Concluded Case

DYSPNEA ON EXERTION WITH DRY COUGH

34yrs/M presented with 2 days Dyspnea and dry cough and wheezing with mild fever.No documented medical history.O/e - Spo2 -78%,Temp -100°F.INTERPRET CXR WITH MANAGEMENT PLAN? Chief Complaints Dyspnea and dry cough and wheezing with mild fever Lab Report ABG - pH -7.02,Hco3 - 15,Na -145,K -3.2,Ca - 0.67,Lac -4

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Straightening of left heart border. Bil basal haziness seen. Findings sugg of bronchopneumonia with? ILD Needs to evaluate for active infection including covid pneumonia. Start with oxygen support and NIV sos . Broad spectrum antibiotics. CT thorax. If sugg of GGos and organising pneumonia, can consider antivirals. Bronchodilators. Abg Sugg of met acidosis. Needs to support hemodynamically. Fluid management.

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X- Ray Picture along case history and examination and reports are indicative of COVID-19 disease.. There is a mixed picture of ground glass opacities and air consolidation as well in this X- ray highly suggestive of COVID-19 disease. I take an opportunity to clearly differetiate between ground glass opacities and consolidation. In radiological terms - Ground glass means a hazy lung opacity shows on imaging that is NOT dense enough to obscure any underlying pulmonary vessels or bronchial walls,as in this case .In this case one can clearly see underlying pulmonary vessels and bronchial walls indicative of ground glass opacities of COVID-19. In consolidation- there is a dense opacity which completely obscures vessels and bronchial walls,. X- ray in COVID-19 is not that informative to differentiate between COVID-19 disease viral pneumonia or bacterial pneumonia. CT scan should be done in this case to confirm classical findings of COVID-19 in chest .Also a rt - RT - PCR from Nasopharyngeal, oropharyngeal and if possible from broncho alveolar lavags secretions should be done Management plans - Considering SPO2 7.O2 and respiratory acidosis- I think patient should be put directly on non - invasive or invasive mechanical ventilation. These are the cases - in whom life can be saved by early resorting to mechanical ventilation. Thanks

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Air space consolidation in both lower lobes Highly suggestive of pneumonia This patient has severe Hypoxia with ABG showing metabolic acidosis with increased lactate level He has likely possibility of COVID 19 infection RT PCR test for COVID 19 need to be sent He can be started in high flow nasal cannula oxygenation and to see if oxygen saturation improves If oxygen saturation do not improve then he will need invasive/ noninvasive ventilation IV antibiotics Ionotropic support if required to maintain hemodynamic stability Sugar control preferably with insulin

Sir thanks for opinion,is there ground glass opacities in x ray
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Straightening of left heart border. Bil basal haziness seen. Findings sugg of bronchopneumonia with? ILD Needs to evaluate for active infection including covid pneumonia. Start with oxygen support and NIV sos . Broad spectrum antibiotics. CT thorax. If sugg of GGos and organising pneumonia, can consider antivirals. Bronchodilators. Abg Sugg of met acidosis. Needs to support hemodynamically. Fluid management.

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Bil basal pneumonia with ground glass appearance of both lungs. Severe acidosis with hypokalemia and anion gap . ? COVID pneumonia Suggest RTPCR for COVID,HRCT Renal function test Patient will require high flow oxygen / ventilation, Remedesvir , methyl prednisolone , LMWH

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It's a suggestive case of pneumonitis, mild cardiomegaly, COPD, LRTI, DO FIRST RTPCR DUE TO COVID -19,

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Chief complaints corelating with findings Spo2 is 78% and temp is 100°f Xray shows GGOs bilateral in lower zones Findings are indicative of covid19 pneumonitis Rx ICMR protocols for covid19 NIV 02 supplement Broadspectrum antibiotics Azithromycin 500 mg 1od or injectable Add antiviral oselmtivir150mg 1bd Tab deriphyllin 200mg 1tds Adv sr ferritin and D-dimer Compensate respiratory alkalosis

Thanx dr Kute Ankush
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Bilateral basal consolidation/ pneumonia changes noted, in patients who are infected with Covid19 , in the last three months I have noticed that when they present with respiratory symptoms X-ray shows basal consolidation and CBC shows Leucopenia, Covid19 test should be done to confirm.

Rt bronchioles prominent Lt cardiac apical haziness Favor pneumonitis spo284 low alkalosis Do RT PCR clia to r/0 sarscov2 Hrct expiratory films

Acute acidosis
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ABG is showing metabolic acidosis with high lactate suggestive of spsis with hypoxaemia. Get R t PCR for covid..19..plus all routine investigations including D dimer and CRP..HRCT CHESTto rule out covid the pneumonia IF COVID ..19 infection positive Iv AZITHROMYCIN IV THIRD GEN CEPHALOSPIRIN Iv steroids Iv Ramidesvir O2with high concentration mask to maitain spo2above 94percent.if not sble to maitain o2saturation ..NIV WITH BIPAP OR CPAP OR INVASIVE VENTILATION .GOAL IS TO MAINTAIN SPO2ABOVE 96PERCENT IV FLUIDS..MAINTAINING ELECTROLYTE BALANCE AND ADEQUATE URINE OUTPUT AND HIS BP

A case of PNEUMONITIS please ask for COBID-19 INVESTIGATION

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