A 60 yr old male who is a chronic smoker presented with Breathlessness, pedal edema , poor oral intake and personality changes since 5 days....vitals at presentation were BP-160/100 PR-106/min, spO2-85%, Rbs- 88....No h/o any comorbidity..comment on the approach to this patient...



X- ray shows pleural effusion encapsulated needs to be drained and examined could be tubercular or malignant.

Corpulmonale with destroyed lung

Looking at clinical featurs & provided reports appear to be caze of ccf with reduced EF 'ascites .on xray could be lt siddd pleural effusion or pneumonitiS .Treatccf with o2 & diuretics.Thenre assess

It's cardiac asthma.... Ink. Lasix.... O2,bipap If saturation still reduced.. Shift on ventilator bcoz spo2is deteriorating

This pt. Needs very extensive investigation, like CXR to exclude chest malignancy, gastroscopy for any stomach pathology,cardiac investigation to exclude CCF control of BP. AND in. View of personality changes C,T scan of brain.and treat the causes.

Have you done routine blood exam.to rule out hypothyroidism anemia creatine level. Ecg.and 2 deho is also required.

Can lanoxin be prescribed right now in this low potassium??

Sir i said first correct the ionic balance and yes pts lt ventricular functions are vary poor we have to restore as early as possible yes you will have to keep monitoring as well including potassium

This pt is critically ill.pt is air hunger as protrusion of tounge says.presence of ketone bodies and hyponatrimia i.e. ketoacidosis.at the same time 2d echo shows gross Lv dysfunction Lvef is 35 to 40 % only usg also shows hepatomegaly with mild ascitis or interloop collection.pts x-rayis informative.lt side shows gross pl effusion with collapseof the lt lung and on rt sidecanon ball opacities are visible with dense shadow in rt middle and hilar region.mediastinum is in centre.pt is chr smoker predisposing factor for malignancy.ecg is not posted. I shell treat this pt as ca lung with lvf since he is hypertensive he must be on anti hypertensive drugs. Fisrt treat ketoacidosis put him on iv diuretics maintain p02. Tap pleural effusion sent for confirmation condition improves i will start lanoxin.he seems to be nondiabetic. Sofar hepatomegaly is concerned that is secondary to long standing chf.

Thanx dr Nsv Nair

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Dcmp wid ccf .propped up.neb wid duolin budacort bd.oxygen inhalation.inj lasix infusion 1mg per hr.tab ramistar 5mg od. Tab lanoxin .25 mg od .

Kindly see echo

CCF....Ischaemic cardiomyopathy...Diuretics...Correction of dyselectrolitemia..Anti platelets and statins...Tovaptans for hyponatremia...Close monitoring.

Kindly see echo...there is no e/o cardiomyopathy

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