78 year old electric shock Pt

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Here is a case i have seen:

78M with electric shock and fractures

78 year old pt presented with complaints of  inability to mover upper limb and lower limb since 4 days ,altered sensorium since two days, slurred speech since two days,  
Patient was apparently asymptomatic 3 days back, then he had an electric shock injury due to contact with damaged switch following which he fell down on left side. 
Attenders denied the history of head injury, loss of consciousness, seizures, bleeding through orifices. Following shock he developed slurring of speech which is progressed to only sounds with in 2-3hrs with gradual deterioration of sensorium within 1 day while under the treatment. 
Patient attenders denied the history of fever, cough, SOB, pedal edema, palpitations. 
On evaluation for h/o fall and inability to move left upper and lower limb the xray was taken which shows ? Intertrochantric fracture and  ? Fracture surgical neck of humerus displaced. 
Pt is known smoker since 30years 
And chronic alcoholic since 20-30 years. 

O/E :
Pt drowsy but Arousable
GCS 10/15 (E4V2M4) 
BP - 130/70
Temp : Febrile (100.4 F)
PR - 106bpm
SpO2 =88 at room air

CVS - S1 S2 +
           JVP normal 
         No murmur heard

RS - decreased air entry on left side. 

P/A - soft and non tender

CNS - drowsy. 
            Tone and power in Rt upper limb is normal    and left limbs did not tested due to fracture. 
Biceps ++      ++
Triceps   +         +
Knee     -          -
Ankle    -          -
Plantar  mute     mute

Investigations  : 
CBP
Hb 4.9 (anemia) 
TLC 5800
Hct - 15.6
Mcv 67.2 ( micro
Plt 82000 ( thrombocytopenia) 

RFT 
Urea 45
Creat 0.8
UA 4.9
Na 140
K 3.9
Cl 104

CUE
Albumin trace
Sugar NIL
Pus cells 3-4
Epithelial cells 2-3
RBC Nil

LFT 
Tb 1.18
Db
AST 86
ALT 38
ALP 263
TP 5.0
sr Albumin- 2.9 (hypoalbuminemia) 
A/G - 1.38


ECG at 2 pm on 7/12/2020

ECG at 7 pm on 7/12/2020



ECG at 8am on 8/12/2020




atient was taken to ophthalmologist 
0/E patient has SMC in right eyes and IMSC in left eye.

Patient was referred to orthopaedic there he was diagnosed with fracture of left surgical neck of humerus and  fracture of left basicapita neck of femur 

DIAGNOSIS: DELIRIUM 2 TO ELECTRIC SHOCK
With RT HEART FAILURE 2 TO COPD. WITH Lt LOWER LOBE CONSOLIDATION  AND art. UPPER LOBE ATELECTASIS FRACTURE  LT SURGICAL NECK OF HUMERUS AND FRACTURE LEFT BASICAPITAL NECK OF FEMUR.



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