Concluded Case

COVID 19 POSITIVE CASE

64yrs/F patient with H/o HTN presented to emergency department in Unconscious and gasping condition, subsequently intubated for airway protection.Two days prior admission she complaint of Altered mental status. The family denied history of fever or cough.But upon arrival she was having high grade fever(103°F) KINDLY SHARE YOUR OPINIONS. Chief Complaints Altered mental status,Fever History HTN Vitals BP -100/60,PR -130,RR -32,Spo2 -82% on room air Investigations Attached Diagnosis Covid 19 positive

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Concluded answer

Covid - 19 bilateral viral pneumonia with GGO's with cerebral hypoxia with severe metabolic disturbances, hyponatremia, hypocalcemia , hypochloraemia ,and metabolic acidosis . Treatment- 1.Mechanical ventilation after endo tracheal intubation 2.Correction of Sodium, chloride and calcium 3.Specific Treatment for COVID-19 with remdesivir, LMWH , dexamethasone 4.Parenteral 3rd generation cephalosporins 5.Supportive Treatment- maintenance of B.P , monitoring, urine output, maintenaning renal functions A small haemorrhagic lesion is seen in right temporal region

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As patient is covid + ve , gasping so altered mental status can due to hypoxic brain injury or electrolyte imbalance ( due to metabolic acidosis). Doing Hemogram, Sr.Electrolyte, sr.creat will help to do corrections. Note spO2 level to avoid further hypoxic brain injury if present.. If brain injury present..Add anti coagulant + IV.OPTINEURON ..OD for 3 days + IV.CERACETAM ..OD for 3 days + TAB.BECOCNX D3..OD.. Repeat CT on 4 th day for follow up. Continue specific treatment of covid19 Note : GCS - TDS , Urine output ( as gasping may lead to acute kidney injury)

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Covid - 19 bilateral viral pneumonia with GGO's with cerebral hypoxia with severe metabolic disturbances, hyponatremia, hypocalcemia , hypochloraemia ,and metabolic acidosis . Treatment- 1.Mechanical ventilation after endo tracheal intubation 2.Correction of Sodium, chloride and calcium 3.Specific Treatment for COVID-19 with remdesivir, LMWH , dexamethasone 4.Parenteral 3rd generation cephalosporins 5.Supportive Treatment- maintenance of B.P , monitoring, urine output, maintenaning renal functions A small haemorrhagic lesion is seen in right temporal region

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Classical c/o covid19 pneumonitis with pulmonary oedema Hrct shows CO-RADS 5 and 6 Ct brain is normal ABG suggest respiratory alkalosis with hyponatremia Pt is hypoxic and tachyapnic High D-dimer and crp and LDH All suggest pt is critically ill with poor prognosis To be kept in ICU under ICMR protocols Inj Remdesivir Inj Ceftriaxozone Inj dexamethasone Inj lasix Inj LMWH Inj azithromycin SPO2 to be maintained with monitoring of vitals

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CXR.. BL.. GGO.. SPO2 .. 82% . HYPOXIC.. COMPLICATIONS.. NEED'S.. LIFE..SUPPORTIVE MEASURES.. MANAGEMENT AS PER PROTOCOLS..

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Its COVID 19 picture

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