COVID 19 Pneumonitis in elderly female

72 years old female with history of Cough with hemoptysis single episode, fever n dyspnoea on exertion for 5 days. On admission Saturation was 90% on air With O2 via NC 2L/MIN SPO2~96% Temp 99 Pulse 60/min BP 110/70 RS shows bilateral basal crackles CVS S1, S2 normal No murmur Blood investigations reveal:- N/L ratio 6 CRP 101 Creatinine 1.51 SGPT 100 ABG showed pH 7.3 PO2 69 PCO2 32 BICARB 17 RT PCR for SARS COV-2 is Positive Chest X ray PA is shown below Kindly discuss further management plan including stage of disease.


X ray chest shows bilateral lungs ground glass pattern - prominently seen in middle and lower lobe - it is typical of COViD 19 This patient has mild Hypoxia, raised CRP lymphopenia which indicate that he has severe disease Immediate target is to get oxygen saturation to normal, in this patient target was achieved by simple oxygen by mask Non invasive ventilation is next in line, if oxygen saturation do not improve IV antibiotics can be given if there is leukocytosis, which indicates infection Antiviral drugs role are debatable, none antiviral available to date has been proven to be effective Strict control of blood sugar - is single most important factor which can make significant improvement in this patient. I would prefer to use Glargine insulin which is looking acting insulin for control of blood sugar in critically ill patients Steroids to be considered in case oxygen saturation do not improve - as a part treatment of cytokine Strom Steroids cause increased blood sugar, hence patients in steroid will need higher dose of insulin treatment
Covid19 positive is concomitant with xray chest suggest ground glass appearance with floppy swellings likely pulmonary oedema Pt is maintaining 02 saturation but since aged one any time can collapse hence oxygenation to be continued Inj azithromycin Inj dexamethasone Bronchodilators Inj lasix And go for D-dimer and sr ferritine As CRP IS HIGH likely to land in DIC Follow protocols
Thanx dr Akansha Gupta

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Tnx Dr Shivraj Agarwal sir

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