A male pt aged 50 yrs who had no previous history of any comorbidity presented to us in intubated state from outside and his GCS at presentation was E2VtM4.... On asking the attendants, he had High grade fever since 2-3 days and developed sudden onset breathlessnes since today morning and while he was being taken to nearby hospital, his condition deteriorated and he was intubated and was referred to us... Discuss the differentials and approach to this pt..



Pt is in deteriorating stated x-ray chest shows snow storm presentation suggestive of pulmonary oedema with IgG positive decreased plt obviously he looks to be grade4 dengue fever throbocytopenia is cause of his pulmonary oedema which may be hemorrhagic even parameters are not complete ie sr electrolytes and ABG as pt is intubated bcz of hypoxia due to pulmonaryoedema so treat him on icu basis for terminal denguefever with iv fluids and iv platelets with antibiotics and antipyretics rest as per symptomatic. Bp should be monitored. Given ecg show tachycardia due to fever and dehydration.

Is iv platelets necessary

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Bil diffuse alveolar opaque shadows seen. Dds :ITP/TTP ARDS,SEPSIS DENGUE MALARIA Rv status. Hypersensitivity pneumonitis,alveolitis. Alveolar hemorrage.

Fever with thrombocytopenia ARDS, Influenza fever, Diffuse alveolar hemorrhage may be. IV antibiotics with atypical coverage, anmalarial drugs, Oseltamivir. ICU care.

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ECG S.Tachy Lab-- Viremia History of High grade fever All r s/o ARDS Need to evaluate for zika/ swine

Thnkyou doctors It's a case of Acute Sepsis with ARDS

? Swine flu with dengue ( tcp)

CNS.disorder .