Dr Gillani"s Blog

Saturday, 8 May 2021

A 45 year old female presents to your OPD with 3 days history of sore throat and fever and difficulty in breathing

A 45 year old female presents to your OPD with 3 days history of sore throat and fever and difficulty in breathing. She also complains of body aches and lethargy.

Her BP is 100/70 mmHg and pulse is 110/min.

1. What would be your next plan of action with regards to investigations?

2. What would be your management plan?

Answers given in comments section.

Copyrights reserved with the author.

1. Next steps in management:

1. Monitor oxygen saturation, in this patient case, they were 95 percent on Air.

2. Chest X-ray, it shows left lower lung infiltration + pneumonia.

3. FBC, CRP , inflammatory markers : IL6, procalcitonin, ferritin, LDH

4. HRCT

5. Renal and liver profile

6. Continue monitoring oxygen saturation and respiratory rate.

2. Management plan:

Currently this patient seems be having SARS Covid 19 infection , in earlier stages with stable oxygen saturation.

We need to start her on broad spectrum Antibiotics intravenously such as Tazocin 4.5 mg TDs and Moxifloxacin and intravenous steroids.

We need to continue monitoring her inflammatory markers and oxygen saturation + Renal profile.

In case of deterioration, she may need more intense treatment with High flow oxygen, intravenous steroids, Remdesivir, IV fluids and Acterma and invasive ventilation/ intubation

Monday, 3 May 2021

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.

Copyrights reserved with the author,

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.

Friday, 30 April 2021

Case History : A 45 year old female presents with increasing shortness of breath and bilateral pitting oedema of both legs.

A 45 year old female presents with increasing shortness of breath and bilateral pitting oedema of both legs. Her oxygen saturation is 86 percent. She is afebrile and her inflammatory markers are normal.

BP :145/65 mmHg

Her Chest X-ray is given below:

1. What are the chest X-ray findings?

2. What is the most likely Diagnosis?

3. What further investigation Should be performed?

4. How will you manage this condition?

Answers given in comments section.

1. Cardiomegaly+ peri hilar congestion + Bilateral pleural effusions.

2. Most likely Diagnosis: Advanced Congestive Cardiac Failure

3. Further investigations :

Echocardiogram

BNP levels

4. Management:

Intravenous diuresis with furosemide 40 mg 8 am, 20 mg 2 pm

High flow hoxygen

Bisoprolol

Loprin

Clopidrogel

Sunday, 25 April 2021

A 72 year old man comes to your OPD with complaints of swelling in both feet, and shortness of breath on climbing stairs.

A 72 year old man comes to your OPD with complaints of swelling in both feet, and shortness of breath on climbing stairs. Also complains of fullness in his right hypochondrium.

His pulse is 68/ min

BP is 126/75 mmHg.

Resp rate is 17/min.

Examination shows bilateral pitting oedema.

CXR given below:

1.What is the most likely Diagnosis?

2. What is the cause of fullness in Right hypochondrium.

3.What are the findings on Chest X ray.

4. How will you manage this patient?

Answers given in comments section.

1. Most likely Diagnosis:

Congestive Cardiac Failure

2. Cause of Fullness in Right Hypochondrium:

Congestive Hepatomegaly.

3. X ray findings:

Cardiomegaly

Peri hilar congestion

4. How to manage such patients:

1. Diuretics

2. Oxygen

3. Salt restriction.

4. Daily weights.

5. Fluid restriction of 1.5 litre.

https://www.kaizerleather.com/en/

Friday, 23 April 2021

A 63 years old man presents to your OPD with complaints of palpitations and light headedness since 6 hours.

A 63 years old man presents to your OPD with complaints of palpitations and light headedness since 6 hours. According to his attendant, he sometimes gets such episodes and becomes restless and confused during these episodes.

BP is 156/70 mmHG.

You find he has an irregular pulse.

JVP is normal.

No peripheral oedema is present

You perform an ECG which is given