A obese female with history of day time sleepiness presented with sudden onset breathlessness, cough with expectoration and drowsiness since 2 days....She is having no history of any comorbidity or drug intake....Vitals - BP- 150/90 PR- 108/min spO2- 82% ....comment on the approach to this patient



CXR- Cardiomegaly, Rt. mid zone Pneumonitis ABG- Respiratory Acidosis Lab- WNL, maybe prediabetic Dx- Acute Respiratory Failure type II ppted by Pneumonia, Hypoventilation, CCF Obesity, HTN, Prediabetic OSA with Hypoventilation synd., CCF Adv-serial ABGs, pro BNP, Cardiac enzymes, Troponin, Cultures, 2D ECHO Sleep study at discharge Rx - NIV/BiPAP/ maintain Oxygenation Antibiotics Diuretics Supportive care

Only thing, Hypothyroidism may also be a contributor.

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Apnea hypoapnea syndrome Rule out LRTI and pulmonary hypertension X-ray : nh opacities + cardiomegaly Adv 2Decho Sputum culture g/s AFB Arterial blood gas

Obstructive sleep apnea.abg s/o respiratory acidosis wid compensatory metabolic alkalosis.pt should be put on bipap.if altered sensorium then mechanical ventilation.inj augmed to cover chest infection.cbc lipid profile repeat chest xray

Respiratory acidosis needs ventilatory support .cxr is no clear .adv cbc kft lft ECG and echo

Pt did well on NIV

OHS with hypercapnea may be precipitated by CCF ; get 2D echo ; connect to NIV

Given this patient is obese wity history of daytime sleepiness and she also seems to have a short neck - she is probably a case of OSAHAS (obstructive sleep apnea hypo...).. so go for an ABG to look for Pco2 levels.. and she is also hypertensive at present.. so look for signs of long standing hypertension like LVH in ecg And changes in funds.. auscultate cheat for Basal carrots as hypertensive heart failure ppl2are at high risk for Co2 narcosis..

Yes she is a case of OSAHS....On Auscultation, b/l crepts presebt

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Its a case of respiratory acidosis.


Respiratory acidosis due to ptb

OSA with Resp acidosis Bipap and sleep study latter

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