A 65 year old man is brought to A & E department by his son on a wheel chair.

 A 65 year old man is brought to A & E department by his son on a wheel chair.

He is having difficulty in breathing since 4 days and according to his son he had attended a social gathering 8 days ago. After wards he had been complaining of a sore throat for 2 days and increasing weakness and had fever as well. The son also says he was given some medications including panadol and other medicine for his fever and sore throat by a local doctor but he is not able to exactly inform which medications were given.

On examination ,the patient appears drowsy and weak. His BP is 100 /60 mmHg.

His Oxygen saturation is 78 % on air

Respiratory rate is 25 / min

Pulse 110/min

Chest auscultation reveals bilateral crepitations.

You organize a portable X- ray chest which is shown below .

1 .What further investigation will you perform?

2. What is the most likely diagnosis?

3. How will you manage this patient ?

Answers given in comments section.

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1. What further investigation will you perform?

FBC , CRP , Covid 19 PCR Testing Serum Ferritin , Procalcitonin, IL6 , LDH , Arterial Blood Gases. Renal profile and Liver profile

HRCT / high resolution CT of lungs ( May show crazy paving and ground glass appearance ).

2 .What is the most likely diagnosis?

Severe ARDS secondary to SARS-COVID. The history is suggestive of Covid -19 associated Acute Respiratory Distress Syndrome and Chest X -ray is also strongly suggestive of SARS Covid ARDS.

3 .How will you manage this patient ?

Management will consist of giving High flow oxygen by rebreathing mask and if needed CPAP / Non inavsive or invasive ventilation depending on oxygen saturations and extent of lung damage on HRCT as determined by Netherlands Co-Rads classification.

Also dpending on results of PCR and inflammatory markers , Management consist of Intravenous steroids, IV broad spectrum antibiotics9 Such as Moxifloxacin or Tazocin , Antiviral medications ( Remdesivir / Tocizulumab and monitoring of intake output record and iv fluids depending on extent of AKI / Acute Kidney injury. Patient should ideally be managed in an isolation room in HDU / Covid Ward.