58M heavy smoker since 30yrs. with c/o mild breathlessness, decreased urine output, cough, pedal edema since 1week. spo2 80 RA on admission now 96% aftr O2 supp. bp 120/80, No tachypnea or tachycardia. cvs Nad, Rs decreased BS right side. crepts+. kindly Discuss ECG n CXR. and probable DX. how to manage the cass


History suggests hypoxemia with normal rate of respiration peculiar of COPD. SpO2 has been corrected by giving oxygen is suggestive of parenchymal lung disease. Although you have not sent the value of PAO2-PaO2 value. ECG suggests low voltage with LAEnlargement. With septal wall ischaemia. X-ray suggests right sided pleural effusion. No history of fever. Exclude LVF by echo. Do MxT test and aspirate pleural fluid for for biochemical and cytologycal examination. At present whatever you are giving is correct . Prefer to add small dose of oral diuretics. If you do ABG at present the combined effect on breathlessness can also be separated.
thankyou 4 ur valuable explanation sir. but u didnt mention about pedal edema and decreased urine output

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Septal and lateral wall ischaemia with pleural effusion right, advised pleural tapping,AKT and cardiac profile.
X Ray shows Rt. Side pleural effusion. ECG is normal considering long history of smoking. Pedal oedema is not uncommon in COPD patients. This may be partly due to Rt side heart failure and partly due to hypo protein . Low urine out put is due to water retention. Rx 1 pleural tapping for testing. 2 CBC , renal and liver profile. 3 nebulisation, oxygen, 4 Prednisolone 10mg tds 5 Amoxy clev 625 tds. 6 ATT. Most likely it is a case of tubercular effusion and should be treated accordingly.
Looks like right plural effusion with underlying lung collapsed ( shud look for malignancy ) Require ct-scan chest and plural tapping Ecg low voltage could be associated pericadial effusion ? Or just because of plural effusion Require 2decho
First do fasting c peptide levels, ghba1c.if cpeptide levels r low.do gad anti bodies, start rx with insulin mix tard. start with 0.5iu /kg
EKG may be S1S2S3 syndrome Rt Vent preponderance, Rt Pneumothorax,treat conservatively on line of COPD
it's cc f with pleural effusion look for signs of right side heart failure it may cause effusion
pleural effusion rt.chf
4dx according to x ray right sided pleural effusion with straightening of left heart border that is suggestive of mitral stenosis . while breathlessness without tachypnea seems ridiculous.. what about the patient physical activity profile..? NYHA Grade? rx 1. ceasation of smoking must 2.diuretic thaizide may relief symptoms 3.deriphyllin 100mg od 4.drainage and examination of pleural fluid. 5.surgical intervention for mitral valve stenosis.
I hv one pt having high sugar nearly 550rbs what the best treatment and he is 20 yrs old newly diabetic other reports r normal shall I start insulin r metformin plz let me know
start with tab metformin500 be advice fasting postmeal sugar then adjust the side accordingly

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