Concluded Case

35yrs male, RTA (23/1/19), with left humerus fracture. developed tachypnea and dyspnea, required invasive ventilation. today required tracheostomy. Clinicoradiologicaly deteriorated. today spo2 95% on IPPV 100% fio2, PEEP 8. CVP 8cm. RFT, LFT normal. on vancomycin meropenum and fluconazole. plz interpret and guide further.


Concluded answer

patient improved Clinicoradiologicaly with ventilation and medical management. latest cxray uploaded.

All Answers

Xray shows ARDS with pul oedema with left side pleural effusion with right side fissure effusion with cardiomegaly.. (post traumatic shock lung??) Ad- conservative management acc to ARDS protocol with invasive ventilation.. With high fiO2 and PEEP >5 with low tidal volume and high RR -mepanem and vancomycin is good.. But i would like to prefer pipzo 4.5gm in place of mepenam.. -diueretics -nebulization, mucolytics,, expectorant -low dose steroids -chest physiotherapy -routine investigations along with HRCT thorax

CARDIOMEGALY.... PULMONARY. EDEMA... RT SIDED.... ..... FISSURE. EFFUSION... ADVISABLE.... 1. BLOOD. and. Urine. Culture /. Sensitivity. Tests 2. E C HO 3. U S G... WHOLE. ABDOMEN 4. MEROPENUM. causes..... ..... Focal. Seizures..... and. also.. .... drug. TOXICITY. with..... LASIX.... 5. MEROPENUM. can. be. Substituted. with........ INJ.. TAZOBACTUM +. PIPERACILLIN...

Valuable opinion

As we do not know scan status bebore rRTA So I want to interpret this scan in ...view of...RTA THIS is response to injury to body..known as ...shock lung

Likely ARDS. Please follow the ARDSnet protocol for low volume ventilation. If unable to maintain saturation can try prone positioning ( seldom useful). ECMO if facilty available Also if renal function is ok, i will also consider a Cta. i have seen many PE in my practices in patients with ARDS which adds to their respiratory issues

Valuable opinion

Rule out pulmonary embolism correct hypotension due to blood loss..meropenam is good choice only change if counts increase..fluconazole is not needed..

Fracture long bone ,probably multiple attempts at close reduction . Has gone for pulm embolism . Continue the treatment till settles .

Kindly rule out pulmonary fat embolism besides managing along lines of ARDS. With the h/o trauma, it should be rule out

patient improved Clinicoradiologicaly with ventilation and medical management. latest cxray uploaded.

Pulmonary embolism may from Long bone marrow. Wach for paticieal hemorrhage. Dr. S, L. Gupta.

Pulmonary oedema with cardiomegaly. Minor fissure effusion right.

Thank you doctor
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