14F Sikle cell tibial pain Telangana PaJR

14F with SLE

[7/15/2022, 12:31 PM] Dr Rakesh Biswas Sir Hod Gm Kam: @⁨saicharankulkarni⁩ @⁨Dr Vinay Gm Kam⁩ Can you check with admin PGs if our pharmacy is not keeping ranitidine. Didn't want to give her PPIs because of renal scare

[7/15/2022, 3:32 PM] pt advocate : Pyna unna mandulu vesina pain thagutaledu memu  general wardulo unnamu

[7/15/2022, 3:34 PM] Dr. NARSIMHA Jnr GM Kam: Naproxen Ye Time ki Vesaru ??

[7/15/2022, 3:58 PM] pt advocate: Mokalu pain thagutaledu

[7/15/2022, 3:58 PM] pt advocate: RR

[7/15/2022, 4:08 PM] Dr Rakesh Biswas Sir Hod Gm Kam: Alright @⁨Dr. NARSIMHA Jnr GM Kam⁩ Check her serum creatinine and give her injection Voveran im once now. Who will be looking after the wards at night? Please inform them

[7/15/2022, 4:22 PM] pt advocate: Mokalu pain akkuvaga unnaduna  adustunadi

[7/15/2022, 4:26 PM] Dr. NARSIMHA Jnr GM Kam: Ok Sir

[7/15/2022, 4:29 PM] pt advocate: Emergency lo chepinchani sir

[7/15/2022, 4:31 PM] pt advocate: Emergency lo chepinchani sir

[7/15/2022, 4:32 PM] Dr Rakesh Biswas Sir Hod Gm Kam: Dr @⁨Dr. NARSIMHA Jnr GM Kam⁩ Aakade wostaru.

If necessary AMC ward (emergency ward laga) aakade shift chestaru

[7/15/2022, 4:32 PM] Dr Rakesh Biswas Sir Hod Gm Kam: @⁨Dr Vanshi Gm Kam⁩ Please get her to AMC asap

[7/15/2022, 4:43 PM] pt advocate: Please sir pain thagutaledu

[7/15/2022, 4:44 PM] Dr Vanshi Gm Kam: Sir there is shortage of beds here

We need to shift someone to get her here

[7/15/2022, 4:44 PM] Dr Vanshi Gm Kam: Will look in to it sir

[7/15/2022, 4:44 PM] Dr Rakesh Biswas Sir Hod Gm Kam: Shift someone

[7/15/2022, 4:45 PM] Dr Rakesh Biswas Sir Hod Gm Kam: Go and check her out or send someone to check her now in the ward. We need one PG to be stationed in the ward

[7/15/2022, 4:46 PM] Dr Vanshi Gm Kam: I already saw her and given her Tab.naproxen sir

[7/15/2022, 4:46 PM] Dr Vanshi Gm Kam: Ok sir will adjust

[7/15/2022, 4:55 PM] Dr Rakesh Biswas Sir Hod Gm Kam: We gave that in the morning. 

I had asked her to be given injection Voveran im stat

[7/15/2022, 5:06 PM] saicharankulkarni: https://venkata-phaneendra.blogspot.com/2022/02/13-yr-f-with-sickle-cell-crisis.html

I hope this is the case we are discussing here..??

[7/15/2022, 5:07 PM] Dr Rakesh Biswas Sir Hod Gm Kam: Probably not. 

Please check her once

[7/15/2022, 5:08 PM] saicharankulkarni: Okay sir

[7/15/2022, 5:10 PM] Dr Rakesh Biswas Sir Hod Gm Kam: It's possible because she has had multiple pulmonary crisis before this. But this time it's polyarthritis which also happened to her only once earlier

[7/15/2022, 6:44 PM] saicharankulkarni: Same case sir. She came with pulmonary crisis last time.

[7/15/2022, 6:44 PM] saicharankulkarni: Given diclo and pt slpt comfortably now sir

[7/15/2022, 6:46 PM] saicharankulkarni: Ecg showing voltage criteria for LVH sir.

[7/15/2022, 8:18 PM] saicharankulkarni: Bones are the second most affected organs by SCD, after the spleen.

In a study conducted in Africa, the leading cause of emergency care of children with SCD was painful osteoarticular crises observed in 58.6% of the cases.(5)

The bone microcirculation is a common site for the sickling of red blood cells leading to thrombosis, infarction and necrosis.(7)

Chronic medullary hyperplasia due to bone marrow hypersolicitation caused by hemolysis causes bone alterations, as the expanded marrow spaces are filled by red marrow, which spreads through widened Haversian canals, invading the cortex and may extend to the periosteum.(6) This results in the thinning of the cortical bone, marrow space enlargement and diffuse and irregular trabeculation.

Clinically, patients complain of severe localized pain in one or more areas of the skeleton, which may be accompanied by edema and erythema in the infarction area. When the ischemia involves the epiphyses, there may be joint swelling, making it similar to septic arthritis.(4)

"Osteoarticular involvement in sickle cell disease" https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3459393/

[7/15/2022, 10:49 PM] Dr Rakesh Biswas Sir Hod Gm Kam: How is her pain now?

[7/16/2022, 5:19 AM] pt advocate : Diclofenac inje 5.30 pm vesharu thagginadi kani    1.30am nundi mokalu pain unnadi.

[7/16/2022, 5:34 AM] pt advocate: Pain Akkuva avuthunnadi

[7/16/2022, 6:38 AM] pt advocate: Genaral wardulo unnamu mokalu pain akkuvaga unnadi please sir

[7/16/2022, 7:24 AM] Dr Vinay Gm Kam: Giving voveran IM injection

[7/16/2022, 7:47 AM] Dr Rakesh Biswas Sir Hod Gm Kam: What is her serum creatinine? 

Also start her on tablet Ultracet half tablet four times daily

[7/16/2022, 8:17 AM] saicharankulkarni: For acute pain fentanyl patch would be help ful sir...?

[7/16/2022, 8:21 AM] Dr Rakesh Biswas Sir Hod Gm Kam: Yes but we don't know how long she will continue to need the patch, which is in limited supply. On the other hand low dose Tramadol may build her opiod levels gradually and once the pain subsides hopefully in a few days we can stop the low dose weaker opiod?

[7/16/2022, 11:07 AM] pt advocate: My report vachinaya sir

[7/16/2022, 12:16 PM] pt advocate: Bindhu Reports vachinda sir

[7/16/2022, 2:22 PM] pt advocate: Bindu reports cheppandi sir

[7/16/2022, 8:10 PM] saicharankulkarni: @⁨~Ramavath Govind⁩  ఎలా ఉంది ఇప్పుడు నొప్పి తగ్గిందా...??

[7/16/2022, 8:13 PM] Rajkumar Sir DAC Kam Rajkumar Sir DAC Kam: Excellent. Talking in telugu script is a unique thought.

[7/16/2022, 8:20 PM] saicharankulkarni: I feel that they understand and can communicate better in their own language than Telugu sir.

[7/16/2022, 8:23 PM] Rajkumar Sir DAC Kam Rajkumar Sir DAC Kam: I spoke to her father calling him to DAC today Prof. Rakesh Sir. Inspite of all this genetic difficulties his daughter is going through,he wants to get his daughter married to a person as part of consanguinity. I didn't understand how to explain him. He wanted to take our advice on this aspect. I know we don't have answer him, but to quell his insanity, how can we explain him? .

[7/16/2022, 8:34 PM] saicharankulkarni: I will find out weather genetic counsellor available on monday not if there il counsel first and then take him to genetic counselor on monday

[7/16/2022, 8:35 PM] pt advocate: Ultracet Mandu vesina kuda mokalu pain  vastunadi

[7/16/2022, 8:37 PM] saicharankulkarni: నిన్నటికి ఈరోజుటికి నొప్పి పెరిగిందా లేదా తగ్గిందా...??

[7/16/2022, 8:39 PM] +pt advocate: 50% thagginadi sir

[7/16/2022, 8:44 PM] Dr Rakesh Biswas Sir Hod Gm Kam: Will blood transfusion help to reduce the pain of this sequestration crisis?

[7/16/2022, 8:55 PM] saicharankulkarni: Adequate fluid management would be help ful sir...?? As she is in ward and I assume no IV fluids going to her

[7/16/2022, 8:55 PM] saicharankulkarni: గ్లూకోస్ బాటిల్లు ఏమైనా పెట్టారా...?

[7/16/2022, 9:11 PM] Dr Rakesh Biswas Sir Hod Gm Kam: Please discuss with the ward PGs @⁨Dr Shashikala Gm Kam⁩ and start

[7/17/2022, 1:40 AM] pt advocate: Glucose Battil   amipettaledu sir

[7/17/2022, 2:14 AM] pt advocate: Mokalu   pain assalu thagutaledu sir

[7/17/2022, 2:20 AM] pt advocate: Papa wakkate edusthunnadi pain undani

[7/17/2022, 5:03 AM] pt advocate: Pain Ekkuvaga unnadi sir

[7/17/2022, 6:48 AM] pt advocate: Pain inj Evandi sir

[7/17/2022, 6:58 AM] Dr Rakesh Biswas Sir Hod Gm Kam: @⁨Dr shilesh Med Kam⁩ @⁨Dr  Nishitha Gm Jnr Kam⁩ @⁨Dr Vinay Gm Kam⁩ @⁨Dr Shashikala Gm Kam⁩ Please check her and inform. Ensure proper analgesia and hydration. Requisition one packet of PRBC transfusion today

[7/17/2022, 7:12 AM] Dr Vinay Gm Kam: Ok sir

[7/18/2022, 6:19 AM] pt advocate: Night Blood Ekkichina pain thagutaledu

[7/18/2022, 6:20 AM] pt advocate: Mokalu pain

[7/18/2022, 8:16 AM] Dr Rakesh Biswas Sir Hod Gm Kam: @⁨Dr Vinay Gm Kam⁩ @⁨Dr Pavan Jnr Gm Kam⁩ How many injections Voveran did she receive yesterday? 

Did she take her tablet Ultracet half tablet four times yesterday? 

How much is her intake output yesterday?

[7/18/2022, 8:24 AM] Dr Vinay Gm Kam: Two injections were given sir yesterday.. 

Taking ultracet 1/2 QID

1000/800 is input output sir. 

Pain reduced by 40% sir

[7/18/2022, 8:35 AM] Dr Rakesh Biswas Sir Hod Gm Kam: Please ensure and intake of 2-3 lts and maintain adequate hydration and urine output

[7/18/2022, 8:35 AM] Dr Pavan Jnr Gm Kam: Okay sir

[7/18/2022, 8:53 AM] Dr Rakesh Biswas Sir Hod Gm Kam: Ask patient advocate @⁨~Ramavath Govind⁩ To help us to monitor her hourly intake output by sharing it here hourly

[7/20/2022, 6:21 AM] pt advocate: Decharge apudu chestaru sir

[7/20/2022, 7:46 AM] Dr Rakesh Biswas Sir Hod Gm Kam: @⁨Dr Vinay Gm Kam⁩ Please share the discharge summary in the case report link

[7/23/2022, 6:21 PM] pt advocate: Sir Bindhu matton thinavacha

[7/23/2022, 6:40 PM] Dr Vinay Gm Kam: Water manchiga thaaagipisthunnaraa??

[7/23/2022, 6:40 PM] Dr Vinay Gm Kam: Tablets??

[7/23/2022, 6:40 PM] Dr Vinay Gm Kam: Pain Ela vundhi?

[7/23/2022, 6:46 PM] pt advocate: Pain ledu sir thanks

[7/23/2022, 6:48 PM] Dr Vinay Gm Kam: @⁨Dr Rakesh Biswas Sir Hod Gm Kam⁩ he is asking whether she can have meat(lamb)for lunch/ dinner?? If yes how much amount she can take??

[7/23/2022, 6:49 PM] Dr Rakesh Biswas Sir Hod Gm Kam: Can take. 

Please ask him to share the images of her daily meals and her hourly activities

[7/23/2022, 6:50 PM] Dr Vinay Gm Kam: Mutton pettandi parledhu..  Kaani roju thine mundhu thanu em em food teeskunyundhi group lo photo pettandi mem thinaala vaddhu aa anedhi chepthaamu.. Alage em em chesthundhi chepthe inka ela improve cheyyachu anedhi chepthaamu

[7/23/2022, 7:33 PM] saicharankulkarni: ఎలా ఉంది మోకాలు నొప్పి

[7/23/2022, 7:46 PM] pt advocate : Pain ledu sit

[7/23/2022, 8:38 PM] Rajkumar Sir DAC Kam Rajkumar Sir DAC Kam: ఓకె వేళ నొప్పి వస్తే ఎట్లా కంట్రోల్ చేయాలో చెప్పిన

[7/23/2022, 8:41 PM] Rajkumar Sir DAC Kam Rajkumar Sir DAC Kam: Aa vidhanga practice cheyamani cheppandi

[7/28/2022, 1:19 PM] pt advocate: Mokalu pain  unnadi sir

[7/28/2022, 1:59 PM] saicharankulkarni: Ultracet veyandi full water taaginchandi

[9/24/2022, 4:34 PM] pt advocate: 

Pt ki Fiver And Headache Right hand pain sir

[9/24/2022, 5:01 PM] saicharankulkarni: ఎన్ని రోజుల నుండి...?

[9/24/2022, 5:02 PM] saicharankulkarni: ఇపుడు ఎల ఉంది....?

[9/24/2022, 5:20 PM] pt advocate: Nenaa  Fevar, today Headache,right hand pain

[9/24/2022, 5:23 PM] pt advocate: Today Fevar  sir

[9/24/2022, 5:24 PM] saicharankulkarni: ఎంత ఉంది..?? టెంపరేచర్ ..??

[9/24/2022, 5:56 PM] pt advocate: 100 vundi

[9/24/2022, 5:57 PM] pt advocate: Qq

[9/24/2022, 6:10 PM] saicharankulkarni: నీలు మంచిగా తాగించండి..

[9/24/2022, 6:10 PM] saicharankulkarni: Dolo tablet 4 సార్లు వేయండి

[9/24/2022, 6:10 PM] saicharankulkarni: తగ్గకపోతే రేపు తీసుకురండి

[9/24/2022, 8:10 PM] Dr Rakesh Biswas Sir Hod Gm Kam: దయచేసి ఆమె ఉష్ణోగ్రతను తీసుకోవడం కొనసాగించండి మరియు ప్రతి ఆరు గంటలకు ఇక్కడ మాతో పంచుకోండి

Dayacēsi āme uṣṇōgratanu tīsukōvaḍaṁ konasāgin̄caṇḍi mariyu prati āru gaṇṭalaku ikkaḍa mātō pan̄cukōṇḍi

Please continue to take her temperature and share it every six hourly with us here

[10/5/2022, 5:19 PM] pt advocate: Sir Bindhu cheken thinala, vadda. Fevar No

[10/5/2022, 5:23 PM] Dr Rakesh Biswas Sir Hod Gm Kam: 👍

[10/5/2022, 5:28 PM] saicharankulkarni: ఏం కాదు తినొచ్చు పండగ కదా

[10/5/2022, 5:28 PM] saicharankulkarni: దసరా శభాకాంక్షలు

[11/7/2022, 5:20 PM] +pt advocate: Mokalu pain Ekkuvaga undi sir

[11/7/2022, 5:21 PM] saicharankulkarni: ఏమైంది...? ఎన్ని రోజుల నుండి మళ్ళీ నొప్పి.....?

[11/7/2022, 5:26 PM] pt advocate: Today oftarnoon nunchi sir

[11/7/2022, 5:29 PM] Dr Rakesh Biswas Sir Hod Gm Kam: Please ask him to share her daily routine everyday since his last post

[11/7/2022, 5:31 PM] saicharankulkarni: దసరా తర్వాత నుండి పాప రోజు ఎం పని చేస్తుందో చెప్పండి..? రోజు వారీ దినచరియ..

[11/7/2022, 5:55 PM] +pt advocate Dasara nunchi daily school ki veluthundi sir

[11/7/2022, 7:09 PM] saicharankulkarni: హాస్టల్ లో నే ఉంటుందా..?? ఇంట్లో ఉంటుందా ..?? స్కూల్ ఐపోయాక ఇంట్లో ఎం చేస్తారు...?

[11/7/2022, 7:15 PM] +pt advocate: Home work chesukuntadi Entlo sor

[11/10/2022, 2:03 PM] saicharankulkarni: @⁨Dr Pavan Jnr Gm Kam⁩ please can u add our volunteer..

[11/10/2022, 2:04 PM] Dr Pavan Jnr Gm Kam: Ookay sir

[11/10/2022, 2:04 PM] saicharankulkarni: Please make me admin

[11/15/2022, 4:27 PM] pt advocate: Mokalu pain unmadi sir

[11/15/2022, 4:31 PM] pt advocate: Weeks ki two time pain sir

[11/15/2022, 4:32 PM] pt advocate: Eppudu akkuvaga unmadi sir

[11/15/2022, 5:18 PM] Dr Rakesh Biswas Sir Hod Gm Kam: @⁨saicharankulkarni⁩ Can you ask them to share their daily diet and exercise activities even when things are normal and not just when she has knee pains

[11/15/2022, 6:44 PM] saicharankulkarni: పాప రోజు చేసే రోజు వారి దినచర్య ను ఇక్కడ మెసేజ్ చేయండి

[11/16/2022, 9:00 AM] +pt advocate : Eppudu pain vastundi sir.mokalu

[11/16/2022, 9:01 AM] saicharankulkarni: చాలా రోజులు అయ్యింది ఒకసారి పాప ని హాస్పిటల్ కి తీసుకురండి చూడాలి. కామెర్లు ఏమైనా వచ్చాయా..?

[11/16/2022, 9:06 AM] +pt advocate: Kandlu pachaga unmlnnadi sir

[11/16/2022, 9:19 AM] saicharankulkarni: అయితే ఒకసారి తీసుకురండి.

[1/7, 4:03 PM] Dr. NARSIMHA Jnr GM Kam: ఎలా ఉన్నారు?

[1/12, 1:38 PM] saicharankulkarni: ఏమైనా ఇబ్బంది ఉందా..?

[3/15, 1:27 PM] pt advocate: Left, right mokalu pain

[3/15, 1:31 PM] saicharankulkarni: Eppati nundi ippudu..? Photo pettandi okasari.. kudurthy hospital ki randi ..

[3/15, 1:38 PM] pt advocate: Today nunchi sir

[3/15, 2:05 PM] pt advocate: Kim's Narketpally Hosptal vastnamu sir haliya nunchi

[3/15, 2:07 PM] saicharankulkarni: Eppudu ostunnaru...?

[3/15, 2:27 PM] pt advocate: Haliya nunchi kims   Hosptal Eppudu vastunamu sir

[3/15, 2:28 PM] +91 89788 89418: Inka emaina problems vunnaya

[3/15, 2:28 PM] +91 89788 89418: Joint pains kakunda?

[3/15, 2:28 PM] +91 89788 89418: Mokalu nopulu tho patu Inka emaina samasyalu gurinchi chepthunda

[3/15, 2:29 PM] +91 89788 89418: Jvaram emaina unda , fever?

[3/15, 2:37 PM] pt advocate: Joint pains undi,fever ledu sir

[3/15, 2:37 PM] +91 89788 89418: Ok

[3/15, 2:37 PM] +91 89788 89418: Stomach pain?

[3/15, 2:37 PM] +91 89788 89418: Vanthalu kani??

[3/15, 2:38 PM] +91 89788 89418: Eppudu start ayuindi?

[3/15, 2:42 PM] pt advocate: Stomach pain ,vanthulu kani ledu sir.back side pain

[3/15, 2:43 PM] +91 89788 89418: Ok ok

[3/15, 2:47 PM] +91 89788 89418: Eppudu kala reach avthari hospital ki?

[3/15, 6:52 PM] pt advocate: 5.00 pm kala reachavutamu sir

[3/15, 6:52 PM] pt advocate: Hosptal ku vachamu

[3/15, 7:44 PM] saicharankulkarni: Ela undi ippudu...?

[3/15, 8:02 PM] pt advocate : Mokalu pain unadi

[3/15, 8:14 PM] Dr Rakesh Biswas Sir Hod Gm Kam: Ippudu ward lo unnara? 

@⁨saicharankulkarni⁩ Please find out who has seen and adviced what about her knee pains and how is it now and share here asap

[3/15, 8:49 PM] saicharankulkarni: @⁨Dr Keerthi Jnr Gm Kam⁩ please update regarding her complaints, analysis, acute pain management here

[3/15, 8:53 PM] Dr Keerthi Jnr Gm Kam: she is complaining of pain in Bilateral lower limbs 

continues pain since 3 days no aggravation and relieving factors.

calf muscle tenderness is present bilaterally

peripheral pulses are present

as it is acute pain we are giving her tab.naproxen 250 mg and Inj.diclofenac IM now her pain has reduced sir

[3/15, 8:55 PM] saicharankulkarni: Please check for signs of Inflammation.. look for cellulitis or Vaso occlusive crisis..

[3/15, 9:25 PM] Dr Rakesh Biswas Sir Hod Gm Kam: Is it muscular or bony pain!

[3/15, 9:25 PM] Dr Keerthi Jnr Gm Kam: muscular sir

[3/15, 9:26 PM] +91 89788 89418: Sure she was  also complaining of lower back pain in the morning sir

[3/15, 9:27 PM] Dr Rakesh Biswas Sir Hod Gm Kam: Was that muscular or bony?

[3/15, 9:27 PM] +91 89788 89418: Sir she said near her tailbone

[3/15, 9:28 PM] Dr Rakesh Biswas Sir Hod Gm Kam: In sickle cell anemia can one see vaso-occlusive pain in muscles @⁨saicharankulkarni⁩ ?

[3/15, 9:28 PM] Dr Rakesh Biswas Sir Hod Gm Kam: Sounds bony

[3/15, 9:29 PM] +91 89788 89418: Sir in sickle cell anemia , vasocclusive pain can occur in the bones due to osteomyelitis/ osteonecrosis and the muscles crampy pain is complained of due to occlusion of small vessels.

[3/15, 9:29 PM] +91 89788 89418: Often times they are seen concurrently

[3/15, 9:40 PM] saicharankulkarni: In patients with sickle cell disease, recurrent vaso-occlusive crisis coupled with chronic tissue hypoxia manifest as various skeletal tissue changes, which include bone and bone marrow infarction, bone marrow hyperplasia, osteomyelitis, and secondary growth defects.17

[3/15, 9:40 PM saicharankulkarni https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4020897/

[3/15, 9:41 PM] saicharankulkarni: Not mentioned about muscle sir will review more

[3/15, 9:41 PM] Dr Rakesh Biswas Sir Hod Gm Kam: Occlusion of muscle vessels? Reference link with quote?

[3/15, 9:45 PM] +91 89788 89418: https://go.gale.com/ps/i.do?id=GALE%7CA123332706&sid=googleScholar&v=2.1&it=r&linkaccess=abs&issn=00384348&p=AONE&sw=w&userGroupName=anon%7E63e11fde

[3/15, 9:45 PM] +91 89788 89418: Abstract: Vascular occlusion is responsible for most of the severe complications of sickle cell anemia (SCA). The involvement of muscle and fascia is uncommon in SCA, but myonecrosis may occur in SCA crisis. The data accumulated in the literature is limited to only a few reports describing mainly adult patients presenting with severe muscular pain. We report a rare case of sickle myonecrosis and secondary involvement of an associated joint after a severe painful crisis in the left thigh.

[3/15, 9:46 PM] +91 89788 89418: Sir upon further review it's not exactly muscle vessels but rather microvasculature

[3/15, 9:46 PM] +91 89788 89418: Is what I could infer

[3/15, 9:47 PM] Dr Rakesh Biswas Sir Hod Gm Kam: But it's muscle microvasculature isn't it?

[3/15, 9:47 PM] +91 89788 89418: Yes sir

[3/15, 9:47 PM] +91 89788 89418: But it's not exactly mentioned anywhere so I wasn't sure

[3/16, 9:12 PM] pt advocate: Right mokalu pain akuvaga unadi sir

[3/16, 9:23 PM] Dr Rakesh Biswas Sir Hod Gm Kam: @⁨Dr Vinay Gm Kam⁩ @⁨saicharankulkarni⁩ 

No one presented her today? 

Who's presenting her tomorrow?

[3/16, 9:28 PM] Dr Vinay Gm Kam: @⁨~Shreeya⁩ has taken the case sir.. She will presenting her tomorrow sir

[3/16, 9:28 PM] saicharankulkarni: Few students have taken today sir.. they will present tomorrow and day after tomorrow

[3/16, 9:28 PM] saicharankulkarni: Given ultracet 1/2 tab.

[3/17, 8:31 AM] pt advocate: Pain,fevàr sir

[3/17, 8:33 AM] Dr Rakesh Biswas Sir Hod Gm Kam: @⁨saicharankulkarni⁩ Share her fever chart asap and ask the interns to share the charts of all patients in the 2017 and volunteers groups. 

Why is this process not happening inspite of 3 Year PG training? @⁨Dr Vinay Gm Kam⁩

[3/17, 8:43 AM] saicharankulkarni: Okay sir

[3/17, 9:09 AM] +91 83283 75666: Date of admission 15/3/23

Dr.Nikitha SR

Dr.Vamsi PGY3

Dr.Keerthi PGY2

Dr.Vivek PGY1

Dr.Prachethan PGY1

Dr.Sravya intern

Dr.Sathwik intern

Dr.Sofia intern

S 

Pain in both lower limbs

Fever spike present

O

Pt is C/C/C

BP:120/80mmhg

PR:78bpm

RR:16cpm

Temp:99.3F

CVS:S1S2 heard

RS:BAE+NVBS heard

P/A-soft,non tender

CNS:NFND

A

SICKLE CELL ANEMIA WITH?VASO OCCULSIVE CRISIS (EXTREMITIES) WITH CHOLELITHIASIS

P

IV FLUID-NS@75ml/hr

TAB.PENCILLIN 800mg PO

TAB.FOLIC ACID 5mg PO OD

TAB.SHELCAL 500mg PO OD

TAB.ECOSPRIN 75mg PO OD

TAB.HYDROXY UREA 1000 PO OD

TAB.NAPROXEN 250mg PO BD

INJ.TRAMADOL 1Amp in 100ml NS BD

INJ.PANTOP 40mg IV OD

INJ.ZOFER 4mg IV SOS

TAB. PCM 650 mg PO/SOS

[3/17, 2:46 PM] Dr Kranthi Jnr Gm Kam: Soft tender swelling noted with local rise in temperature. On right lower limb over tibial shaft

[3/17, 3:11 PM] Dr Rakesh Biswas Sir Hod Gm Kam: Good observation. 

Next step is X-ray or ultrasound?

[3/17, 4:17 PM] Dr Kranthi Jnr Gm Kam: Ultrasound showed findings s/o  superficial thrombophlebitis sir.

[3/17, 4:33 PM] Dr Rakesh Biswas Sir Hod Gm Kam: Would be great to have images of this clinico radiologic correlation

[3/18, 8:59 AM] Dr Satwik 17kam: Date of admission 15/3/23

Dr.Nikitha SR

Dr.Vamsi PGY3

Dr.Keerthi PGY2

Dr.Vivek PGY1

Dr.Prachethan PGY1

Dr.Sravya intern

Dr.Sathwik intern

Dr.Sofia intern

S 

Pain in both lower limbs

Fever spike present

O

Pt is C/C/C

BP:120/80mmhg

PR:78bpm

RR:16cpm

Temp:99.3F

CVS:S1S2 heard

RS:BAE+NVBS heard

P/A-soft,non tender

CNS:NFND

A

SICKLE CELL ANEMIA WITH?VASO OCCULSIVE CRISIS (EXTREMITIES) WITH CHOLELITHIASIS

P

IV FLUID-NS@75ml/hr 

Inj.TRAMADOL 1 AMP IN 100 ML NS BD 

INJ ZOFER 4MG PO SOS                  

TAB.PENCILLIN 800mg PO

TAB.FOLIC ACID 5mg PO OD

TAB.SHELCAL 500mg PO OD

TAB.ECOSPRIN 75mg PO OD

TAB.HYDROXY UREA 1000 PO OD

TAB.NAPROXEN 250mg PO BD

TAB.PANTOP 40MG PO BBF 

TAB.PCM 650MG PO SOS

[3/18, 7:16 PM] pt advocate: Pain thaguthledu sir

[3/18, 7:17 PM] saicharankulkarni: Fever emina unda..??

[3/18, 7:19 PM] pt advocate: Fevàr ledu sir.

[3/18, 7:36 PM] Dr Rakesh Biswas Sir Hod Gm Kam: Make the Tramadol and Naproxen tid for a day

[3/18, 7:38 PM] saicharankulkarni: Okay sir

[3/19, 2:34 PM] Dr Sneha Jr18 Kam: Ippudu nopi unda?

[3/19, 2:37 PM] pt advocate: Lytga nopi  undi sir.

[3/19, 2:38 PM] Dr Sneha Jr18 Kam: Fever

[3/19, 2:38 PM] Dr Sneha Jr18 Kam: ??

[3/19, 2:39 PM] pt advocate: Fevàr ledu sir

[3/19, 2:39 PM] Dr Sneha Jr18 Kam: Ok

[3/19, 2:47 PM] saicharankulkarni: Vaapu taggindha..?