A 2 yr old with foreign body

18022018 NICU 1 Refferd case 2.5 month male 5.5 kg Admitted with c/o tachypnea dyspnea SCR+nt abdominal distension O/E RR 68 bmp PR 164 bpm SpO2 79% off O2 P/A distended soft with hepatomegalae(+4 cm Urine passed Stool passed Temp Afebrile Pallor +nt Refferal history 15 days before asymptomatic then noisy breathing with tachypnea present admitted in another hospital with inj pipzo,amika and discharged with syp linezolid After 1 day of discharge remision of symptoms occured admitted again for 7 days with inj vanco,amika,azithro,meropenem,linezolid and pipzo CTthorax suggestive of multiple consolidation 18/02/2018 8 am Pt is on vent with SIMV/28 bpm/40%/5cm H2O SpO2 97% PR 182 bpm RR 58 bpm(on disconnecting vent with very much sCR) Reports attached( note:digital x ray is older than normal one) What could be the causetive organism (CMV??Pulm koch?) What may be role of surfactant in this case? Kindly comment your valuable opinion Our ddx bronchopneumonia vs pulm koch with septicemia 19/02/2018 Disconnected vent but not maintaining PR 164 bpm RR 70 bmp SPO2 74% P/A distended soft with liver +4 cm Temp afebrile 1.which vent mode is best for such a case in with baby is tachypnic hypoxic poor activity with exessive SCR+nt...SIMV or AC 20/02/2018 Inj fluconazole and ATT started since the day of baby arrival ...baby is on vent so unable to nebulise with tobramycin(for suspected pseudomonas infection ....culture of a blocked ETT sent yesterday) exessive drooling was present so iadded glycopyrolate 0.1 ml iv 8 hrly Baby was placed on vent CPAP yesterday20/02/2018 since morning but suddenly at 4 pm baby held his breath f/b gasping and cynosis hypoxia(what could be the cause ...antibiotics? )

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

Dear Friends.. ARDS is an important clinical condition which needs discussions.. ARDS (Acute respiratory distress syndrome) It is an Acute onset of rapidly progressive dyspnea, tachypnea, and hypoxemia. DIAGNOSTIC CRITERIA for ARDS: (1)acute onset (2)PaO2/FiO2 of 200 or less regardless of PEEP (3)bilateral infiltrates seen on frontal chest radiograph and (4)no clinical evidence of left atrial hypertension(pulmonary artery wedge pressure of 18 mm Hg or less if measured) ARDS is believed to occur when a pulmonary or extrapulmonary insult causes the release of inflammatory mediators which causes damage to the vascular endothelium and alveolar epithelium… leading to pulmonary edema, hyaline membrane formation, decreased lung compliance, and poor air exchange. ARDS has to be differentiated from congestive heart failure, which usually has signs of fluid overload, and from pneumonia. I have attached tables to help you differentiate.. TREATMENT It is largely supportive and includes… (1)mechanical ventilation with a strategy of Low tidal volume & high positive end-expiratory pressure. (2)prophylaxis for stress ulcers and venous thromboembolism (3)nutritional support (4)treatment of the underlying injury. (5)conservative fluid therapy Applying above strategy of  treatment improves outcomes. A spontaneous breathing trial is indicated as the patient improves and the underlying illness resolves. Most cases of ARDS in adults are associated with pulmonary sepsis or nonpulmonary sepsis. Risk factors include those causing (1)Direct lung injury (e.g., pneumonia, inhalation injury, pulmonary contusion) (2)Indirect lung injury (e.g., nonpulmonary sepsis, burns, transfusion-related acute lung injury). Risk factors in children are similar to those in adults, with the addition of age-specific disorders such as … Respiratory syncytial virus infection and near drowning aspiration injury. Pharmacologic options for the treatment of ARDS are limited. Although surfactant therapy may be helpful in children with ARDS,   The use of corticosteroids is controversial. Randomized controlled trials and cohort studies tend to support early use of corticosteroids However, no consistent mortality benefit has been shown with this therapy. Mortality is between 34 and 55 percent in different recent trials and most deaths are due to multi-organ failure. Thanks Dr K N Poddar

Hello everyone, Here are some important facts about COVID-19. From Clinical presentations to treatment. Please check it out and feel free to add more points. CLINICAL PRESENTATION: In a study describing 1099 patients with COVID-19 pneumonia in Wuhan, the most common clinical features at the onset of illness were: •Fever in 88% •Fatigue in 38% •Dry cough in 67% •Myalgias in 14.9% •Dyspnea in 18.7% Pneumonia appears to be the most common and severe manifestation of infection. In this group of patients breathing difficulty developed after a median of five days of illness. Acute respiratory distress syndrome developed in 3.4% of patients. Other symptoms •Headache •Sore throat •Rhinorrhea •Gastrointestinal symptoms About 80% of confirmed COVID-19 cases suffer from only mild to moderate disease and nearly 13% have the severe disease (dyspnea, respiratory frequency ≥30/minute, blood oxygen saturation≤93%, PaO2/FiO2 ratio <300, and/or lung infiltrates >50% of the lung field within 24-48 hours). Critical illness (respiratory failure septic shock, and/or multiple organ dysfunction/failure) is noted in only in less than 6% of cases. INCUBATION PERIOD: The exact incubation period is not known. It is presumed to be between 2 to 14 days after exposure, with most cases occurring within 5 days after exposure. THE SPECTRUM OF ILLNESS SEVERITY: Most infections are self-limiting. COVID-19 tends to cause more severe illness in the elderly population or in patients with underlying medical problems. As per the report from the Chinese center for disease control and prevention that included approximately 44,500 confirmed Infections with an estimation of disease severity. • Mild illness was reported in 81% of patients. • Severe illness (Hypoxemia, >50% lung involvement on imaging within 24 to 48 hours) in 14%. • Critical Disease (Respiratory failure, shock, multi-organ dysfunction syndrome) was reported in 5 percent. • Overall case fatality rate was between 2.3 to 5%. AGE AFFECTED: • Mostly middle-aged (>30 years) and elderly. • Symptomatic infection in children appears to be uncommon, and when it occurs, it is usually mild. **The 4th version of Belgian guidance for COVID 19 is published on19th March 2020. It is one of the most precise guidelines published yet. Some points from that: 1. Chloroquine is found to have good efficacy in vitro and it reduces the duration of viral shedding. But the drug has a narrow therapeutic window and cardiac toxicity is the most limiting side effect. 2. Hydroxychloroquine is more potent and is superior to chloroquine according to the very recent Gautret’ study. 3. Azithromycin may have a viral suppressive effect, but this needs to be proved as it was noticed accidentally in 6 patients of Gautret’ study. But I think it is a good choice for coverage of bacterial pneumonia. 4. Lopinavir/Ritonavir recently shown not to provide clinical benefit in hospitalized patients with COVID-19. It may reduce ICU stay if given within 10 days of infection but not beyond. 5. Remdesivir is promising but the studies are ongoing. Also, availability is a key issue. 6. Corticosteroids are not recommended as a systemic adjunctive treatment. 7. Paracetamol is the first-line analgesic and antipyretic over NSAIDs which are used with caution. 8. No need to stop ACEIs/ARBs in non-hospitalized patients. CONSIDER changing ACEIs/ARBs to another equivalent antihypertensive in hospitalized patients. 9. Antiviral therapy is not indicated in all patients with suspected/confirmed COVID19.

A male child 8 years comes my clinic with fever dyspneoa and ribs INDRAWING plz share management?