Concluded Case

55yrs lady presented with dyspnea cough, Chest pain and fever since a week. she is unable to even stand. HR 126/min spo2 90% BP 80 systolic. Rv neg, sr creat 1.5 , sr bil 5.5. WBC raised. left sided breath sounds reduced. plz comment.

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Left sided consolidation Trachea is shifted to right due to rotated film Leucocytosis ( infection) Elevated bilirubin Hypotension Investigation Sputum examination for afb Blood culture Lft Treatment Iv fluids Oxygen Nebulisation with ipratropium n budecort Broad spectrum antibiotics ( don't add fluoroquinolone as might turn out to be pulmonary tb) Nutrition

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Pt has lobar pneumonia lt mid lobe with leucocytosis suggesting sepsis hrct and xray chest supports the findings Pt is in septic shock as hypotension with hypoxia Probably there is bacterial hepatitis as sr bil over 5.5 2nd hemogram shows well controlled infection Maintaining hemodynamics and bp with control of liver dysfunction Keep ventilation on niv Supportive treatment for anaemia Seems to be well settled ecg normal continue the same

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Marked hazy shadow in upper and middle zone of lt side Mild obliteration of lt cp angle due to infiltration ? Pneumonia with Anaemia with ventricular tachy cardia septicaemia Investigate for the cause of leucocytosis Bone marrow to rule out any leukemia

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Hyperinflated lungs, COPD. Mediatinum pulled to right . Infiltrations and fibrosis right lung. Rt hilum and diaphragm pulled up. Left midzone opacity suggestive of consolidation . Consider bilateral PT, mass Left lung ECG IS normal Blood counts suggestive of acute bacterial infection ..severe iron deficiency anaemia. Serum BILIRUBIN is raised. ? Biliary sepsis, malignancy. SEPSIS and acidosis related hypotension Data needed LFT, RFT, USG abdomen ,ABG,

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Due toRotated xray film it seems shifting of mediastinum to right but to mebit seems an acute event I.e lt upper middle zone pneumonia......with sepsis n sec symptoms.........microcytic anaemia n sepsis nleading to tachycardia n shock......plus raised bil need to b worked ou in details....till then do a gramstain culture .....start antibiotics acc plus udiliv n supportive management nebulisation chest physiotherapy steam inhalation etc etc

Left side synpneumonic big patch present mid and upper lobe Wide mediastinum with tubular heart Rt apical shows fibrocalcified lesion. Serum bilurubin raised with Leucocytosis Get sputum culture for bacterial and fungal pneumonia and AFB also Ecg shows ventricular tachycardia Broad spectrum antibiotics, hepamerz, nebulization, mucolytics bronchodilaters Rehydration

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Rotation ++ Consolidation with air bronchogram sign at left midzone . Trachea appears to be shifted to right due to rotation.

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Left midzone big pneumonia with creatinine raised jaundice leucocytosis do lft serum electrolyte bun

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Left sided consolidation Trachea is shifted to right due to rotated film Leucocytosis ( infection) Elevated bilirubin Hypotension Investigation Sputum examination for afb Blood culture Lft Treatment Iv fluids Oxygen Nebulisation with ipratropium n budecort Broad spectrum antibiotics ( don't add fluoroquinolone as might turn out to be pulmonary tb) Nutrition

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Left side pneumonia wbc raised give antibiotics control heart rate and bp by inotrop treat jaundice

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Do further investigation like LFT Sputum culture blood culture n sensitivity n HRCT n sr electrolyte Its a case of COPD acute bacterial infection anemia hepatitis Manage O2 level broad spectrum antibiotics Nebulization with duolin n budecort tds Syp mucolite 5ml tds tab folvite od

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