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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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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X ray chest shows bilateral ground glass opacities, high CRP, High D dimer and lymphopenia are all pointing to COVID 19 as cause of her condition She is critically ill and hypoxic She needs noninvasive ventilation to get her oxygen saturation to normal Very high D dimer is indication of cytokine storm, she needs support with Inj. Methylprednisolone to counter cytokine storm Consider Remdesivir Her HbA1c is high, she needs her sugar to be normalised - consider insulin infusion Thrombosis is very common in COVID 19, gm high D dimer is indicative of thrombosis, she needs heparin infusion in therapeutic dose with Target PTT 2 times normal

Valuable opinion
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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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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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* 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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ARDS/Respiratory Alkosis/ B/L haziness with opacities/ Mediastinal is widen & slightly deviated/ Hypokalemia with Hypernatremia/ ILD/ Emphysema She is critically ill & Need Non Invasive Pressure Ventilator Therapy, High Oxygen Therapy DO RTPCR - ?COVID -19... Start Broad Spectrum Antibiotic Do Bedsided 2D Echo, HRCT CHEST ABG..

Thanx@Dr. Maqusud Ansari sir ji
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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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Chest X-RAY shows ground glass appearance bilateral, CRP raised , d - dimer suggest thrombosis ,Lymphopenia ask for COBID-19 investigation

Strongly favourable to covid 19 Get the covid 19 done Management is according to protocol of covid 19

Acute Respiratory Distress Syndrome? Agree with Dr.shivraj Agrwal sir

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