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Suggest Treatment For Respiratory Distress
hi.........m a doc from west bengal, india. my father is suffering from severe respiratory distress 4m last 5 months....he was a chronic smoker bt not for last 3 yrs before he developed resp distress limiting his daily activities. he was primarily diagnosed to have PAH along with COPD nd was prescribed sildenafil when he developed hemoptysis 5 months ago...not relived nd was added bosentan...again it failed to correct hemoptysis,nd the dyspnoea aggravates. he was admitted here under at burdwan medical college.west bengal india..where i m persuing MD. treated wid various antibiotics bt all went in vain.Rather he developed new onset lower lobe consolidation (lt)along with the pre-existing rt lower lobe. his spo2 goes beyond 71% nd is on LTOT for last 3 months. he was given ANTI TUBERCULAR DRUGS empirically for his B/L consolidation. at present neither his saturation nor his dyspnoea at rest is improving rather it detoriates time to time....WHAT SHOULD I DO NOW?
Wed, 25 Oct 2017
Hello
Thank you for trusting HCM
Dear friend sorry to hear about your father health status.
What about echo findings?? Pulmonary hypertension mild, moderate or severe? What about Ra, Rv? How much ef???
Weather he is intubated???
What is platelet count and pt/in??
What about leukocyte count??
Possible causes for heaemoptysis??
1.infection (it may be pneumonia, pulmonary tb, or aspergillosis or paragonimus)
2.bronchetasis???
3.pulmonary embolism??
4.pht with dilapidated ra and Rv with TR with invective endocartitis?? With septic thrombus??
Advice :
HRCT, D-dimer, sputum culture, blood culture pt /inr, platelet count, usg chest.
Treatment :
1.If blood pressure normal you can add amlodipine.
2.You can add prostaglandin analog epoprostenol and treprostinil(use nor adrenaline if systemic blood pressure low)
3.increase antibiotic reach to area by reducing pulmonary artery resistance
4.add metrogyl or clindamycine if you think he developed aspirated pneumonia.
Use linezolid with meropenam.
Thank you
Thank you for trusting HCM
Dear friend sorry to hear about your father health status.
What about echo findings?? Pulmonary hypertension mild, moderate or severe? What about Ra, Rv? How much ef???
Weather he is intubated???
What is platelet count and pt/in??
What about leukocyte count??
Possible causes for heaemoptysis??
1.infection (it may be pneumonia, pulmonary tb, or aspergillosis or paragonimus)
2.bronchetasis???
3.pulmonary embolism??
4.pht with dilapidated ra and Rv with TR with invective endocartitis?? With septic thrombus??
Advice :
HRCT, D-dimer, sputum culture, blood culture pt /inr, platelet count, usg chest.
Treatment :
1.If blood pressure normal you can add amlodipine.
2.You can add prostaglandin analog epoprostenol and treprostinil(use nor adrenaline if systemic blood pressure low)
3.increase antibiotic reach to area by reducing pulmonary artery resistance
4.add metrogyl or clindamycine if you think he developed aspirated pneumonia.
Use linezolid with meropenam.
Thank you
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