66yr /F presented with Acute Respiratory distress and history of Fever for 8days. She is known hypertensive on treatment with Telmisertan 40 daily. Non Diabetic. Her Serial ABG, Biochemical profile, CXR (AP), ECG enclosed. Blood TC 14500, P74, L22, M0, E4, Hb 11.6gm%.

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Acute Respiratory Distress with Fever Known hypertensive Xray showing b/l opacities with cardiomegaly ? Pulmonary edema Possibilities - Acute LVF ARDS B/l pneumonitis

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DD: ARDS ?Pulmonary edema ABG reveals respiratory acidosis with severe hypoxia Suggest: Start with NIV,if needed Intubate and ventilate Emperical antibiotics Send chest secretions for Gram stain and c/s 2D-Echo Add diuretics if needed Routine workup

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Rotation seen Cardiomegaly Severee pul odema Both cp angles clear Dgx Hypertensive cardiomegaly with rt heart failuure

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ECG old IWI x-Ray viral pneumonia ABG shows respiratory acidosis with severe hypoxia only thing bothering me is why leococytosis in viral infection repeat cell count pt has to be put on ventilator

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Rotated film Cardiomegaly+ B/l pleural effusion B/l patchy lung infiltrates S/o Acute Pulmonary Edema with ?CCF Rx. PPV/Diuretics/fluid restriction/ UOP monitor/ +-inotropes/ ECHO

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X-ray Cardiomegaly P.Odema Bilateral lower lobe pneumonitis Lab show Acidosis with leucocytosis ECG LAHB IVCD( no rbbb because absent S wave in lead 1) S.Tachycardia

ABG - only type l failure CXR - Bilateral pulmonary infiltrates DD - ARDS, Acute LVF, atypical pneumonitis Needed- a bed side echocardiography

Multiple non homogeneous oascities more centrally para cardiaccardiomegaly.ARDS vs cardiac pulmonary oedema septicaemia.pneumonitis billet.exclude vivid 19.cardiac markers.

Ards rt pneumonitis basal cardiomegaly copd emphysema

RT CAP WITH PL EFFUSION HYPERTINSIVE HEART DISEASE WITH CARDIOMEGALY

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