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

1 Like

LikeAnswersShare
Concluded answer

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.

All Answers

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

Valuable opinion
1

View 2 other replies

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
0

View 1 other reply

It is a case of B/L consolidation(R>L) secondary to pneumonia.....send Rt-Pcr to r/o COVID -19 pneumonia(possibility is quite high that patient comes COVID -19 positive)....start inj meropenem and inj azithromycin....inj dexamethasone....inj LMWH.....tab oseltamivir 150 mg Bd....kindly update the proper ABG.(po2 and pco2 not mentioned)...prognosis and treatment highly depends on it especially if the patient is on ventilator...repeat ABG every 12/24 hrly... repeat x Ray after 3rd day....if Rt-Pcr positive then treat acc to guidelines.

Valuable opinion
0

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.

Valuable opinion
0

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
0

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

Valuable opinion
0

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

Valuable opinion
0

View 2 other replies

A case of PNEUMONITIS please ask for COBID-19 INVESTIGATION

In this pandemic I would like to suspect COVID 19 infection Other possibilities is community acquired pneumonia. Blood gas is showing severe metabolic acidosis He will require invasive ventilation. Do RT PCR covid swab test. Do routine lab testing, CRP , Ferritin and D dimer and liver function test Start remedesivir and methyl pred with antibiotics cover. Can try trial of methylene blue Monitor blood glucose level

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.

Load more answers

Cases that would interest you