Concluded Case

80 yrs chulha smoker female, known copd ,off treatment since a year, presented with cough fever and dyspnea since last 5 days. HR 110, BP 140/100, spo2 50%. taken on NIV. RS-bil polyphonic wheezing with tachypnea. reports are attached. plz discuss approach to the case.

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Chronic Chulha Smoking with h/o COAD Cough, fever n dyspnea Type 1 Respiratory Failure ECG showing LBBB Echo s/o Cor Pulmonale sec to Lung Disease with Pulmonary HTN HRCT shows b/l ground glassing and diffuse septal thickening with emphysematous changes... NIV (Bipap) with I/v steroids plus Respiratory Antibiotics plus Bronchodilators for in hospital treatment f/b long term LABA plus LAMA plus ICS for maintenance.... Pneumococcal and Influenza vaccine for Prophylaxis... Roflumilast to prevent exacerbations
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Sir, this seems to be a case of acute exacerbation of biomass fuel exposure COPD with pulmonary hypertension now presenting with acute on chronic type 2 respiratory failure. My line of treatment would be: Iv abx (preferably sputum/BAL guided) Bronchoscopy will provide diagnostic information and will also provide support in clearing secretions. Iv steroids NIV support to keep spO2- 88-92% Bronchodilators Mucolytics Diuretics if required. If wheezing or type 2 RF does not improve aminophylline infusion may be considered. What is interesting is.. that on discharge this patient will be a candidate for ICS+LABA+LAMA since biomass fuel induced COPD is now seen to be an eosinophilic process (according to recent studies).
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Chronic Chulha Smoking with h/o COAD Cough, fever n dyspnea Type 1 Respiratory Failure ECG showing LBBB Echo s/o Cor Pulmonale sec to Lung Disease with Pulmonary HTN HRCT shows b/l ground glassing and diffuse septal thickening with emphysematous changes... NIV (Bipap) with I/v steroids plus Respiratory Antibiotics plus Bronchodilators for in hospital treatment f/b long term LABA plus LAMA plus ICS for maintenance.... Pneumococcal and Influenza vaccine for Prophylaxis... Roflumilast to prevent exacerbations
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ABG S/o type 1 RF with metabolic alkalosis with compensatory respiratory acidosis , NiV plus for moderate PAH add tab dytor 5 mg 10 am od , for 5 days start inj solumedrol 125 mg, CXR s/o emphysematous changes with some B/l ring like opacities b/l mid zones prominent on rt side... Most probably bronchiectasis changes...sent sputum samples for AFB and pyo /s , pls tell TLC counts also , future plan FOB if pat stable and also vaccination.
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RA ...and. RV.... ...are. Dilated.. Moderate. Pulmonary. HYPERTENSION.... with. Effusion...65 percent.. K / C / O.. .....C O P D... ACUTE. Exacerbation.... Corpulmonale... ADVISABLE..... 1. I / V...... INJ. Aminophylline ....over 10. Min. 2. Pulmoceph 500 3. Mucolytics 4. INJ. Dexa. ........I / V.. 5. Bronchodilators.. 6. INJ. Lasix.....I / V.. 7. Nebulization..
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COPD with COR PULMONALE WITH TYPE 2 RESPIRATORY FAILURE with PAH Nebulization Diuretic Antibiotics Steroids BIPAP ( Ipapa/epap to be cautiously selectedas there are multiple bullae )
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IT'S A CASE OF COPD..WITH.. RESPIRATORY ACIDOSIS..
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Agree with Dr Dinesh Gupta.
Thanks Dr Dinesh Gupta.
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Agreed with colleagues she is a c/o acute on copd with respiratory failure type 2 but she is in distress as abg suggest compensatory redp acidosis good line of treatment Dr Sandeep she has PH 50mm with diuretics i prefer bosantan as pt has dilated rt chambers I agree dr Tarang Kulkarni
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Congratulations! Your case has been selected as Case of the day and you have been awarded 5 points for sharing the case. Keep posting your interesting cases, Happy Curofying!
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COPD Tab cefodroxil 200 BD Tab Mucinac 600 BD (water soluble) Tab Theophylline SR BD Syp Doxofylline. 10ml TDS
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