Patient in ICU with COVID pneumonia

This patient was admitted to the ICU with COVID pneumonia a few weeks ago and due to a very high D-dimer level, empiric anticoagulation was initiated. The night prior to extubation, the patient's oxygen saturation plummeted, fresh blood appeared in the ventilator tubing, and the second X-ray was obtained.

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Progressive versioning clinical status GGOs bilateral 2nd xray shows advancing disease As pt is covid19 positive and D-DIMER raised right step to initiate anticoagulation yes fall out is excessive bleeding or oozing noticed in ventilator tubing Pulmnonary perfusion is compermised and pulmonary oedema increased probably landing in pulmonary thrombosis thence oedema Gcs is 0

Thanx dr Pushkar ji Bhomia
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* COVID 19 case showing pneumonia and ARDS. 2ND X-RAY DETERIORATING CONDITION MAY LEAD TO EVENTUALITY.

Thanks Dr kute Ankush
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RT ETT Central line in situ. Bil ground glass opacities with nodular infiltration seen. Findings sugg of ARDS. Comparable cxrays are progressively deteriorated.

Typical covid pt bilateral pneumonia 2 nd xray infection spread anticoagulation anti inflamatorry steriod antiviral ramsibir antibiotics azithro pt has to sleep on abdomen results positive hcq no pt of rheumatoid died due to covid those on steriod & hcq

* SEQUENCE OF COVID-19 .. PNEUMONITIS.. * ARDS.. * SARI..

Tnx Dr Sandeep Ghodekar sir..
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Very interesting case Thank you for updating There is a recommendation for Anticoagulation in COVID 19 because of extensive Thrombosis found in cases of COVID 19 First X Ray shows peripheral ground glass appearance typical of COVID 19 Second X Ray shows dense infiltrate in middle zone in both lung field - right now than left, there is evidence of peribronchial thickening in right middle zone - seen by prominent air filled bronchus surrounded by thick homogenous hyperdensity This kind of picture may be secondary to aspiration pneumonia Kindly check for Coagulation parameters in view of bleeding

Rapid worsening of COVID pneumonia , probably made worse by pulmonary bleeding induced by anticoagulation. What anticoagulation was used ? Suggest continuing ventilation, tranexamic acid. Plasma therapy can be tried .

B /L Pneumonitis mid & lower zone more on right side ARDS COVID infection

Bilateral pneumonitis.deterioration possibly due to pulmonary haemorrhage.

SUGGESTIVE. OF WORSENING. OF COVID. ,19. PNEUMONIA ARDS

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