Case of the day

HEAD INJURY IN SUSPECTED COVID POSITIVE PATIENT

42yrs/F victim of head injury presented to casualty in Respiratory distress condition with Covid like symptoms.The patient had Complaints Intermittent fever for 4 days with dry cough before admission.Patient maintaining Spo2 on High flow nasal cannula. Chief Complaints Head injury History Fever,dry cough Vitals BP -120/80,Spo2 - 91%,RR -27,Temp -100°F Physical Examination Drowsy, Agitated,Pupils - B/l 4mm RTL,GCS -11/15,Chest - B/l Crepts present Investigations TLC -18000,Neutrophils -80,Lymphocytes -12,ESR -65,D dimer -630,CRP -45,LDH -545,PCT -0.5.LFT n KFT normal ABG - Ph -7.4,Pco2 -32,Po2 -87,Na -123,K -2.4 COVID 19 PCR AWAITED

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Non visualisation of sulci and gyri.Thin SDH left temporal with small ventricular system. Spotty blood in the left temporal gray matter, left parietal white matter.Diffuse brdin edema with small Thin SDH left temporal with scanty spotty blood probably suggestive of early hypoxic changes. Pt is young,active supportive management,correct the metabolic abnormality.

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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!

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A covid case with head injury Intresting Generalised brain oedema with sulci and gayrae are not visible SDH lt temporal region Hrct is typical of GGOs in basal areas bilaterally and a patch of pneumonitis rt mid lobe supported by raised inflammatory markers D-dimer LDH and positive crp Leucocytosis Pt is hypoxic and drowsy Poor prognosis Treatment Under ICMR protocols start for covid Intubation and ventilator support Inj dexamethasone Inj Ceftriaxozone Inj piperacillin+inj tazobactum Inj lasix Inj paracetamol Rest as per investigations Sos consider inj Tocilizumab and plasma antibody

Head injury Cerebral concussion Hypo natremia Hypokaelemia Nasal bone smashed Opinion of maxofacillary region

B/l ggo in hrct chest alog with covid like symptoms which is suggestive of covid along with lt temporal sdh & ivh .

POSSIBLY .S D H WITH METABOLIC ABNORMALITIES

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