Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Plan To Start Metoprolol And Enalapril Once Hemodynamics Is Maintained And Renal Function Improved For Enalapril
Question: Hi my name is selam . I want to get medical advice for my father. He is in ICU for COVID in XXXXXXX The doctor text me his situation as follows .
Admission diagnosis: Severe COVID19 ARDS with superimposed bacterial infection
+Rt.side hemiparesis 2ry to ?ischemic stroke
+STEMI
+Septic/cardiogenic shock
+AKI(non oligouric)
+Rt.lower limb(popliteal) DVT
Currently,he is on
Meropenem and vancomycin
Aspirin 81mg po daily
Atrovastatin 80mg po daily
Heparin 17500IU SC BID
Dexamethasone 6mg IV daily
On sedation and NG feeding
Mechanical vent:
FiO2=80%. PEEP =10
Pinsp =15
ABG
PH=7.225 PO2=82 PCO2=42.5. HCO3=16.5 lac=2.25 Na=144 Cl =114
Renal:
Cr=4.29 BUN=96
Liver function:normal
ECG:
ST segment elevation on lead 2,3 and aVF
Cardiac enzymes:
Troponin=26,422
Bedside echo:RWMA on the inferior wall
EF is estimated >40%
Plan:to start metoprolol and enalapril once hemodynamics is maintained
And renal function improved for enalapril
Admission diagnosis: Severe COVID19 ARDS with superimposed bacterial infection
+Rt.side hemiparesis 2ry to ?ischemic stroke
+STEMI
+Septic/cardiogenic shock
+AKI(non oligouric)
+Rt.lower limb(popliteal) DVT
Currently,he is on
Meropenem and vancomycin
Aspirin 81mg po daily
Atrovastatin 80mg po daily
Heparin 17500IU SC BID
Dexamethasone 6mg IV daily
On sedation and NG feeding
Mechanical vent:
FiO2=80%. PEEP =10
Pinsp =15
ABG
PH=7.225 PO2=82 PCO2=42.5. HCO3=16.5 lac=2.25 Na=144 Cl =114
Renal:
Cr=4.29 BUN=96
Liver function:normal
ECG:
ST segment elevation on lead 2,3 and aVF
Cardiac enzymes:
Troponin=26,422
Bedside echo:RWMA on the inferior wall
EF is estimated >40%
Plan:to start metoprolol and enalapril once hemodynamics is maintained
And renal function improved for enalapril
Brief Answer:
The cause of the hemiparesis should be evaluated further.
Detailed Answer:
Hello,
It is clear that this is a severe case of COVID-19 infection with multiple systems complications.
The treatment of the COVID-19 itself and the subsequent complications is a matter of approved treatment protocols combined with adjustments according to the patient's status, and I think the treatment in your father's case is correct.
One thing about hemiparesis, in my opinion, brain imaging ( in this case a brain CT scan seems more justifiable ) is necessary to understand the underlying cause, which, besides ischemic, may be hemorrhagic too.
After this evaluation, the overall treatment should be reevaluated.
Hope you found the answer helpful.
Let me know if I can assist you further.
The cause of the hemiparesis should be evaluated further.
Detailed Answer:
Hello,
It is clear that this is a severe case of COVID-19 infection with multiple systems complications.
The treatment of the COVID-19 itself and the subsequent complications is a matter of approved treatment protocols combined with adjustments according to the patient's status, and I think the treatment in your father's case is correct.
One thing about hemiparesis, in my opinion, brain imaging ( in this case a brain CT scan seems more justifiable ) is necessary to understand the underlying cause, which, besides ischemic, may be hemorrhagic too.
After this evaluation, the overall treatment should be reevaluated.
Hope you found the answer helpful.
Let me know if I can assist you further.
Note: Get 1 to 1 help with your critical health concerns.Click here..
Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
