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Name - Perumal Sex: M - Age
Name - Perumal Sex: M - Age
HISTORY
• Name- Perumal
• Age- 48 sex: M
• DOA- 3/12/2004
• Chief complaints- fever 4 days
cough & expectoration 4days
seizure 1 episode with altered
sensorium 4hrs prior to adm
HISTORY
• H/O continuous fever of high grade ass
with chills
• Associated with cough &expectoration
• Difficulty in breathing
• H/o generalised tonic seizure associated
with urinary incontinence
• Jaundice 3 yrs back
• Chronic smoker & alcoholic
EXAMINATION
• Conscious, restless,obeying commands
• No pallor,icterus,cyanosis,clubbing
• Mild pedel edema +
• Afebrile, tachypnea+
PR- 110/min,regular BP- 80 systolic
CVS-S1,S2 not heard clearly
RS- Bil crepts + ,occ rhonchi +
P/A-diffuse tenderness/guarding +
PROVISIONAL DIAGNOSIS
• Pt in grade 3 sensorium
• PR-157/min BP-100/70 mmHg
CVS – S1S2 +
RS- bil crepts +, Rhonchi +, gasping &
chest indrawing +
• Pt put on PB ventilator with SIMV PC PS
with 50% FIO2
Contd….
• Pt weaned from ventilator and extubated on
7th morning
• Pt monitored with ECG,Spo2,HR,NIBP
• At present pt is conscious,oriented,obeying
commands ,febrile
PR-98/min RR-26/min BP- 118/105mmHg
Spo2- 98% in room air
RS- clear, NVBS CVS-S1S2 +
P/A-soft distension+
workup
• WBC-13,200cells/cu mm Hb-10gms%
• N-77% E-7% L-16%
• BU-114mg% BS- 189mg% SC-3.4mg%
• Na 144 K-5.3 se amylase-113 iu/l
• STP-4.6, Alb-2.4, bil-0.6,AST-109,ALT-73
ALP-413
• CSF-protein-100mg% sugar-71mg%
• MP/MF- negative
• Tracheal aspirate- pseudomonas sens to
cipro,amikacin,ceftazidime
ACUTE RESPIRATORY
DISTRESS SYNDROME
DEFINITION
• Acute onset
• Bil infilterates on chest radiograph
• PAWP-<18mmHg or absence of
clinical evidence of lt atrial
hypertension
• ALI-Pao2/Fio2<= 300mmHg
• ARDS-Pao2/Fio2<= 200mmHg
Pathophysiology
• Hallmark-increased vascular
permeability to proteins
• Three stages-initiation
ampilification
injury
• Interstitial and alveolar edema
• Alveolar collapse and decreased
compliance
Pathology