Concluded Case

ACUTE PULMONARY EMBOLISM WITH RESP ALKALOSIS

40yrs/F presented to ED with C/o Severe Respiratory distress and altered mental status.Patient started noticing symptoms 5 days after operated for hysterectomy (Uterine fibroid) at some other hospital.Emergently intubated after acute respiratory failure,patient had to be deeply sedated and paralysed. O/e - Crackles and wheezes,BP -140/80,PR -72,Spo2 -98,Temp -103°F. DIAGNOSIS AND SUGGEST MANAGEMENT PLAN?

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Concluded answer

Respiratory alkalosis with hypoxemia and co2 retention. Hypokalemia Cxray shows bil mid basal inhomogenous heziness with mediastinal widening. Adv covid 19 swab Looks mixed infection. Antibiotics bronchodilators mucolytics Mechanical ventilation Tocilizumab remdesivir therapy may be helpful if proven.

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Xray chest shows floppy opacities bilateral more dense and spread on lt side Markedly raised D-dimer suggest thrombus causing pulmonary embolism with oedema higher hba1c suggest pt is diabetic Leucocytosis suggest sepsis So overall it is a picture of septic pneumonitis with pulmonary embolism Pt is in ARDS All probabilities of covid19

Thanx dr Sumit Koulwar
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X ray more of look like ARDS abg shows resp acidosis,hypoxemia According to recent IFCC guidelines d-dimer is deranged in patients with SARS cov and autopsy perform of covid patients they had pulmonary embolism and DVT So this case is more in favour of covid 19 Pt has co morbidity , Dm Aneamic, dehydrated--na+ 158,hypokalemic Recently hysterectomy done

Corona virus disease- COVID-19 Features in favour of COVID-19 are 1.Sudden onset severe respiratory distress and altered mental status, 2.Blood gas analysis indicative of CO2 retention with respiratory alkalosis and hypoxaemia 3.X- ray chest bilateral haziness - with ground glass appearance 4.As a sequelae to post - hysterectomy- may have acquired virus infection from hospital 5. A Significantly raised D- Dimer levels more than 10000 and Significantly raised another acute phase reactant - CRP - 37.5 6.A leukocytosis - more than 15000 7.Lymhopenia - 8 in DLC , which is commonly seen in COVID-19 Further investigations required are 1. A Nasopharyngeal swab for RT - PCR for COVID-19 2.A CT scan of chest

Valuable opinion
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Covid19

* ANEMIA.. * LEUKOCYTOSIS.. * HYPERNATEMIA .. * HYPOKALEMIA.. * RESPIRATORY..ALKOLOSIS.. * BL.. BASAL .. HEZINESS .. * WIDER..MEDIASTINAL SHADOW.. ? ILD.. ? COVID-19.. NEED'S.. RT.. PCR..COVID-19.. HRCT..

Thank you doctor
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Diffuse consolidation

Ards anaemia leucocytosis hypernatremia hyperkaelemia alkalosis lactia acid raised hyper chloeremia infiltrated chest bilateral basal pneuonitis rt cardiomegaly nutrophil to lyumphocyte ratio do hrct sarscov2 RT PCR operated aspiration pneumonia do cbnat may be covid

Thank you doctor
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Adv Covid-19

Respiratory alkalosis with hypoxemia and co2 retention. Hypokalemia Cxray shows bil mid basal inhomogenous heziness with mediastinal widening. Adv covid 19 swab Looks mixed infection. Antibiotics bronchodilators mucolytics Mechanical ventilation Tocilizumab remdesivir therapy may be helpful if proven.

Sir thanks for opinion,d -dimer and CRP raised
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