In Context Case Summaries Profile of Adult Patient Cases pages 2-37


Profile of Paediatric Case 00-011



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Profile of Paediatric Case 00-011


Case summary

Age: 8/12 Gender: Male

Diagnosis: Purpuric rash vomiting – treat as meningococcal infection

Length of stay: 6 days

GENERAL SUMMARY OF CASE:-

Admitted via A/E with a history of vomiting for 6 hrs and purpuric rash on right leg. Rash spreading. (Has been in contact with his cousin who is at present in hospital with meningococcal infection).

Treatment given was IV antibiotics, referral to public health.

Discharged following a good response to IV antibiotics. Outpatient’s appointment and hearing test arranged on discharge



Profile of Paediatric Case 00-064



Case summary

Age: 20/12

Gender: Female

Diagnosis: Croup

Length of stay: 9 hrs

Admitted following history of coughing overnight and febrile.

Previous admissions: Croup aged 1 yr; Vomiting age 18/12.

Born at 30wks gestation – caesarean section for pre-eclampsia. Whilst on the ward queried to have had a febrile convulsion, temperature 39°C. Anti pyretic treatment given.

Discharged home within the evening due to being apyrexial for 7 hrs. 24hrs open access to the ward permitted.

Profile of Paediatric Case 00-068


Case summary

Age: 6/52

Gender: Female

Diagnosis: Purpuric rash

Length of stay: 4 days

6/52 old baby girl admitted with non-blanching rash, otherwise well.

Commenced antibiotics IV until all results obtained. IV antibiotics given for 48 hrs. Heart murmur noted on physical examination. To be re-assessed in clinic 6/52 following discharge.

Rash subsided and discharged home 4 days following admission.


Profile of Paediatric Case 00-069



Case summary

Age: 2 Years old

Gender: Male

Diagnosis: Asthmatic attack

Length of stay: 2 days
General Summary of Case:

Two year old boy admitted with wheeze – known asthmatic who normally requires Ventolin daily. Mother has not given Ventolin due to having none available.

Admitted for regular Ventolin, chest x-ray and observation.

Condition improved and discharged home with Ventolin and an out-patient appointment.


Profile of Paediatric Case 00-070



Case summary

Age: 5 years old

Gender: Boy

Diagnosis: Epileptic Convulsion

Length of stay: 1 day

General Summary of Case:

Admitted following status epilepticus (40 mins). He is a child who is known to have epilepsy. He has hydrocephalus with a ventricular peritoneal shunt in-situ. Fits are normally right sided only. He was given diazepam PR in ambulance. Post-ictal on arrival to hospital.

No focus for fit established. VP shunt working well. Medication – Epilim (anti-convulsants) reviewed and dosage changed.

Discharged home following 24 hours admission.

Profile of Paediatric Case 00-071


Case summary

Age: 4 years old

Gender: Male

Diagnosis: Unexplained purpuric rash. ? Meningococcal infection – treat as such

Length of Stay: 6 days

General Summary of Case:

4 year old boy admitted with an unexplained purpuric rash. The child was generally well, afebrile but rash extending. Decision was made to treat as a meningococcal infection. Antibiotics given for a period of 5 days. Public Health informed. Discharged home on Day 6. No previous medical history. All immunisations up to date.


Profile of Paediatric Case 00-072



Case summary

Age: 10 years old

Gender: Female

Diagnosis: Abdo pain

Length of stay: Two episodes of care: Day 1 - Day 2, 1 day.

Re-admitted Day 4 – Day 5, 1 day.

General Summary of Case:

First episode of care – fell off a horse and sustained injury to left flank. Complaining of abdo pain and vomiting. Ultrasound performed – normal. Urine blood +++ protein ++. Discharged following 24 hrs of care.

Second episode of care – re-admitted after continuing to vomit – dehydrated on admission – commenced intravenous fluids – repeat renal scan normal treated with analgesia. Urine specimen sent. All results were negative – discharged home – seen in clinic following day – looked well – no further vomiting.

Profile of Paediatric Case 00-074



Case summary

Age: 6 years old

Gender: Female

Diagnosis: Encephalitis? Epilepsy

Length of stay: 11 days

General Summary of Case:

Six year old girl admitted following generalised fitting movements. She required treatment for the seizure - Diazepam; Lorazepam; Paraldehyde and Phenytoin. She was intubated and ventilated for 24hrs.

Showing raised WCC – commenced on Cefotaxime and Aciclovir. CT scan was normal.

Previously fit and well prior to admission – mother has epilepsy, well controlled.

Discharged home following 11 days of treatment. Out-patients appointment given on discharge.


Profile of Paediatric Case 00-076


Case summary

Age: 2½ years old

Gender: Male

Diagnosis: Viral upper respiratory tract infection – leading to febrile convulsion.

Length of stay: 1 day

General Summary of Case:

2½ year old boy admitted via A&E following 2 febrile convulsions. Associated pyrexia.

24hr history of being ‘snuffly’ – not eating on day of admission.

No previous admissions, but previously anaemic. Awaiting surgery for hypospadias. On admission - pyrexia, throat red, tonsils enlarged. Small blanching pin-point spots on right calf.

Discharged 24hrs following admission. Medication on discharge Paracetamol, Brufen and Difflam. Parents given advice and written information regarding febrile convulsions.



Profile of Paediatric Case 00-078



Case summary

Age: 6 years old

Gender: Female

Diagnosis: Fractured radius and ulna

Length of stay: 5 days

General Summary of Case:

6 year old girl admitted via A&E following a fall from a bench.

On admittance complaining of pain in right forearm. Diagnosis – fractured radius and ulna.

Prepared for theatre – underwent a general anaesthetic for manipulation of fracture.

Discharged home – follow-up arranged.



Profile of Paediatric Case 00-084


Case summary

Age: 9 years

Gender: Male

Diagnosis: Acute exacerbation of asthma? Aspiration

Length of stay: 2 days

General Summary of Case:

Nine year old boy admitted with acute exacerbation of asthma. ? Aspiration.

Previous history – diagnosed with cerebral palsy at the age of 8/12. Frequent hospital admissions due to chest infections.

This episode of care was for 2 days in length. Wheezy on admission requiring Salbutamol hourly. Commenced Prednisolone. O2 to keep saturations above 92%.

No temperature. Chest x-ray - bilateral wheeze – commenced antibiotics.

Discharged home with Salbutamol via spacer, antibiotics and follow up appointment.

Profile of Paediatric Case 00-085



Case summary

Age: 8 yrs

Gender: Male

Diagnosis: Grade 3 supracondylar Fracture (L) humerus

Length of stay: 1 day [plus readmission x 1 day]

General Summary of Case:-

Eight year old boy admitted at 21:10 hours with a painful left elbow.

No past medical history

O/A (L) elbow was swollen and bruised. He had a good radial pulse and there was no sensory loss.

He went to theatre where he had manipulation and k wiring. A backslab was placed in situ and he was discharged the following day with a weeks follow up appointment.



Profile of Paediatric Case 00-086



Case summary

Age: 16/12

Gender: Male

Diagnosis: Viral induced wheeze

Length of stay: 5 days

General Summary of Case:-

16/12 old boy admitted with a viral induced wheeze.

No previous hospital admissions.

Born at 34 weeks SCBU for 2 weeks – no specific problems identified.

This episode of care was 5 days in length. Drinking well but not eating. Wheezing – required intermittent O2 when O2 sats dropped below 94%? Sleep apnoea

Responded well to Prednisolone, Ventolin and a course of antibiotics.

Discharged home with PRN Ventolin and an outpatient’s appointment.



Profile of Paediatric Case 00-087


Case summary

Admitted via A&E following a fall at home down some concrete steps.

No history of loss of consciousness or vomiting. Skull X-demonstrated a fracture in the occipital area. Child also had a right haemotympanium and # right temporal bone. Known to have grommets fitted and referred to ENT for an opinion and advise on continued management.

Four hourly neurological observations were unremarkable and remained stable throughout his four day in-patient stay. Discharged home on day four with Augmentin 250mg TDS for a further seven days.

Unfortunately the multidisciplinary notes scanned so badly they were largely undecipherable as we could not verify there accuracy they were rejected.


Profile of Paediatric Case 01-072



Case summary

Age: 10 years old

Gender: Female

Diagnosis: Abdo pain

Length of stay: Two episodes of care: Day 1 - Day 2, 1 day.

Re-admitted Day 4 – Day 5, 1 day.

General Summary of Case:
First episode of care – fell off a horse and sustained injury to left flank. Complaining of abdo pain and vomiting. Ultrasound performed – normal. Urine blood +++ protein ++. Discharged following 24 hrs of care.

Second episode of care – re-admitted after continuing to vomit – dehydrated on admission – commenced intravenous fluids – repeat renal scan normal treated with analgesia. Urine specimen sent. All results were negative – discharged home – seen in clinic following day – looked well – no further vomiting.



Profile of Paediatric Case 01-112



Case summary

Female aged 16 years

Admitted for 11 days

Presented with loose stools with blood present, wt loss, abdominal pains, awaiting sigmoidoscopy

Diagnosis Ulcerative colitis

Had blood transfusion, MRI and Flexible sigmoidoscopy

Sat GCSEs while in hospital

Follow up in OPD in 3 weeks



Profile of Paediatric Case 01-117


Case summary

Female aged 41/2 weeks

Admitted from home via the GP

Presents with Pyrexia of unknown origin and lethargy for 24 hrs

Inpatient for 5 days

Parents initially refused lumbar puncture

Given bolus and intravenous antibiotics

Diagnosis viral infection

Discharged without follow up


Profile of Paediatric Case 01-119



Case summary

Male aged 12 ½ years

Presented with herpetic skin lesions, underlying cellulitis and tracking from right hand towards right auxilla

Diagnosis recurrent herpes and thrombophlebitis treated with IV anti-virals and antibiotics.

Follow up at paediatric out patients department 4-6 weeks

Re-referral to regional immunology clinic



Profile of Paediatric Case 01-120



Case summary

Male aged 4 days

Presented with 14% weight loss and jaundice

Referred by midwife

Close inter-professional working with midwives throughout care.

Discharged home to midwife for review and weight monitoring at home


Profile of Paediatric Case 01-121



Case summary

Female aged 4 days

Presented with 12% weight loss, sleepy and jaundiced

Breast fed with top ups

Close inter professional co-operation

Discharged to care of midwives for review and weight monitoring


Profile of Paediatric Case 01-122



Case summary
Female 9 months

Admitted for 24 hours


Presented at A&E following a fall from bed to floor the previous night with boggy, bluish discoloured swelling to left parietal area.

Diagnosis

Left parietal bone fracture not depressed and moderate head injury. Admitted for 2-4 hourly neuro observations. Discharged home, no follow up.



Profile of Physiotherapy Case 01-131



Case summary

This 41 year old male was referred from his GP with a complicated history of left scapula pain radiating to the anterior chest wall and pain and parasthesia in the posterior aspect of the left arm. The patient had no relief from non steroidal anti inflammatory drugs, but a recent change of medication to gabapentin was helping to ease symptoms.

History had initially involved a rear end shunt RTA eleven months previously, current symptoms had commenced with no added mechanism of injury four months prior to assessment.

Main findings on examination included elevation of the left shoulder and a flattened thoracic kyphosis. There was poor scapula control on the left during eccentric movement of the glenohumeral joint. Neurological findings were normal. Multiple trigger points were present in trapezius and the scapula retractors. On palpation R1 was early and reproduced comparable arm parasthesia at T4/5. Palpation of R5 left costochondral joint reproduced the anterior chest wall pain.

A functional marker is used for assessment and reassessment.

Treatment consisted of manual trigger point release and mobilisation of the thoracic spine. Home exercise programme concentrated on scapula control and thoracic mobility.

The patient received four treatment sessions and experienced a full recovery.

Profile of Physiotherapy Case 01-132


Case summary

This 41 year old female was referred from her GP with a 2 week history of acute and severe lumbar and left sciatic pain.

Main findings on examination were reduction of the L5 and S1 myotomes and absence of the ankle jerk reflex bilaterally. Straight leg raise on the left was reduced to 30 degrees.

Most comparable joint findings were seen on palpation unilaterally at L5.

Clinical reasoning suggested a posterolateral disc bulge at L5/S1

Treatment consisted of joint mobilisation at L5/ S1, manual acupuncture for pain relief and exercises focusing on the McKenzie regime, core stability, and neural mobility.

A full recovery was made.

Profile of Physiotherapy Case 01-133



Case summary

This 36 year old female dance and PE teacher was referred from her GP with a three week history of pain and parasthesia in her left arm.

Main findings on examination included a full active range of movement at the glenohumeral joint, but with decreased scapula – thoracic control. Pain and parasthesia was reproducible on immediate cervical extension, cervical stability testing was normal. Dermatomes reflexes and myotomes were normal.

Comparable symptoms were reproduced by palpation unilaterally at C6.

Treatment consisted of mobilisation of the cervical spine, scapula stability exercises, mobilising exercises for the cervical spine and neural mobility exercises.

The patient received 7 treatment sessions and made a full recovery.



Profile of Physiotherapy Case 01-134



Case summary

This 54 year old female was referred via fracture clinic five weeks after sustaining a left fractured radius following a fall down stone stairs. As a professional musician regaining full function was imperative.

On initial examination all wrist movements were limited and grip strength was significantly decreased.

Treatment consisted of wrist mobilisations, home exercises and participation in a hand class.

After a course of eleven treatments the patient regained full functional movement and returned to her musical career.

Profile of Physiotherapy Case 01-135


Case summary

This 47 year old female was referred from the orthopaedic clinic with a deep laceration on the volar aspect of her right wrist following a fall through glass.

On initial assessment she had no active flexion at the distal DIP of her middle finger.

She was reviewed by orthopaedics and went on to have a flexor tendon repair. Post operative treatment followed the tendon repair protocol, but the patient went on to develop complex regional pain syndrome which was treated with acupuncture and TENS.

Profile of Physiotherapy Case 01-136



Case summary

This 31 year old male was referred with a six month history of neck pain and an additional three week history of arm pain and pins and needles

On examination the following were noted: myotomal weakness, decreased sensation in the C6 dermatome, absent triceps reflex and pain on palpation at C6, 7

The physiotherapist made a diagnosis of cervical disc bulge.

Treatment included, McKenzie exercises, TENS machine, and manual therapy.

The patient received 6 sessions of physiotherapy and made a good recovery.


Profile of Physiotherapy Case 01-137



Case summary

This fifty six year old female was referred to physiotherapy from the orthopaedic clinic with a chronic history of low back and hip pain.

Main findings on initial assessment were of limitation of hip movement in a capsular pattern bilaterally.

Treatment in the first instance consisted of home exercises and a course of hydrotherapy. This was followed by 6 sessions of manual therapy.

Some symptomatic relief was gained.

Profile of Physiotherapy Case 01-138


Case summary

This 28 year old female was referred to physiotherapy from occupational health with a one month history of back and right thigh pain.

Severity was at times 10 on the VAS scale and affecting work.

On initial examination SLR was reduced to 55 degrees on the affected side, L5 myotome was present but reduced. Reflexes were normal. Pain was reproduced on palpation at L5 and on lumbar flexion and extension.

Full recovery was achieved after 9 treatments.

Treatment consisted of manual therapy (Maitland, mulligan, MET) and exercises (McKenzie extension, core stability and neural mobility)

Profile of Physiotherapy Case 01-139



Case summary

This 56 year old male self referred to physiotherapy via telephone access with a six week history of cervical pain.

X ray showed severe degenerative changes and loss of bone density.

On examination side flexion and rotation to the affected side was restricted. Neurological examination was normal.

Treatment included exercises, manual therapy and acupuncture.

Significant symptomatic relief was achieved.


Profile of Physiotherapy Case 01-140



Case summary

This 63 year old female was referred following ORIF for a L ankle fracture.

On assessment although able to be FWB, the patient was non weight bearing and using a wheelchair.

Treatment of hydrotherapy and home exercises enabled the patient to become fully weight bearing and regain active movement, but pain remained a problem. A course of acupuncture was used for pain relief.



Profile of Physiotherapy Case 01-141



Case summary

This 54 year old female teaching assistant self referred to physiotherapy with a 6 month history of right Achilles tendon pain.

On examination the tendon Achilles was thickened and painful when palpated or put on a stretch.

Treatment consisted of soft tissue techniques and electrotherapy.



The patient made a full recovery.




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