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a 27 yr female , SOB grade 4 since 5 days,her hb is 6.7gms ,b/l pedal. edema, 2d echo was EF 45% ,RF positive, ESR 70 1st hour ,now she is on O2 inhalation through mask 3 lit,inj piptaz 4.5 gr and inj moxiflox,inj dexamethasone,inj pan 40, any modifications regarding medication and management, advised 2units PRBC,pleural taping was unsuccessful,??? thankyou
Dr. Polepally Praveen Kumar4 Likes43 Answers - Login to View the image
Pulmonary Hypertension with BVF. *Chief Complaints* A 46 yr old female attended Mopd with progressive SOB and productive cough since 1 month with pedal edema since 10 days. No associated fever,chest pain,palpitation,Hemoptysis,Diaphoresis,pain abdomen etc. She is K/C/O Hypothyroidism and Br Asthma. No H/O HTN,DM,Substance abuse. Normal Menstrual Cycle. General Examination normal except B/l pedal edema and prominent Neck veins. Systemic Examination- B/l Infrascapular fine crepts with occasional Ronchi. Routine Ix was advised. Pt attended Mopd with reports showing- CXR - increased CT ratio suggestive of Cardiomegaly with b/l lower zone opacity. Sputum C/S normal flora. Rest blood Ix normal. ECG - multiple VPCs. 2D ECHO- 1. LV function is mildly depressed with estimated LVEF of 45%. 2. IVS and apex are mildly hypokinetic. 3. Right Atrium & Left Atrium are dilated. 4. Right Ventricle is dilated. 5. Moderate Tricuspid Regurgitation. 6. Severe pulmonary hypertension with calculated RVSP of 65mmHg +RAP. 7. Mild Mitral Regurgitation, 8. Trivial Aortic Regurgitation. 9. No LA/LV clot or pericardial effusion. NT Pro BNP not done. Pt started on conservative treatment.
Dr. Ashutosh Chandan Dubey44 Likes115 Answers - Login to View the image
27 year old female , recently diagnosed with bronchial asthma and 8 months amenorrhea post delivery , presented to ER with sudden onset of grade 4 SOB today morning at 11:00 am with profuse sweating and abdominal discomfort , patient was apparently asymptotic till then Had h/o dry cough since 2 months No h/o vomitings, chest pain , giddiness ,loose stools , decreased urine output ,burning micturition One episode of bleeding per rectum in hospital On arrival Pt -Drowsy,arousable GCS-E3V4M6 Bp-100/60 HR-123/min Grbs-33 Mgdl Chest -Bae , mild wheeze Laboured breathing pattern CVS-s1s2 heard Spo2-98% on room air Cold peripherals with feeble peripheral pulses Advised for CBP,ABG, electrolytes, RFT, urine for ketones, CXR,ECG CBP- HB-13.2,RBC-4.4,wbc-8300,platelet-41000 Electrolytes ,urea & creat in normal range ABG- Ph 6.994,pCO2 10.9, pO2 120.6, HCO3act 2.6 mol/l ,HCO3std 7.2mmol/l UPT is negative Viral markets are negative Couldn’t get Ketones as there is no urine output for patient since morning
Dr. Surya Teja Rudraraju4 Likes21 Answers - Login to View the image
57 yr old female.admitted in ICU day three Case of dilated cardiomyopathy with EF 30. O/e b/l wheeze,(now subsided) Vitals stable. PT on Bipap repeated ABG posted below... Ur advice on the case pls/!!! And comments on ABG...
Dr. Siddharth Ajay1 Like7 Answers - Login to View the image
42M,progressive cough,dyspnea gr4,since 8days, travelled to kerala recently.spo2 84%on nasal 02.HR130,BP110/60,newly ムT2DM.whats possible diagnosis and treatment?
Dr. Sandeep Ghodekar4 Likes26 Answers