Concluded Case

DIARRHOEA ASSOCIATED WITH ATYPICAL VIRAL PNEUMONIA.

86yrs/M presented to ED with fever and diarrhoea of 3 day duration.SOB since yesterday.COVID RT PCR NEGATIVE Chief Complaints Fever,Diarrhoea,SOB History Recent THR Vitals Spo2 - 92% with 13 litre O2,BP -160/80,PR -120,RR - 32, Physical Examination Chest - Diffuse coarse crackles at base, Conscious, oriented to TPP Investigations D Dimer -1800,LDH -200,CRP -50,Hb -12,Urea -80,Creat -2.1 Diagnosis DIAGNOSIS AND MANAGEMENT PLAN?

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Concluded answer

A case of RT - PCR negative- COVID-19 atypical viral pneumonia. Certain diagnostic criteria in this case are Fever and Diarrhoea- SOB A low SPO2 and high RR Chest examination findings A Significantly raised D- Dimer Raised LDH, CRP, Acute kidney injury X - ray - typical of COVID-19 picture HRCT- GGO's and crazy Pavement pattern Management- High flow - non invasive ventilation Restricted IV fluids Inj Dexamethasone 6 mg O.D LMWH Inj Cefriaxone 1 gm B.D A nephrologist consultation Remdesivir is optional

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A case of RT - PCR negative- COVID-19 atypical viral pneumonia. Certain diagnostic criteria in this case are Fever and Diarrhoea- SOB A low SPO2 and high RR Chest examination findings A Significantly raised D- Dimer Raised LDH, CRP, Acute kidney injury X - ray - typical of COVID-19 picture HRCT- GGO's and crazy Pavement pattern Management- High flow - non invasive ventilation Restricted IV fluids Inj Dexamethasone 6 mg O.D LMWH Inj Cefriaxone 1 gm B.D A nephrologist consultation Remdesivir is optional

Sir y to restrict fluid n y to start heparin?
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Adv Echo CD to rule out cardiogenic Pulmonary edema. May consider NIV support with diuretics. If pulmonary edema, it should settle in next 12 hrs or so. If non resolving shadows, consider bacterial sepsis with ARDS. May go for d dimer, PCT levels, sr lactate level. ABG, NT pro BNP.

ARDS TYPICAL COVID19 PNEUMONITIS BILATERAL WITH PLEURAL EFFUSION LT SIDE All symptoms and signs are supportive of covid19 infection Pt is on oxygen support of 13lits High D dimer crp LDH early deranged KFTS I will treat this case as covid19 pneumonitis irrespective of negative RT pcr which can turn positive any time Rx pt has to be on 02 support Iv inj Ceftriaxozone Inj Remdesivir Inj dexamethasone Inj lasix Inj enoxiparum Orally azithromycin Antipyretics Bronchodilators Nebulisation

Can we use inj meropenum and inj lenazolid
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? ILD..PNEUMONITIS.. ? ARDS.. CLINICAL..PICTURE .. FEVER.. DIARRHEA.. NEED'S.. MANAGEMENT AS PER PROTOCOLS FOR COVID-19..

Tnx &wc
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Ards ild pneumonitis Inspite of negative PCR Hypoxia all parameter positive for sarscov2 Ct score Creatinine raised D d ards with viral pneumonia ild with ard Admit