Brugada Group 6 Ateneo School of Medicine and Public Health.

BrugadaBrugadaGroup 6

Ateneo School of Medicine and Public Health

HISTORYHISTORY

MS 25 years old Male Filipino Roman Catholic Pasig City Informant: Self Reliability: Very Good

General DataGeneral Data

Loss of consciousness

Chief ComplaintChief Complaint

30 minutes PTA Riding a motorcycle with companion Chest discomfort described as tightness, diffuse, non-

radiating, 6/10 severity with associated dyspnea lasting 30 seconds

Stopped bike on sidewalk where vision dimmed Loss of consciousness lasting 2 minutes No headache, vomiting, dizziness, weakness,

numbness No stiffening of extremities or drooling

History of Present IllnessHistory of Present Illness

28 minutes PTA Pt regained consciousness, was diaphoretic Chest pains continued Was picked by a serendepititiously located

RedCross van and rushed to TMC

History of Present IllnessHistory of Present Illness

General◦ (-) Fever, (-) Weight changes, (-) Fatigue

Musculoskeletal/Dermatologic◦ (-) Itching, (-) Muscle/joint pains, (-) Rashes

HEENT◦ (-) Vision/hearing problems, (-) Epistaxis/gum bleed,

Respiratory◦ (-) Hemoptysis, (-) Cough, (-) Wheezing

Review of SystemsReview of Systems

Cardiovascular◦ (-) Orthopnea, (-)PND

Gastrointestinal◦ (-) N/V, (-) Dysphagia, (-) Heartburn, (-) Change in bowel

habits, (-) Rectal bleed, (-) Jaundice Genitourinary

◦ (-) Nocturia, Dysuria, Frequency, Hematuria Endocrine

◦ (-) Heat intolerance, (-) Polyuria, (-) Excess thirst, (-) Cold intolerance

Review of SystemsReview of Systems

Nonspecific abnormal ECG, 2008 For pre employment Initially diagnosis unrecalled ECG repeated which turned out normal

Head trauma, January 2010 Sustained while lifting machinery Causing bleeding, necessitating stitches No loss of consciousness, vomiting, or

neurological sequelae

Past Medical HistoryPast Medical History

(+) Asthma, father's side (+) Hypertension, father's side (+) Myocardial infarction, father's side (+) DM, mother’s side (+) Stroke, mother’s side (+) Leukemia, mother's side (-) PTB, Kidney Disease

Family HistoryFamily History

College graduate Systems developer Cohabiting, no children Current smoker (2 pack years) Occasional alcohol beverage drinker (3 / month

max 3 bottles) No history of illicit drug use

Personal/Social HistoryPersonal/Social History

PHYSICAL EXAMINATIONPHYSICAL EXAMINATION

General◦ Alert, coherent◦ Height 166 cm, Weight 68 kg, BMI 24.7

Vital Signs◦ BP 110/80, HR 88, RR 19, T 37.1 C

Skin◦ pink, no rashes/scars/lesions

Physical ExaminationPhysical Examination

HEENT◦ Normocephalic◦ Anicteric sclerae, Pink palpebral conjunctivae◦ Moist pink lips, pink buccal mucosa◦ (-) Nasal discharge, (-) facial tenderness◦ (-) TPC, (-) CLAD, non distended neck veins

Physical ExaminationPhysical Examination

Respiratory◦ Symmetric chest expansion◦ Resonant chest wall◦ (-) Rales, rhonchi, wheezes

Cardiovascular◦ PMI 5th ICS LMCL◦ Normal rate, regular rhythm◦ Distinct S1 and S2, (-) Murmurs

Physical ExaminationPhysical Examination

Abdominal◦ Flat abdomen◦ Normoactive bowel sounds◦ Tympanitic on percussion◦ No tenderness on light and deep palpation◦ No organomegaly

Extremities◦ Full and equal pulses◦ CRT <2s , no cyanosis

Physical ExaminationPhysical Examination

Neurologic◦ Cranial Nerves intact◦ Motor 5/5 on upper and lower extremities◦ Sensory - no deficits

Physical ExaminationPhysical Examination

CBC Electrolytes Thyroid Function Tests CKMB, CKMM, CK Total PT, PTT Creatinine, Uric acid, Lipid Profile

CBG: 97

Diagnostics Diagnostics

PEFR MeasurementsPEFR Measurements

Nebulization Best PEFR Percent Best (350)

Pre 250 200 200

71 %

1 250 240 250

71%

2 250 250 250

71%

3 300 250 300

86%

PARAMETER RESULT NORMAL VALUES

Hgb 162 115-135 g/L

Hct .49 0.36-0.47

RBC 4.2-5.4

WBC 10.2 4.5 - 10 x 10^9/L

PC 253 140 - 400 x 10^9/L

Differential

Neutrophil .71 .56-.66

Lymphocyte .26 .22-.40

Monocyte .04-.08

Eosinophil .01-.04

Complete Blood CountComplete Blood Count

PARAMETER RESULT NORMAL VALUES

Na 141

K 3.0

Mg 1.85

Ca 5

Creatinine .84

Uric acid 6.61

APTT 28.8 31.2

PT 13.4 13.3

PTT

Blood ChemistryBlood Chemistry

PARAMETER RESULT NORMAL VALUES

CK Total 337.2

CK MM 304.7

CK MB 32.7

Trop T Negative

TSH 3.4

FT3 3.01

FT4 1.22

Blood ChemistryBlood Chemistry