Patient came to hospital to have surgery for bladder stone...underwent cystolithotripsy with TRUS... Next day developed AF and x ray shows this.... TLC- 14000... Creatinine -2.70.... Patient now on mechanical ventilation., ionotropic support, antibiotics( teicoplanin, levofloxacin) What to do next???

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opacities are more on right side. patient has aspiration pneumonitis with pulmonary edema, may be he was given iv fluids in excess after operation, resulting in pulmonary edema, how was the pre operative ecg? ?

pt. is in sepsis and shock post surgery. on inotropic support with raised serum creatinine. rule out acute kidney injury. fluids acc. to cvp to be given. can be sepsis due to staph. it may cause such cxr picture. send et sec. for c/s. get bnp levels done, procalcitonin, echo fr ejection fraction, aspergillus galactomannan. give cover for staph and voriconazole. keep in isobalance. get lft done. antibiotics acc. to c/s or shift to colistin and tigecycline acc. to creatinine clearance

ET tube is below its normal position. It appears to be aspiration pneumonia leading to pulm edema

looks like pulmonary edema go for pro BNP level and if elevated then start diuretic infusion under cover of dobutamine support and plz do an ecg also and attach here

obstructive uropathy resulting in renal failure. Possibility of bladder stone either not removed completely or another stone might have slipped down . Imaging can help for localization of stone and rest is to manage the renal failure. Regarding CXR , its showing multiple opacities on right side. possibility of pneumothorax on left side , cardiomegaly is also there. ?Iatrogenic pneumothorax .

Wat about right side of x ray??? Could it be ARDS??
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check for hiv status. pcp may be. consider mets also. check for PSA level. left lung pneumothorax is also there. There is also a cavity in left side. may be tubetcular etiology. AF is secondary to parenchymal lesion.

Pulmonary edema

Pulmonary oedema.

monitor CVP,strict intake output charting, start diuretics acc to BP,continued antibiotics, keep in negative balance,

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