Pulmonary embolism

30 year old male patient presented to casualty with complaints of 
-bilateral pedal edema extending upto ankle since 7 days which was pitting type.
-decreased urine output,burning micturition and loss of appetite since 2 days.
-shortness of breath since 1day(grade 3-4)
patient got admitted in outside hospital and got treated for urosepsis and AKI,where HRCT was done(CO RADS-1)
On presentation to our casualty patient had grade 4 dyspnea with mild confusion.

GENERAL EXAMINATION-
pt was drowsy
BP-80/50 mmhg, on giving fluid bolus bp was 90/60mmhg.
PR-91bpm
RR-26cpm
spo2-82% on room air-after supplying12lit O2 it was 96%
CVS-S1S2 heard,no murmurs
RS-BAE +,b/l fine crepitus+

INVESTIGATIONS-
ABG-
ph-6.83
pco2-28.9 mmhg
po2-93.4 mmhg
Hco3-5.1 mmol/l
st.Hco3-3.8 mmol/l
s.O2-82.1%
ECG-


Showing S1 Q3 T3 pattern

CHEST X-RAY AP VIEW-

2D ECHO-
Showing RA,RV dilated with RV hypokinesia

PROVISIONAL DIAGNOSIS-
? pulmonary embolism with AKI secondary to urosepsis 


 

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