55 years old female c/o pain in left shoulder and upper abdomen

55 years old female c/o pain in left shoulder and upper abdomen since 4 days c/o nausea since 4 days 

Pt was apparently normal one week ago 

Then she developed fever intermittent type relieved on medication not associated with chills and rigors 

Pain in left shoulder which is graduall in onset, progessive, restriction of shoulder movements 

Upper abdomen pain - pain gradual and progressive.

No h/o trauma are excessive load of left arm 

K/c/o htn and on regular medication 

On examination 

Pt is c/c/c 

General condition fair 

Afebrile 

Bp-140/90 mmhg 

Pr-86bpm 

Spo2- 99%

L/E -

Left shoulder skin normal 

No swelling 

No local rise temperature 

Tenderness present diffuse movements restricted and painful 

Per abdomen 

Skin normal , no swelling 

On palpation tenderness present in rt hypochondriac region 

Cvs-s1s2 heard no murmurs 

Rs- nvbs , BAE present 

CNS- NAD.

Diagnosis: pericardial effusion.cardiac tamponade- s/p pericardiocentesis ?metastasis

Treatment 

Day1 

Inj. Tramadol 1 amp in 100 ml ns/iv/oD 

T. Hifinac-p po/Bd 

T. Pan 40 mg po/od 

Day-2 

Inj. Optineuron in 100 ml ns /iv/ od 

Inj. Tramadol 1 amp in 100 ml ns /iv/ BD 

Tab. Pan 40 mg po/od 

Tab. Zofer 4 mg po/ sos 

Day 3 

Subjectively pt c/0 pain in lumbar region 

Was unable to getup from bed 

Tab. Tramadol po/od 

Inj.optineuron 1 amp in 100 ml ns iv 

Tab. Pcm 650 mg po tid 

Inj. Zofer 4 mg iv bd 

Tab. Ultracet PO QID 

IN THE evening pt there’s a drop in patients saturations 

And was intubated around 6:00 pm 

Later at 9:00 pm pericardiacentesis is done after taking high risk consent 

Procedure 

Under aseptic procedure pt chest is cleaned with betadine under 2d echo guidance 16 G needle is inserted and 60 ml of pericardial fluid is drained and bp, pulse and spo2 was increased after procedure 

Pr-104 

Bp- 150/90 mmhg 

Spo2-87% with 6 lit of oxygen 

Day4 

O2 inhalation 6 lit 

Tab. Ultracet 

Tab. Zincovit od 

Monitor vitals