERUS CYANOSIS CLUBBING LYMPHADENOPATHY, EDEMA
VITALS
AFEBRILE
PR-120BPM
BP-130/80 MMHG
RR-22 CPM
SPO2-100% ON F102
GRBS-132M5%
SYSTEMIC EXAMINATION PER ABDOMEN
INSPECTION
ABDOMEN IS SCAPHOID UMBILICUS IS CENTRAL
ALL QUADRANTS ARE MOVING EQUALLY WITH RESPIRATION NO SINUSES ENGORGED VEINSVISIBLE PULSATIONS
HERNIAL ORIFICES ARE FREE
PALPATION
NO LOCAL RISE OF TEMPERATURE
NO TENDERNESS
LIVER AND SPLEEN-NOT PALPABLE PERCUSSION TYMPANIC NOTE HEARD OVER THE ABDOMEN
FLUID THRILL ABSENT
SHIFTING DULLNESS ABSENT
AUSCULTATION
BOWEL SOUNDS ARE HEARD.
CARDIOVASCULAR SYSTEM
INSPECTION SHAPE OF CHEST IS ELUPTICAL NO RAISED JVP NO VISIBLE PULSATIONS SCARS, SINUSES, ENGORGED VEINS PALPATION APEX BEAT-FELT AT LEFT 5TH INTERCOSTAL SPACE
THRILLS PRESENT
NO PARASTERNAL HEAVES
AUSCULTATION
S1 AND S2 HEARD
RESPIRATORY SYSTEM
INSPECTION
DYSPNOEA PRESENT
SHAPE-ELLIPTICAL
B/L SYMMETRICAL
BOTH SIDES MOVING EQUALLY WITH RESPIRATION
NO SCARS, SINUSES, ENGORGED VEINS, PULSATIONS
PALPATION
TRACHEA-CENTRAL EXPANSION OF CHEST IS SYMMETRICAL
VOCAL FREMITUS-NORMAL PERCUSSION RESONANT BILATERALLY
AUSCULTATION:
BILATERALAIR ENTRY PRESENT
NORMAL VESICULAR BREATH SOUNDS PRESENT
CREPTS ARE HEARD
GCS EIVIM2
CENTRAL NERVOUS SYSTEM COMATOSE ON MECHANICAL VENTILATION SEDATED NO SIGNS OF MENINGEAL IRRITATION CRANIAL NERVES CANNOT BELICITED MOTOR SYSTEM-POWER CANNOT BE ELICITED TONE-NORMAL IN BILATERAL UPPER AND LOWER LIMBS SENSORY SYSTEM- CANNOT BE ELICITED REFLEXES
RT LT
B - -
T - -
S--
A--
K--
CEREBELLAR SIGNS CANNOT BE ELICITED
COURSE IN HOSPITAL
25 YEAR OLD MALE PRESENTED TO HOSPITAL WITH RTA TRAUMATIC BRAIN INJURY (20/03/23) WITH INTRA VENTRICULAR HEMORRHAGE (RESOLVED) WITH ASPIRATION
PNEUMONIA (RESOLVED), FRONTAL BONE FRACTURE S/P RIGHT FRONTAL LACERATION
WITH DEBRIDEMENT WAS DONE ON 21/03/23 HFMEF (EF 50%) SUDDEN CARDIAC ARREST
HIE ON MECHANICAL VENTILATION DAY 5 (25/03/23) POST CPR STATUS (2CYCLES) ON
25/03/23 PATIENT WAS EVALUATED CLINICALLY WITH APPROPRIATE INVESTIGATIONS
CONTINUED ON ACMV ON MY MRI BRAIN WAS DONE WHICH SHOWED FEATURES SUGGESTIVE OF SEVERE HYPOXEMIC BRAIN INJURY AND FEW ACUTE TO SUBACTUE
HEMATOMAS IN LEFT FRONTAL, MEDIAL, TEMPORAL AND LEFT LATERAL VENTRICLES
NEUROSURGEON OPINION WAS TAKEN IN VIEW OF SEVERE HYPOXEMIC BRAIN INJURY
AND ADVISED FOR TRACHEOSTOMY ON DAY 3 PATIENT HAD EPISODES OF MYOCLONIC JERKS. ANTIEPILEPTICS(VALPROATELEVIPIL)ICTMEASURED(3% NS, BROMOCRIPTINE) AFTER EXPLAINING THE ATTENDERS THE NEED FOR TRACHEOSTOMY AND WITH DUE CONSENT TRACHEOS TOMY WAS DONE ON 29/03/23 PATIENT HAD ANTERIOR WALL MI
PATIENT WAS ON IONOTROPE SUPPORT AND WEANED OFF BRAINSTEM REFLEXES INTACT PATIENT WAS WEANED OFF FROM VENTILATOR SUPPORT ON TO CPAP MODE AND
ON TO T PIECE PATIENT HAD INTERMITTENT HIGH GRADE FEVER SPIKES AND
DESATURATIONS, TREATED SYMPTOMATICALLY WITH ANTIPYRETICSCOLD SPONGINGS
T PIECE WAS REMOVED AND PATIENTS SATURATIONS IMPROVED ON ROOM AIR MINI BAL
PROCEDURE WAS PERFORMED IN VIEW OF VENTILATOR ASSOCIATED PNEUMONIA AND
REPORTS AWAITED PATIENT WAS DISCHARGED IN HEMODYNAMICALLY STABLE CONDITION WITH BED CARE, TRACHEOSTOMY CARE AND PHYSIOTHERAPY EXPLAINED TO
ATTENDERS
NEUROLOGY OPINION WAS TAKEN AND ANTIEPILEPTICS WEANED OFF CONTINUED VALPROATE
REFERAL TO ANAESTHESIOLOGY ON 27/3/23
ADVICE
1 HEAD END ELEVATION AT 45
2 IV FLUIDS AT 3% NS @70ML/HR
3. ET TUBE ORAL AND RYLES TUBE SUCTIONING EVERY 4RTH HOURLY
4. INJ. PCM 100MLIVISOS IF TEMPERATURE 100F 5. EYE PROTECTION POSITION CHANGING FREQUENTLY
6. CONTINUE SEDATION @ 6ML/HR (IN FENTANYL 200MCGINJ, MIDAZOLAM 30MG+
INJ ATRACURIUM INFUSION)
7. REST CONTINUE TREATMENT AS PER PHYSICIAN ADVICE
8. GCS MONITORING
9CHEST PHYSIOTHERAPY
10. MAINTAIN NUTRITION
11 MONITOR BP PR SPO2, TEMPERATURE GRES 12. VENTILATOR SETTINGS MODE ACMV - VO, 7V 380ML RR 10-128PM, PEEP 5CM H20,
FI02-40%
REFERRAL TO OPTHALMOLOGY ON 26/05/23
IMPRESSION ON FUNDUS EXAMINATION NO FEATURES OF LOT NOTED
REFERRAL TO NEUROSURGERY ON 25/03/2023
ADVICE
1. INJ. MANNITOL 100ML IV/TID OR INF 3%NACL @20ML/HR
2INJ LEVERA 1GM/V/BD
3. INJ LACOSAMIDE 200MG IV/BD
4. REVIEW SOS
5. TAB CITICHOLINE 500 MG RT/BD
6.T DONEP-M RT/BD
7. TAMAN TAX 100MG RT/BD
8TAB BROMOCRIPTINE 2.5MG RT/BD
REFERRAL TO GENERAL SURGERY
GRADE 2 BED SORE
ADVICE
1. PNEUMATIC COMPRESSION BED
23RD HOURLY POSITION CHANGE OF PATIENT
3MS (WET,DRY) DRESSING
Investigation
BLOOD CULTURE- NO GROWTH SEEN
URINE CULTURE NO GROWTH SEEN
ET CULTURE- NO GROWTH SEEN
HEMOGRAM 26/3/23
HB-17 O GM/DL
TLC-13000CELLS/CU MM
N/L/E/M-57/28/5/10
PLATELET COUNT 3.62
7/4/2023 HB-10.3 GM/DL
TLC 10,000 CELLS/CUMM N/LE/M-54/30/4/12 PLATELET COUNT 307 LAKHS/CU MM
Treatment Given (Enter only Generic Name)
25/03/23
RYLES FEED 200ML MILK + 2 SCOOPS PROTEIN POWDER -4RTH HOURLY 100ML WATER-2
HOURLY
INJ NORADRENALINE 2AMP +46MLNS
INJ ATRACURIUM UNDILUTED-1ML/HR
INJ MIDRAZOLAM-SML/HR INJ.3% NS-20ML/HR
INJ LEVATIRACETRAM-16/IWBD INJ LACOSAMIDE200MG/V/ED
24/03/23
RYLES FEED 200ML MILK +2 SCOOPS PROTEIN POWDER -4RTH HOURLY, 100ML WATER-2
INJ NORADRENALINE 2AMP +46ML NS SMUHR INJ ATRACURIUM UNDILUTED SML/HR AMP+46MLNS
INJ MIDRAZOLAM-5ML/HR INJ.3% NS-20ML/HR
INJ LEVATIRACETRAM-1G/VBD INJ.LACOSAMIDE200MG/V/BO
EYE CARE FREQUENT POSITION CHANGE AIR BEDDING
BP PR RR SPO2 MONITORING HOURLY
GRBS MONITORING 2ND HOURLY
INJ LASIX 40MG/V/BD IV FLUID 0.9-50MLHR
27-03-23
RYLES FEED 200ML MILK + 2 SCOOPS PROTEIN POWDER -4RTH HOURLY 100ML WATER-2
HOURLY
INJ NORADRENALINE 2AMP +46MLNS 6ML/HR
INJ ATRACURIUM UNDILUTED-5ML/HR 1AMP+46ML NS
INJ 3% NS-20ML/HR
INJ MIDRAZOLAM-30MGHING FENTANYL200MCG+16ML NS 5ML/HR
INJ LEVATIRACETRAM-1C/V/BD
INJ LACOSAMIDE200MG/WBD
INJ LASIX 40MG/IV/BD
EYE CARE FREQUENT POSITION CHANGE AIR BEDDING
STRICT I/O CHARTING BP PR.RR.SPO2,MONITORING HOURLY GRBS MONITORING 2ND HOURLY
IV FLUID 0.9-50ML/HR
28/03/29
RYLES FEED 200ML MILK +2 SCOOPS PROTEIN POWDER WRTH HOURLY 100ML WATER-
HOURLY
IV FLUID NS-75MLHR
INJATRACURIUM UNDILUTED SMUHR AMP +46ML NS
INJ 9% NS-20MLHR
INJ MIDRAZOLAM-80MG+ING FENTANYL200MCG-16MLINS SMUHR
INJ LEVATIRACETRAM-1G/V/B0
INJ LACOSAMIDE200MG/V/BD
INJ LASIX 40MG/V/BQ
EYE CARE FREQUENT POSITION CHANGE AIR BEDDING
STRICTI/O CHARTING
BP PRRR SPO2 MONITORING HOURLY GRBS MONITORING 2ND HOURLY
INJ SODIUM VALPROATE 1GM IV STATFV8 500MG IV BD
29/03/23
RYLES FEED 200ML MILK +2 SCOOPS PROTEIN POWDER 4RTH HOURLY 100ML WATER -2 HOURLY
IV FLUID NS-75MLHR
INJ ATRACURIUM UNDILUTED 5ML/HR 11AMP+46ML NS
INJ.3% NS-20ML/HR
INJ MIDRAZOLAM-30MG+ING FENTANYL200MCG+16ML NS SML/HR
INJ LEVATIRACETRAM-1G/V/BD
INJ LACOSAMIDE200MG/V/BD
INJ SODIUM VALPROATE 1GM IVISTAT FB 500MG IV BD
INJ.CLEXANE 40MG IV/BD
INJ GLYCOPYROLATE 1MG IVISOS INJ NEOMOL 1MG IVISOS IF TEMPERATURE MORE THAN 101F
EYE CARE FREQUENT POSITION CHANGE AIR BEDDING
STRICT I/O CHARTING
BP PR RR SPO2,MONITORING HOURLY GRBS MONITORING 2ND HOURLY
30/03/23
RYLES FEED 200ML MILK + 2 SCOOPS PROTEIN POWDER-ARTH HOURLY 100ML WATER-2
HOURLY
IV FLUID NS-75MLHR
INJ SODIUM VALPROATE 1GM IV STAT FB 500MG IMBD
INJ.CLEXANE 40MG IV/BD
INJ GLYCOPYROLATE IMG MISOS
INJ NEOMOL TMG IVISOS IF TEMPERATURE MORE THAN 1016
EYE CARE FREQUENT POSITION CHANGE AIR BEDDING
STRICT IO CHARTING
BP PRRR SPO2 MONITORING HOURLY
GRBS MONITORING 2ND HOURLY
31/03/23
RYLES FEED 200ML MILK +2 SCOOPS PROTEIN POWDER-4RTH HOURLY, 100ML WATER 2
HOURLY
IV FLUID NS-75MLHR
INJ SODIUM VALPROATE 1GM IV STAT FB 500MG IV BD
INJ CLEXANE 40MG IVBD
INJ GLYCOPYROLATE IMGIVISOS
INJ 3 NS-10MLHR
INJ NEOMOL IMG IV/SOS IF TEMPERATURE MORE THAN 101F
TPCM 650MG RT/SQS
EYE CARE FREQUENT POSITION CHANGE AIR BEDDING
STRICT TO CHARTING
BP PR RR SPO2 MONITORING HOURLY GRBS MONITORING 2ND HOURLY
1/4/23
RYLES FEED 200ML MILK +2 SCOOPS PROTEIN POWDER 4RTH HOURLY, 100ML WATER-2
HOURLY
VFLUID NS-125MUHR
INJ SODIUM VALPROATE IGM IV STAT FB 500MG IV BD
INJ CLEXANE 40MG IV/BD
INJ 3 NS-5MLHR
INJ NEOMOL 1MG IV/SOS IF TEMPERATURE MORE THAN 101F
TPCM 650MG RT/SOS
EYE CARE FREQUENT POSITION CHANGE AIR BEDDING
STRICT VO CHARTING
BP PRRR SPO2 MONITORING HOURLY GRBS MONITORING 2ND HOURLY
INJ PIPTAZA 5GM IV/STAT
2/4/23
RYLES FEED 200ML MILK +2 SCOOPS PROTEIN POWDER -4RTH HOURLY 100ML WATER-2
HOURLY
IV FLUID NS-100ML/HR
INJ SODIUM VALPROATE 1GM IV STAT FB 500MG IV BD INJ CLEXANE 40MG IV/BD
INJ 3 NS-5MLHR
INJ NEOMOL 1MG IVISOS IF TEMPERATURE MORE THAN 101F
TPCM 650MG RT/SOS
INJ PIPTAZA 5GM IV/STAT
EYE CARE FREQUENT POSITION CHANGE AIR BEDDING
THE STRICT I/O CHARTING
BP.PR RR SPO2 MONITORING HOURLY GRBS MONITORING 2ND HOURLY
TEMPERATURE MONITORING 2ND HOURLY
NEOSPORIN POWDER AND BED SORE DRESSING
INJ KCL 2 AMPULES IN 500ML NS IV/STAT OVER SHRS ET TUBE ORAL TUBE
LUBREX EYE DROPS/TID
NEBWITH IPRAVENT 4TH HOURLY INJ GLYCOPYROLATE IMG IV/SOS
CHEST PHYSIOTHERAPY
UPPER LIME LOWER LIMB PHYSIOTHERAPHY
4/4/23
RYLES FEED, 200ML WATER 4 HOURLY 200ML MILK +2 SCOOPS PROTEIN POWDER -4RTH HOURLY IV FLUID NS-125ML/HR
INJ SODIUM VALPROATE 1GM IV 80 INJ PIPTAZ 4.5 GM IV/TID
INJ CLEXANE 40MG SC/BD
INJ NEOMOL 1MG IV/SOS IF TEMPERATURE MORE THAN 101F
T PCM 650MG RT/SOS
INJ GLYCOPYRROLATE 1 MGIVISOS
SYP POTKLOR 15 MLRT/TID
NEOSPORIN POWDER AND BED SORE DRESSING
HOURLY SUCTIONING
EYE CARE FREQUENT POSITION CHANGE AIR BEDDING
STRICT I/O CHARTING
BP PRRR SPO2 MONITORING HOURLY
GRBS MONITORING 2ND HOURLY
TEMPERATURE MONITORING 2ND HOURLY
NEB WITH IPRAVENT4TH HOURLY
TAB CITICHOLINE 500 MG RT/B0
T DONEP-M RTBD
TAMAN TAX 100MG RT/B0 TAB BROMOCRIPTINE 2.5MG RT/BD
CHEST PHYSIOTHERAPY UPPER LIMB LOWER LIMB PHYSIOTHERAPHY
5/4/23
RYLES FEED, 200ML WATER 4 HOURLY 200ML MILK +2 SCOOPS PROTEIN POWDER -4RTH
INJ GLYCOPYRROLATE 1 MGIVISOS
SYP POTKLOR 15 MLRT/TID
NEOSPORIN POWDER AND BED SORE DRESSING
HOURLY SUCTIONING
EYE CARE FREQUENT POSITION CHANGE AIR BEDDING
STRICT I/O CHARTING
BP PRRR SPO2 MONITORING HOURLY
GRBS MONITORING 2ND HOURLY
TEMPERATURE MONITORING 2ND HOURLY
NEB WITH IPRAVENT4TH HOURLY
TAB CITICHOLINE 500 MG RT/B0
T DONEP-M RTBD
TAMAN TAX 100MG RT/B0 TAB BROMOCRIPTINE 2.5MG RT/BD
CHEST PHYSIOTHERAPY UPPER LIMB LOWER LIMB PHYSIOTHERAPHY
5/4/23
RYLES FEED, 200ML WATER 4 HOURLY 200ML MILK +2 SCOOPS PROTEIN POWDER -4RTH hourly
IV FLUID NS-125ML/HR
HOURLY
INJ SODIUM VALPROATE 1GM IV BD INJ PIPTAZ 45 GM IV/TID
INJ CLEXANE 40MG SC/BD
INJ NEOMOL 1MG IV/SCS IF TEMPERATURE MORE THAN 101F
T PCM 650MG RT/SOS
INJ GLYCOPYRROLATE 1 MGIV/SOS
SYP POTKLOR 15 MLRT/TID
NEOSPORIN POWDER AND BED SORE DRESSING
HOURLY SUCTIONING
EYE CARE FREQUENT POSITION CHANGE AIR BEDDING
STRICT I/O CHARTING
BP PRRR SPO2,MONITORING HOURLY
GRBS MONITORING 2ND HOURLY
TEMPERATURE MONITORING 2ND HOURLY
NEB WITH IPRAVENT 4TH HOURLY
TAB CITICHOLINE 500 MG RT/BD
DONEP-M RT/BD
TAMANTAX 100MG RT/BD
TAB BROMOCRIPTINE 2.5MG RT/BD
CHEST PHYSIOTHERAPY
UPPER LIMB LOWER LIMB PHYSIOTHERAPHY
6/4/23
RYLES FEED200ML WATER -2 HOURLY 200ML MILK +2 SCOOPS PROTEIN POWDER-4TH
HOURLY
IV FLUID NS-125ML/HR
INJ SODIUM VALPROATE 1GM IV BD
INJ PIPTAZ 45 GM VTID
INJ CLEXANE 40MG SC/BD
INJ NEOMOL 1MG IVISOS IF TEMPERATURE MORE THAN 101F
T PCM 650MG RT/SOS
INJ GLYCOPYRROLATE 1 MG IV/SOS
SYP POTKLOR 15 MLRT/TID
TCITICHOLINE 500MG RT/BD
T DONEP-MRTBD
TAMANTAX 100MG RT/BD
NEBULISATION WITH IPRAVENT
NEOSPORIN POWDER AND BED SORE DRESSING
HOURLY SUCTIONING
EYE CARE FREQUENT POSITION CHANGE AIR BEDDING STRICT VO CHARTING
BP PR RR SPO2 MONITORING HOURLY
GRBS MONITORING 2ND HOURLY
TEMPERATURE MONITORING 2ND HOURLY TAB BROMOCRIPTINE 2.5MG RT/BD
CHEST PHYSIOTHERAPY
UPPER UMB LOWER LIMB PHYSIOTHERAPHY
7/4/23
RYLES FEED, 200ML WATER -2 HOURLY 200ML MILK +2 SCOOPS PROTEIN POWDER TH
HOURLY
IV FLUID NS-125ML/HR
INJ SODIUM VALPROATE 1GM IV BD
INJ CLEXANE 40MG SC/B0
INJ NEOMOL IMG IV/SOS IF TEMPERATURE MORE THAN 101F
T PCM 650MG RT/SOS
INJ GLYCOPYRROLATE 1 MG IWSOS
SYP POTKLOR 15 MLRT/TID
TPCM 650MG RT/SOS
INJ GLYCOPYRROLATE 1 MG MSOS
SVP POTKLOR 15 MLRT/TID
TCITICHOLINE 500MG RT/BD
TDONEP-M RTBD TAMAN TAX 100MG RT/BD
NEBUUSATION WITH IPRAVENT, MUCOMIST 4TH HOURLY
NEOSPORIN POWDER AND BED SORE DRESSING
HOURLY SUCTIONING
EYE CARE FREQUENT POSITION CHANGE AIR BEDDING
STRICT VO CHARTING
BP PRRR SPO2 MONITORING HOURLY
GRES MONITORING 2ND HOURLY TEMPERATURE MONITORING 2ND HOURLY
TAB BROMOCRIPTINE 2.5MG RT/BD
CHEST PHYSIOTHERAPY
UPPER LIMB LOWER UMB PHYSIOTHERAPHY
Advice at Discharge
RYLES FEED200ML WATER 4 HOURLY 200ML MILK +2 SCOOPS PROTEIN POWDER - 4TH
HOURLY
SODIUM VALPROATE 1GM PO BD TILL ADVICED TO STOP
T.PCM 650MG RT/SOS
TAB CITICHOLINE 500 MG RT/BD
T DONEP-M RT/BD
TAMANTAX 100MG RT/BD
NEOSPORIN POWDER AND BED SORE DRESSING
HOURLY SUCTIONING
EYE CARE FREQUENT POSITION CHANGE AIR BEDDING
NEB WITH MUCOMIST 4TH HOURLYIPRAVENT 6TH HOURLY
CHEST PHYSIOTHERAPY
UPPER LIMB LOWER UMB PHYSIOTHERAPHY
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