30 years old female patient came by have .ca breast Mastectomy done 6days back in my hospital This is the specimen which had collected and send for HPE After 4th pod patient develop sudden onset of sob and desaturation Patient incubated connected to mechanical ventilator Still patient chest not clear And cardiologist done 2decho in that Global hypokynesia With sever lv dysfunction Doctors please what is the further management What is your suggestion


This is an eye opener in that in all major surgeries, a pre-operative cardiologist consultation should be sought. and thing detected should be rectified before proceeding to surgery. IN this case pulmonary embolism is suspected. The events may not be related to surgery but a pre - existing cardiogenic lesion must have been missed

Young patient needing MRM...has been aggressive tumour...may have recieved NACT...it could be chemo induced cardiotoxity which went undiagnosed and got exacerbated due to surgical stress. Though hypercoagulable state due to chemo and otherwise also needs to be ruled out. DVT lower limba also needs to be ruled out. And also whether the patient had a chemo port in place and could that catheter tip hv been a source of thrombus

Sir the specimen is in adequate, have yo done axillary dissection??? The cardiologist would itself have given a good managed plan. Why intubtion ? What mode of ventilation the patient is at present? If she is tried to wean??? Update status

Madam patient develop sob Desaturation Develop pulmonary odema We done ABG co2 levels increses in alkalosis Connected to ventilator present in Simv with pre sure support And doing maintainers ABS Our intensist wean but patient not tolerate Today evening try to spontinous mode Pt not tolerate Still chest not clear

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Agree with Dr. Parveen

I agree with Dr Praveen yograj

Continue with ventilatory support and diuretics.consult cardiologist for improvement of lv dysfunction

Any cardiac history in past.

No sir
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