80/F admitted with history of breathing difficulty since yesterday. h/o passing black and tarry stools since 2 days. h/o dyspnea on exertion present. h/o fever since 2 days. k/c/o T2DM, HTN, parkinsonism on rx s/p left hip reconstruction with proximal femur nail for left hip intertrochanteric fracture. O/E conscious, dyspneic, tachypneic HR:102/min. BP:140/70mmhg. spo2:89%in RA previously admitted for bronchopneumonia and urosepsis 2 months ago

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Bil diffuse parenchymal bronchiectasis seen. Mediastinal widening noted. UTI seen. ABG shows respiratory alkalosis with Metabolic compensation. Hyperglycemia. Leucocytosis. Needs to treat active infection. Evaluate for GI bleeding. Bipap support. Management of hyperglycemia with insulin.

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T2 DM with hypertension with Parkinson's disease with pelvic surgery done with Gastric or duodenal ulcer bleeding with severe U.TI with most likely ARDS or LVF or miliary tuberculosis. Patient needs,urgent emergency care with Oxygen support with mask with Parenteral antibiotics inj Piperacillin 4gm + tazobactum 500mg × 8 hourly . Inj Deriphylline , inj Pantoprazole, oral sucralfate, inj hydrocortisone Other investigations needed are 1.Upper G.I endoscopy 2.Echocardiography 3.ESR , montaux test, sputum for AFB 4.A CECT chest 5 Regular monitoring of ABG studies

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This patient has multiple disease processes occurring at the same time One has to choose very wisely the correct path of management X ray chest shows both reticulonodular lesions dispersed all throughout the lung field, mediastinal widening is seen but it can be secondary to rotation. Arterial blood gas shows PaO2 127 mm of Hg and PaO2/ FiO2 ratio of 397 which is very good for age, it essentially excludes Acute respiratory distress syndrome and interstitial lung disease as differential diagnosis Differential for chest X ray picture would be Viral pneumonitis Tuberculosis Fungal infections Sarcoidosis In addition she is having severe urinary tract infections which need to be treated on priority with appropriate Antibiotics according to past culture, as she had UTI in the past She has bleeding from GI tract, which at present need to be managed conservatively as she is very sick to undergo any invasive investigation Proton pump inhibitors, tranexamic acid, inj metronidazole and if upper GI bleeding is suspected then Inj. Terlipressin can be given Her coagulation parameter need to be corrected because it may aggravate GI bleeding, FFP can be used for same Strict control of diabetes Continuous monitoring of urine output, CVP and other parameters HRCT chest once stable

Needs plenty of plenty of things to explain 1 xray chest suggest bilateral bronchectatic lesions suggestive of chr bronchiactasis with copd 2urine shows proteinurea with plenty of pus cells and bacterimia needs for c&s as kco urosepsis 3ABG is important it explains respiratory alkalosis and need to be corrected 4Pt Aptt are increased and explains GI bleeding shown as black tarry stools Sepsis is responsible for it 5 also increased casual plasma glucose need to control with insulin 6 hyponatrimia needs to be corrected 7 leucocytosis and raised esr ie sepsis bcz of pulmonary and urosepsis needs to be managed by iv macrobiotic like piperacillin and tazobactum or meropanum

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Copd Emphysema Cadimegaly Mediastinal widening B/L lungs are infiltrated with cavity Bronchiactactic changes D/d PTB Sequel Malignancy Ad CBNAAT Sputum exam HRCT thorax

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COPD emphsema Cardiomegaly Viral pneumonitis B/L lungs are infiltrated with cavity Bronchiectasis change Pulm.TB sarcoidosis Hypergylcemia Malignancy HRCT ECHO Antibiotics Obeservation Insuline

80 year old , DM with lactic acidosis , resypiratory alkalosis , hyponatremia GI bleed ? Cause ? NSIDs induced gastritis ., sepsis induced gastritis . Prolonged PT APTT , ? DIVC COPD, ILD, ? Old OT sequel Urosepsis, lung infection Suggest Antibiotics, ventilation , insulin, nebilusers, PPI, ECHO

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COPD empysma Viralbpneonnitis. Bilat. Lung infiltratration with cavity Bronchiactasis

POSSIBLY... P. TB SARCOIDOSIS FUNGAL. INFECTION PNEUMONITIS NEEDS. FURTHER. EVALUATION

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