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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

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 58 year old male, non-smoker, asthmatic patient was referred with 3 weeks history of breathlessness, wheezing, and dry cough. He had a history of acute severe asthma many years ago. However, he had not required ventilatory support during that period. Since then, he had self-medicating intermittently with oral salbutamol and theophylline only. On examination, the patient had dyspnoea at rest and tachycardia. Oxygen saturation was 90% on room air. Respiratory examination revealed bilateral polyphonic rhonchi; otherwise, he was normal. Arterial blood gas analysis revealed hypoxemia (PaO2: 54 mmHg) with respiratory alkalosis (pH: 7.43, PaCO2: 32.3 mmHg and Bicarbonate: 20 mEq/l). Let's discuss the case on today's World Asthma Day

Patient male, 42 years old. Sudden postoperative pain in the sternum for 3 days in the emergency department, the electrocardiogram is shown below. Emergency room BP160 / 102mmHg, symmetrical blood pressure in both upper limbs, double lungs (-), early diastolic murmur in the aortic valve area. *Discussion: * 1. ECG analysis. 2. Diagnostic considerations? 3. What to check next?

A 75-year old man with a history of hypertension, hemorrhagic cerebral infarction one year before, right-sided hemiparesis, and atrial fibrillation was brought to my hospital because of suspicious COVID-19 infection. He was seen in the ER because of a few days of dyspnea which became progressed and bad clinical condition. 7 days before the current presentation patient fell from its bed, and after that, he started to feel pain in his right part of the chest. He also noticed purple discoloration of his feet and left hand, which was painful and progressed further during the next days. He started to have DYSPNOEA, which also progressed. CBC: showed leukocytosis (26,9) and chest X-ray was described as bilateral pneumonia. On exam, the patient was alert, disoriented in time, immobile on the bed, with an obvious right hemiparesis, afebrile, tachypneic (R: 24/min), and bradycardic (P: 55/min), hypoxic (SpO2: 80%), with normal blood pressure. PHYSICAL EXAMINATION: showed dusky purple discoloration of both feet and fingers of the left hand. The patient's right feet showed some darker areas, which could be hematomas. CHEST EXAMINATION: showed the painful right side & we spotted the fracture of the 7th rib. Auscultation of lungs revealed bilateral inspiratory crackles, predominantly on the right side. The heart rhythm was regularly-regular. The rest of the examination was unremarkable. LAB ANALYSIS: revealed elevated urea (11,1) and creatinine (371), hypoalbuminemia (22), elevated LDH (705), and slightly elevated CK (201). The CRP was elevated (272,5), and coagulation panel was highly abnormal - aPTT 85,1s, PT 15%, INR >6,0, fibrinogen 2,4, and D-dimer 162 (normal <0,5). My (differential) diagnosis list for this patient was: - Fat embolism - Warfarin overdose - Bilateral pneumonia - Sepsis He didn't have any criteria for COVID-19, and also, its clinical presentation and disease course was not consistent with COVID-19 infection. The patient was transferred to ICU for further treatment. What do you say on this? I am mostly inclined to fat embolism in the first place, which was complicated, but I do not have experience with this diagnosis. What is your opinion on this case, what would be your further diagnostics and treatment?