27 year old female , recently diagnosed with bronchial asthma and 8 months amenorrhea post delivery , presented to ER with sudden onset of grade 4 SOB today morning at 11:00 am with profuse sweating and abdominal discomfort , patient was apparently asymptotic till then Had h/o dry cough since 2 months No h/o vomitings, chest pain , giddiness ,loose stools , decreased urine output ,burning micturition One episode of bleeding per rectum in hospital On arrival Pt -Drowsy,arousable GCS-E3V4M6 Bp-100/60 HR-123/min Grbs-33 Mgdl Chest -Bae , mild wheeze Laboured breathing pattern CVS-s1s2 heard Spo2-98% on room air Cold peripherals with feeble peripheral pulses Advised for CBP,ABG, electrolytes, RFT, urine for ketones, CXR,ECG CBP- HB-13.2,RBC-4.4,wbc-8300,platelet-41000 Electrolytes ,urea & creat in normal range ABG- Ph 6.994,pCO2 10.9, pO2 120.6, HCO3act 2.6 mol/l ,HCO3std 7.2mmol/l UPT is negative Viral markets are negative Couldn’t get Ketones as there is no urine output for patient since morning

76yr/M, kn HTN, DM, Hypothyroidism on Rx, Previously operated uneventfully- Ing hernia, TURP, and TKR At present admitted with h/o fever, dyspnea X 2day increasing. Conscious,T- 99.8, HR 96/min, BP 190/80, RR 30/min, SpO2- 84% on air. RBS 160. Rx: observation & continuousmonitoring. RBS, intake/ output, chart. Rx : Oxygen, Nebulisation, dytor, paracetamol, Pantocid, emset, antibiotics - zostum, clindamycine nabicard, cardivas, eltroxin . Labtest : CBC 12/ 12100 / 204000. Clotting & Electrolytes-wnl, sgpt 80 & creatinine 2.6 Trop-I neg, BNP- high. ECG and chest x-ray attached. please do interpretation of the ECG and x-ray and further Rx...

Today morning I got a call from neighbor before coming to my hospital duties for 24 hoursSeen patient & requested his son to send reports. On request given reports as per my capabilities. K/C/O T2DM with HTN with COPD. On medication by specialists Present C/O Blood stained cough since last night, febrile conditions, thrust, difficulty in passing urine. P/H/O similar episodes in last year O/E PR 112 BP 120/80, Mod dehydration H/L NAD, Only impaired BS Pt is alert & cognitive Enclosing Xray & blood reports Xray COPD with Emphysema Both basal atelectasis Rt dome of diaphragm retracted with underlying collapse lung Bronchiectatic changes noted ECG Sinus tachycardia RAD LAHB Anterior wall ischemia R/O DKA Advice further & valuable opinion pls & correct me Advised hospitalization

70/F presented to casualty with Severe respiratory distress along with Sweating for 2hrs.She had also Exertional dysnpoea for last 3days.Intubated and ventilated upon arrival.Known Diabetic and Hypertensive on regular treatment. On presentation - HR -120,BP -80/60mmhg,RR -12/Mt,Spo2 -72%.Chest - Breath sounds diminished,CVS - No murmurs,Pupils - B/l 4mm RTL,GCS - E1M5V1.LVEF - 20% with Global hypokinesia of LAD moreover LAD territory.D-dimer - 10000,Sensitive Trop - I -686,Initial labs report enclosed with Xrsy chest,ECG and CT angio.DIAGNOSIS AND SUGGEST MANAGEMENT AND TREATMENT PLAN?

65 yrs man c/o breathlessness with known HTN with COPD ,chest B/L ronchi & wheeze + , Trop T Neg . please suggest management