42 y male Chronic smoker C/o breathlessness Worsening since last two hours Wheeze present bilaterally Air entry diminished rt side BP -140/90 Pulse - 156 Temp normal ICD placed Diagnosis ? Further management ?

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An intubated patient with RT pneumothorax and partial collapse of rt lung and mediastinal shift. Second cxr shows icd in situ with partial expansion of lung except the LL. Mediastinum has shifted back to the normal position. The ICD bag content s look like Anchovy sauce appearance, hence look for e/o ruptured liver abscess into RT pleural cavity as a cause for empyema. Adv USG abd HRCT thorax and upper abdomen Slow negative suction to icd with a suction bottle may help in expansion of the lung.
R Lower lobe Lung Abscess with Pneumothorax. There is no e/o fluid in the Pleural cavity.ICD showing purulent and haemorrhagic fluid collection means ICD is inside the Lung Abscess cavity. ABG shows ?Compensated Metabolic Acidosis. Suggested to continue ICD. Pleural fluid cytology for Malignant cells along with routine cytology needed.
There is right side pneumothorax with ICD , ET tube , Ryles tube in situ. There is lung abscess in the right lower lobe.( Amebic abscess ?) . The amoebic abscess treated with i.v. Metranidazole and other drugs.The wheeze to be treated with bronchodilators and mucolytics. (dt: 24/1/17).
Right sided pneumothorax with lung collapse. Lung expanded after icd insertion
Rt. Side pneumothorax
COPD
R pneumothorax c collapse lung. ICD lung expansion.
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Seems like right lower lobe lung abscess which has ruptured causing right pyopneumothorax.... Drained material should be sent for gram staining ,culture for pyogenic organisms besides culture for AFB. In the meantime patient should be treated with broad spectrum antibiotics besides anaerobic coverage..
Beside Pneumothorax, patient having Pneumonia (cap , if h/o previous prolonged hospitalisation and Antibiotics, Drug Resistance should be considered). CBC , Sputum Exam. GM Stain , fungal stain , C.S , recommended. Optimised AB therapy to avoid drug resistance and evidence based therapy if possible.
@Both sides pneumoniae,Chyavaprasavleh with Abhrakbhasm sahastrputi 2.5 gm,Shreengbhasm 10 gm,Vaikrant bhasm 10 gm,Laghumalini basant 2.5 gm,mixed well in Chyawanprash ,1 tsp bd with warm milk, Tab.Gesend 2 bd,after mael,For chuing tab.sinocold2-3 dayli or with warm water.
Can we add tankanbhasma in it sir?
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tension pneumothorax.... urgent icdt n work of spontaneos pneumothorax like malignacy...bullous rupture.... lung inflatiin exercise quite smoking will stop fither ling damage chest physiothwrapy... sos..antibiotics analgesics
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