How to calculate dose of insulin

Know a patient who is a COVID survivor. He was in the ICU for a month, requiring mechanical ventilation for almost four weeks. That’s much longer than a typical patient with bacterial pneumonia. This patient required a lengthy infusion of the neuromuscular blockade which, along with shock, contributed to the profound weakness. This complication is also called critical illness polyneuropathy. *What can we do during these 4 weeks when the patient is paralyzed to minimize the myopathy and neuropathy that may develop? *Are there treatments or therapies? *Are you familiar with the concept of Disease tolerance and Adaptogens? I’d love to hear others’ reflections on this and if you have any tips for preparation

A 42-year-old male, working as a house builder came with 11-month history of persistent wheezing, heard not only during auscultation but also by the patient himself. This wheezing had no correlation with physical exertion. He had few episodes of haemoptysis within the last 7 months and dry cough for about a month. He had a 10 pack-years smoking history, until the age of 31 when he stopped smoking. He drank alcohol occasionally. His symptoms were unsuccessfully treated with inhaled β2-agonists and steroids for about 10 months. Apart from these medications, he took no other drugs. On auscultation, there were wheezes in the upper fields of both lungs. The chest radiograph showed a disproportion in dimensions. What else do you see?

Covid19 pneumonia 40 years old male patient (bank employee) with a history of coughing for 2 weeks, becomes febrile 2 days before presentation, the fever is responsive to acetaminophen, then chills and myalgia becomes apparent and he develops dyspnea on exertion. when he presented with ill-looking, fever and chills were significant, his vitals were PR 100, RR 20, peripheral O2 sat 85%, BP 140/90, sublingual Temp 39.5. He had DOE and on chest exam, he had coarse crackles all over both lungs. we immediately admitted this patient giving him nasal oxygenation by cannula, IV fluids, paracetamol IV administration , ABG was done pCO2 42, HCO3 22, pH 7.38, paO2 83. we requested a chest CT scan and yup , multiple patchy ground glass opacities infiltrating the peripherals, thus the patient was isolated immediately, multiple nasal swab specimens were sent for rtPCR. CBC was done . mild leukocytosis with no lymphopenia, no thrombocytopenia ... procalcitonin undetectable.. crp 2+ ... renal, hepatic and cardiac markers were all within normal ranges . the patient was then marked as covid19 pneumonia after the second rtPCR test.( first one negative) hydroxychloroquine 400 mg bid then 200 mg bid and azithromycin 500 mg stat and 250 mg daily were continued for 10 days ... no ECG abnormality was noted. the patient remained in a plateau phase, fever disappeared after 5 days, nasal oxygenation discontinued, only some mild dyspnea and mild cough were noted before discharge ( after 10 days) ... He was lucky, as i have seen people with this presentation undergoing intubation and have a poor outcome.

77 yeas old female with a background notable of metastatic small bowel GIST. The patient is on chemotherapy, HTN, thyroidectomy, cholecystectomy presented with 10 day Hx of intermittent fevers, nonproductive cough, and increased Shortness of breath. PO2 8.8 on FiO2 0.85 on admission Admitted to ICU and Intubated Lung protective ventilation commenced but desaturated to 80% following RIJ CVC. Decompressed by the bedside and a CXR was performed that revealed large pneumothorax. The chest drain inserted with pneumothorax resolved gradually. 1 day after admission the admitting diagnosis was confirmed COVID-19. What are your experiences and knowledge of managing COVID-19 patients? Please discuss

A 46-year-old female, was admitted for wheezing and dyspnea. She had been diagnosed with asthma 10 years previously and was well controlled using budesonide at 160 μg + formoterol at 4.5 μg b.i.d. combination therapy until 5 months before when she had a severe asthma attack at that time, during which her wheezing was not well correlated with physical exercise and had persisted for several months. She was treated unsuccessfully with budesonide at 320 μg + formoterol at 9 μg b.i.d. combination, montelukast at 10 mg/day, and oral steroids. Her medical history was significant for appendectomy and hemorrhoidectomy. She was taking thyroid hormone for Hashimoto's thyroiditis and calcium tablets for osteoporosis. What is your opinion on the case?