COVID 19 Pneumonitis with ARDS with probable CYTOKINE storm

35 years old young male without any comorbidity, presented with cough, sneezing, fever n dyspnoea at rest of just 4 days duration. On admission, BP was 100 systolic, Spo2 was 68% on air, Temp was 99.6 Pulse 112/min RS examination revealed bilateral crackles Blood investigations revealed N/L ratio =4 WBC 9100 Platelets 361000 HB 13 SGPT 100 CREAT 0.81 CRP 66 FERRITIN 550 d Dimer 1300 LDH 600 ABG on room air was:- pH 7.2 PO2 was 41 PCO2 was 56 Bicarb 19 RT PCR Positive for SARS COV-2 Please give your valuable opinion for further management..

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Typical history with all investigations supportive of diagnosis covid19 pneumonitis Xray shows cytokine storm Peripheral GGOs with pulmonary oedema Protocol of ARDS to be followed Beside hcq antiviral tab fepinavir 1800mg In my opinion this pt needs inj LMWH As D-dimer and ferritine are high Also look for myocarditis And DIC

Thanx dr Rajendra Rai
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Cxray shows bil densed opacities in bat wing pattern. SARS cov2 PCR positive. ABG shows mixed acidosis. Treatment well discussed by dr Kamran And Dr rajendra. To add Adv PCT level and IL 6 level May consider tocilizumab 400 mg stat and if required 2 nd dose after 12-24 hours depending upon patient's conditions .

Thank you doctor
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ARDS with Serve Pneumonitis Due To COVID -19, MILD PLEURAL EFFUSION, rule out Cardiomegaly, Treat Accordingly To ICMR guidline & prevent Sepsis, Bipap Support & give HFOT, Start Highly antiretroviral Therapy accordingly to guidline of ICMR, Do ABg, Do USG Chest On Bed Side & 2D ECHO, Best of Luck Hope Alive

Thanx@Dr. Sandeep Ghodekar Sir Ji
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Typical bilateral pneumonia spo2 very low parameter high d dimer ldh ferritin do il6 if positive is cytotoxic storm sarscov2 positive injection tocilizumab very effective oxygen therapy score is very vital pt prognosis

Thank you doctor
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Ards due to COVID Bipap support as much as can to avoid invasive ventilation Proning Icmr guidelines medication,higher antibiotics to prevent fr sepsis... God bless the patient as hes young guy

Thank you doctor
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Full blown COVID pneumonia ICU Ventilate patient , Azithromycin, HCQS, steroids ( since patient is in cytokine storm) , cautious IV fluids ,Favipiravir ( Fabiflu) LMWH / aspirin

Thank you,Doctor
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I think antibiotics, antiviral, but supplements, oxygen, ask pt to sleep in prone position and we have to prevent thrombi formation. As not being a clinician I will seek ones opinion.

Nice case.pt to be shifted to ICU for ventilator put on SIMV mode with high peep..... mgt follows as per clinical protocol inverse I:E to withdrawal respiratory setup

Cxr....Mostly peripheral uniform ground glass opacities... ABG... respiratory acidosis with hypoxemia n without compensation RX includes O2/steroid/anti viral.....

Thank you doctor
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ARDS ( COVID 19 positive. Treatment as per protocols of COVID 19. Regular monitoring and constant evaluation to avoid further complications and eventuality.

Thanks Dr Kute Ankush
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