SOB and cough
Chief Complaint A 57 y/o female was diagnosed with right breast cancer. She was on 6th week of chemotherapy and complaints of cough, sob, sweating & fever. Vitals BP: 100/40 mmhg, HR: 107 beats/min, Breaths: 35 bpm, Temp: 102.9 degree F, SpO2 85% on room air. Examination It shows b/l diffuse crepitation and wheezing in the chest. Investigations Hb 89 g/l, Platelets 312 × 109/l. WBC 5.5 × 109/l, ANC 4.1 × 109/l, ECG normal, Liver functions normal. X-ray & CT shows ground-glass opacification of both lungs and b/l airspaces were noted. Treatment What is your opinion on the management?
Pt is febrile hypoxic and sob As you suggested xray chest and hrct are suggestive of GGOs In this context a c/o breast cancer already on immunosuppressants is low with immunity Findings are suggestive of covid infection Confirm by RT pcr Simultaneously consider to r/o secondaries
Overall cryptogenic organising pneumonia with respiratory failure. Evaluate for Infective and neoplastic etiology. Adv throat swab RT PCR for SARS cov 2. Sputum analysis. Bronchodilators mucolytics oxygen/ NIV support, iv antibiotics . Sos antivirals.
Preliminary investigation are suggestive of chest infection with septicaemia with signs if septicaemic shock like hurried respiration rate, low blood pressure Xray and CT showing ground glass appearance. Go for to see oxygen saturation Blood for TR-PCR to rule out Covid 19 if negative treat with high antibiotic High pressure Oxygen by nasal mask if saturation does not show any improvement put the pt on ventlation If positive admit in Covid hospital and to follow the Covid protocol
It appears that she has chest infection with septicemia Adv Admit in ICU Oxygen by nasal prongs X Ray chest, WBC count, creatinine, arterial blood gas etc need to be checked Start on higher antibiotics
NEEDS 1. HIGH. PRESSURE. OXYGEN 2. BROAD. SPECTRUM. ANTIBOTICS 3. COVID. PROTOCOL.... IF. PROVED
NEED'S.. RT..PCR..COVID-19.. MANAGEMENT AS PER PROTOCOLS FOR COVID-19..
As per X-ray report please R/O COVID 19 Ad RT PCR Antibiotics Seroflo & Duoline rotacap inhalation sos Grilinctus BM 2 tsf tds Nsaid orally
? COVID 19 with Right side breast carcinoma Adv: RT PCR for covid, HRCT THORAX Admit the patient to ICU/HDU Keep pt NPO Start IV FLUIDS & OXYGEN THERAPY Maintain BP & saturation above 90% Inj DOXYCYCLINE 100mg bd with 100ml NS Inj MONOCEF SB 1.2g bd Inj PANTOPRAZOLE 1 vial bd Inj ONDEM 4mg bd Inf PARACETAMOL bd Inj MVI NEBULISATION with DUOLIN & IPRATROPIUM tds ASCORIL LS sos Keep head raised to 45° Continue rest drugs and supportive treatment
PCO2 to be maintained
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