40yrs/F presented to ED with C/o Severe Respiratory distress and altered mental status.Patient started noticing symptoms 5 days after operated for hysterectomy (Uterine fibroid) at some other hospital.Emergently intubated after acute respiratory failure,patient had to be deeply sedated and paralysed. O/e - Crackles and wheezes,BP -140/80,PR -72,Spo2 -98,Temp -103°F. DIAGNOSIS AND SUGGEST MANAGEMENT PLAN?

66yr /F presented with Acute Respiratory distress and history of Fever for 8days. She is known hypertensive on treatment with Telmisertan 40 daily. Non Diabetic. Her Serial ABG, Biochemical profile, CXR (AP), ECG enclosed. Blood TC 14500, P74, L22, M0, E4, Hb 11.6gm%.

CXR is from a patient with Miliary Tuberculosis. How to proceed with the case?

62yr / F, came with Type 2 Respiratory Failure, with Fever and Cough for about one month. She was also having urinary incontinence.

Dear Friends.. ARDS is an important clinical condition which needs discussions.. ARDS (Acute respiratory distress syndrome) It is an Acute onset of rapidly progressive dyspnea, tachypnea, and hypoxemia. DIAGNOSTIC CRITERIA for ARDS: (1)acute onset (2)PaO2/FiO2 of 200 or less regardless of PEEP (3)bilateral infiltrates seen on frontal chest radiograph and (4)no clinical evidence of left atrial hypertension(pulmonary artery wedge pressure of 18 mm Hg or less if measured) ARDS is believed to occur when a pulmonary or extrapulmonary insult causes the release of inflammatory mediators which causes damage to the vascular endothelium and alveolar epithelium… leading to pulmonary edema, hyaline membrane formation, decreased lung compliance, and poor air exchange. ARDS has to be differentiated from congestive heart failure, which usually has signs of fluid overload, and from pneumonia. I have attached tables to help you differentiate.. TREATMENT It is largely supportive and includes… (1)mechanical ventilation with a strategy of Low tidal volume & high positive end-expiratory pressure. (2)prophylaxis for stress ulcers and venous thromboembolism (3)nutritional support (4)treatment of the underlying injury. (5)conservative fluid therapy Applying above strategy of  treatment improves outcomes. A spontaneous breathing trial is indicated as the patient improves and the underlying illness resolves. Most cases of ARDS in adults are associated with pulmonary sepsis or nonpulmonary sepsis. Risk factors include those causing (1)Direct lung injury (e.g., pneumonia, inhalation injury, pulmonary contusion) (2)Indirect lung injury (e.g., nonpulmonary sepsis, burns, transfusion-related acute lung injury). Risk factors in children are similar to those in adults, with the addition of age-specific disorders such as … Respiratory syncytial virus infection and near drowning aspiration injury. Pharmacologic options for the treatment of ARDS are limited. Although surfactant therapy may be helpful in children with ARDS,   The use of corticosteroids is controversial. Randomized controlled trials and cohort studies tend to support early use of corticosteroids However, no consistent mortality benefit has been shown with this therapy. Mortality is between 34 and 55 percent in different recent trials and most deaths are due to multi-organ failure. Thanks Dr K N Poddar