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Suggest Treatment For Breathing Difficulty
Question: my dad is in ccu with a breathing issue. nose cultures were taken. the flu was ruled out. mrsa was positive. ct scan of his lungs were taken, they are inflamed and somewhat stiff. not sure if it is viral pneumonia or an auto immune disorder attacking his lungs. he was on a bipap today, now on a ventilator with a bronchoscope planned for tomorrow. he's been on 3 heavy antibiotics, etc.,but now the thought if it is auto immune that they will put him on a high dose of steroids. is there any reason why they don't try the steroids now to see how he responds?
he just had an annual physical 2 weeks ago, and all was great. last Thursday, he was trying to plug in Christmas lights, lost his balance and fell. his right hip and right knee hurt. he was concerned he might have a fracture. everyone was out of town. i found out the next day and he felt better. on Sat. his hip and leg still hurt.
so I had my son take my dad to the e/r. his b/p was slightly elevated and running a fever of 101.5. they took xrays, which I have not been able to find out of what yet. however, I found out today that a ct scan was done of his chest yesterday (maybe sat) w/ a current dx of interstitual lung problem. he is also type 2 diabetic.
he's actually 86. will be 87 in March.
he just had an annual physical 2 weeks ago, and all was great. last Thursday, he was trying to plug in Christmas lights, lost his balance and fell. his right hip and right knee hurt. he was concerned he might have a fracture. everyone was out of town. i found out the next day and he felt better. on Sat. his hip and leg still hurt.
so I had my son take my dad to the e/r. his b/p was slightly elevated and running a fever of 101.5. they took xrays, which I have not been able to find out of what yet. however, I found out today that a ct scan was done of his chest yesterday (maybe sat) w/ a current dx of interstitual lung problem. he is also type 2 diabetic.
he's actually 86. will be 87 in March.
Brief Answer:
Should proceed with bronchoscopy
Detailed Answer:
Hi! Welcome to health care magic! Thanks for sharing your concerns with us. We will try to help you in best way possible. First of all, it is sad to know what your dad had to go through.
Based on the history you have shared, the management which has recieved so far is no doubt excellent. It seems like it was an incidental finding as when he was taken to hospital for hurt knee with fever, it's usually to have all baselines done to rule out any other cause of fever. Xray chest findings might have triggered the reasons to proceed with such extensive work up to look for any impending chest or respiratory infection. It's good that culture detected the right bug and he recieved the treatment.
It's also usual to have blood gases done from time to time as with such lung pathologies it's quite possible to have a decreased gas exchange leading online low oxygen content and carbon dioxide retention. It's right solution is Bipap or CPAP at start and then considering mechanical ventilation through a tube if needed to correct internal acidity due to carbon dioxide retention.
Since he is already on CPAP at home for years it also reflects some other cause of his lung condition along with the current infection like lung fibrosis, stiffening or sleep apnea. The CT scan finding correlate with that too and it can be interstitial lung disease which can be autoimmune or post infection or sometimes idiopathic or due to unknown reasons.
If antibiotics course is completed and other parameters of infection have settled down and still lung symptoms exist they can.give him a steroid pulse. Your query that why didn't it try it earlier is that without antibiotic cover steroids would have run havoc in infection and would have lead to increase in infection.
Now if they want to proceed with bronchoscopy, they want to make sure not to miss any other infection by taking its cultures as well as microscopy for atypical cells. I would recommend to follow their treatment plan and proceed with bronchoscopy.
Wishing him a quick recovery. If you have any more questions, feel free to ask. Regards.
Should proceed with bronchoscopy
Detailed Answer:
Hi! Welcome to health care magic! Thanks for sharing your concerns with us. We will try to help you in best way possible. First of all, it is sad to know what your dad had to go through.
Based on the history you have shared, the management which has recieved so far is no doubt excellent. It seems like it was an incidental finding as when he was taken to hospital for hurt knee with fever, it's usually to have all baselines done to rule out any other cause of fever. Xray chest findings might have triggered the reasons to proceed with such extensive work up to look for any impending chest or respiratory infection. It's good that culture detected the right bug and he recieved the treatment.
It's also usual to have blood gases done from time to time as with such lung pathologies it's quite possible to have a decreased gas exchange leading online low oxygen content and carbon dioxide retention. It's right solution is Bipap or CPAP at start and then considering mechanical ventilation through a tube if needed to correct internal acidity due to carbon dioxide retention.
Since he is already on CPAP at home for years it also reflects some other cause of his lung condition along with the current infection like lung fibrosis, stiffening or sleep apnea. The CT scan finding correlate with that too and it can be interstitial lung disease which can be autoimmune or post infection or sometimes idiopathic or due to unknown reasons.
If antibiotics course is completed and other parameters of infection have settled down and still lung symptoms exist they can.give him a steroid pulse. Your query that why didn't it try it earlier is that without antibiotic cover steroids would have run havoc in infection and would have lead to increase in infection.
Now if they want to proceed with bronchoscopy, they want to make sure not to miss any other infection by taking its cultures as well as microscopy for atypical cells. I would recommend to follow their treatment plan and proceed with bronchoscopy.
Wishing him a quick recovery. If you have any more questions, feel free to ask. Regards.
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Above answer was peer-reviewed by :
Dr. Remy Koshy
Answered by
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