77yrs old/f came with complain tachypenia severe breathlessness with fever with chills headache bodyache 3day k/c/o Pulmonary Koch's completed R O/E bp 100/50 pul 108 temp afeb spo2- 96% RR 32/m RS rt crepes+ CNS conscious and oriented investigation CRP 267 pro-BNP - @ 11428 urine protien -1+ WBC 43,500 HB 11.8 PLT 2.20 BUN 22.5 creat 0.9 Na* 131 k 4.4 cl 95 sgot 18 sgpt 11

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Significantly higher pro BNP. Potential causes of elevated brain natriuretic peptide levels are, Heart failure, Diastolic dysfunction, Acute coronary syndromes. Hypertension with left ventricular hypertrophy. Valvular heart disease (aortic stenosis, mitral valve regurgitation). Atrial fibrillation. Im this case associated sepsis needs to be tackled with antibiotics and ionotropic support. Cxray shows rt basl consolidation with synpneumonic effusion. Mediastinal widening. Along with 2d Echo CD is must, and further management of cardiac failure causing additional hemodynamica instability.

Septicaemia with heart failure tends to multiorgan failure Xray suggests left apical paratracheal lung fibrosis Right lower coastal homogenous heziness? Pneumonitis Keep in ICU Proper cardiac support Inj Meropenem 1gm iv 8 hourly Further investigation is required O2 inhalation LABA/LAMA

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Fibrotic strands lt apical zone with scarring suggest old lesion healed Rt lower zone coastal haziness Pneumonitis Leucocytosis+ Rx broadspectrum antibiotics like amoxyclav625mg 1bd iv inj amikamicin

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Septicemia Pneumonia. Old healed scarring and lt apical fibrosis. Rule out cardiac failure. Needs further investigation and evaluation under constant monitoring and regular evaluation in ICU. Inj meropenum iv bd slowly with iv infusion O2 nasal Nebulization. Multivitamin and antioxidants. Maintain IO chart .

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Hypotensive, leukocytosis, elevated Pro BNP, CXR right Lowee lobe haziness + Left apical fibrosis patient is in sepsis, Patient needs admission under ICU ECHO to r/o HF, blood culture Nasal O2 / NIV IV antibiotics meropenem / piptaz Nebulization Cardiology & pulmonary evaluation..

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Pulmonary fibrosis with infection. Acute heart failure due to right side heart pressure. Pt is going to septic shock. Need O2 SOS, pcm, Meropenem, doxycycline, steroids, inhaler, vit c. Norad infusion. At the same time lasix SOS. echo, CT thorax or may require lung tissue biopsy.

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RT LOWER LOBE. CAP LEUKEMOID REACTION SEPTICEMIA RAISED ALT 1 + PROTEIN IN URINE INSIGNIFICANT HYPONATRAEMIA LVF P/ H PTB RX COMPLETED ADV BLOOD C& S

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SUGGESTIVE OF SEPTICEMIA PNEUMONIA LEUKAEMOID REACTION.... ADVISABLE... E C G BLOOD. AND. URINE......C / S

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Consolidation, right base ? Community acquired pneumonia Broad spectrum Antibiotics, mucolytes, O2,

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Leucocytocic rt basal pneumonia old kochs rt axis deviation tachycardia probnp high keep in mind heart failure 2 decho hrct expiratory films

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