ATYPICAL VIRAL PNEUMONIA WITH RESPIRATORY FAILURE

68yrs/M non smoker with N/h/o T2DM/BA/TB presented with one week H/o Fever with chills,Dry cough+5days,SOB+2days.He was Covid 19 PCR negative.He was managed conservatively on 30L O2 support with NRBM and nasal pronge,Bipap trial was given but patient didn't maintain saturation.Patient was gradually tapered to 18L but his oxygen demand increased and his Spo2 dropped to 70% and he was again taken on 30L O2 support.Patient presently at 30L O2 support with Spo2 89-92%.High risk and poor prognosis explained.SUGGEST FURTHER MANAGEMENT PLAN?

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Consider atypical pneumonia Cardiogenic Pulmonary edema Pulmonary embolism Hypersensitivity pneumonitis Adv Echo CD ABG Repeat swab RT PCR for SARS cov 2 Procalcitonin level, IL 6. Start Antibiotics as per sensitivity test. LMWH and steroids, remdesivir.

Although it looks like atypical pneumonia-,- and as patient is RT - PCR negative- the HRCT picture- doesn't look like that of COVID-19 viral pneumonia as considering his critical condition- the pulmonary involvement is that severe Look for other causes like Pulmonary embolism CCF . Non - covid - 19 viral pneumonia Treatment however remains on the lines of atypical viral pneumonia with parenteral antibiotics, LMWH, heparin Further investigations required like 2D echocardiography D- Dimer Procalcitonin IL6 S.Ferritin LDH CRP

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Bilateral viral pneumonitis Ards Pft obstructive lung disease Abg arterial Repeat rt pcr clia after 4 days Opinion of chest physician

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Bilateral pneumonia CCF also to be ruled out

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Start with broad spectrum antibiotics, steroids, LMWH,CONTINUE O2 AS OER REQUIREMENT and other supportive treatment