(Disclaimer: This article is for general science purposes only, and the relevant information in the following content has been processed to protect Mr. Wang’s privacy)
Abstract: Mr. Wang, 47 years old, had a winter illness with symptoms of high fever and dyspnea, rapid progression of lung shadowing, and severe hypoxemia, and was diagnosed with severe pneumonia and acute respiratory distress syndrome, which are relatively serious lung diseases. After timely symptomatic supportive treatment (oxygenation + medication), Mr. Wang’s body temperature returned to normal, lung shadow was absorbed, oxygenation improved smoothly off the ventilator, and gradually returned to normal, so early diagnosis and early treatment of lung diseases are crucial.
Basic information】Male, 47 years old
Disease Type】Severe pneumonia, acute respiratory distress syndrome
【Treatment hospital】Tianjin Haihe Hospital
Consultation time】February 2016
Treatment plan】Oxygen therapy + tracheal intubation + drug therapy (piperacillin sodium tazobactam sodium for injection, human albumin, oseltamivir phosphate granules)
Treatment period】15 days of hospitalization and 1 month of follow-up
Treatment effect】Symptoms relieved, condition gradually improved
I. Initial interview
Mr. Wang, 47 years old, was admitted to our department as an emergency patient with severe pneumonia and acute respiratory distress syndrome (ARDS). Mr. Wang had a history of smoking and alcohol consumption for more than 10 years, diabetes mellitus and hypertension for 10 years. The main pathogenesis: 7 days ago, he developed fever with a temperature of 39.3℃ after getting cold, had chills without chills, coughing, coughing and shortness of breath, and other symptoms, indicating that he felt wheezing obviously after activity, and consulted the local hospital, considering cold and bronchitis. Half a day ago, his wheezing worsened and he coughed up red watery sputum, so he urgently went to our emergency clinic.
When Mr. Wang was admitted to the emergency room, the oxygen saturation of finger pulse: 85%; blood leukocyte count: 3.75×10^9/L; lymphocyte count: 0.50 x10^9/L, lower than normal; C-reactive protein: 105 mg/L, significantly elevated. The bedside chest X-ray showed multiple solid exudative shadows in both lungs, with the right lung being the dominant one, and severe pneumonia and acute respiratory distress syndrome were considered.
(Chest X-ray of the emergency room on the day of admission)
II. Treatment history
Severe pneumonia and acute respiratory distress syndrome are clinically more serious lung diseases. When Mr. Wang was admitted to the RICU ward, physical examination: 10L/min of oxygen by face mask, finger oxygen saturation only about 90%, respiration 35 times/min, body temperature 38.3℃, heart rate 118 times/min, blood pressure 122/73mmHg, weight 90kg, height 1.72m. He was well nourished, fat, with a body mass index of 30.4. He was in a sedentary position with a wheezing appearance, cyanosis of the lips and mouth, wet rales could be heard in both lungs, negative abdominal examination, and no swelling of both lower limbs.
The physician checked his medical history while giving Mr. Wang high-flow oxygen through the nose, urgently opened intravenous access, and performed an emergency blood gas analysis to assess oxygenation. /L, Mr. Wang had severe hypoxemia, and chest X-ray showed large solid exudative shadow in both lungs. After preliminary assessment, Mr. Wang was diagnosed with severe pneumonia and acute respiratory distress syndrome. After communicating with his family, he was mechanically ventilated with transoral tracheal intubation to improve oxygenation and respiratory support, with an oxygen concentration of 80% and an oxygen saturation of 93%.
Because of the high season of influenza, influenza could not be excluded. At the same time, influenza nucleic acid testing of respiratory specimens was performed, and oseltamivir phosphate pellets were given empirically for antiviral purposes. We continued mechanical ventilation with transoral intubation in prone position, and supplemented with human albumin to increase immunity, improve the internal environment and symptomatic support treatment, and oxygenation stabilized.
On day 2, respiratory secretions of influenza A (H1N1) viral nucleic acid (+), the diagnosis of influenza A was clear, and after treatment bedside chest radiographs suggested: increased permeability of both lungs, the trend of absorption of exudation, blood gas analysis: PaO2: 96.8 mmHg; oxygenation index: 162 mmHg, oxygenation improved. On the third day, a chest CT examination was performed, which revealed multiple large solid exudate shadows in the lungs consistent with severe pneumonia, acute respiratory distress syndrome, and alveolar collapse without dilatation, at which point it was possible to explain the manifestations of wheezing and hypoxemia.
Third, the effect of treatment
After perfect examination and rescue treatment, the area gradually stabilized, and the body temperature returned to normal after 1 week, and the solid exudate of both lungs improved compared with the previous one. Significantly better than before.
On day 11, the influenza virus nucleic acid turned negative, the white blood cell count recovered, C-reactive protein decreased to normal level, the pulmonary infection was controlled, and oxygenation returned to normal.
On the 12th day, the chest CT was rechecked after the 13th day, and most of the lung exudate was absorbed, leaving mechanistic changes. The antibiotics were stopped, and Mr. Wang was generally well enough to get out of bed and was discharged on the 15th day of hospitalization. After 1 month of outpatient follow-up, he basically recovered to his pre-onset state. Mr. Wang and his family were satisfied and increased their trust in the doctor.
(Chest CT check on day 13, most of the lung lesions were absorbed)
IV. Notes
We are glad that Mr. Wang’s condition has recovered, but we need to remind Mr. Wang to get influenza vaccination after discharge to prevent influenza; to maintain good personal and environmental hygiene, wash hands regularly; to pay attention to good self-protection, not to go to crowded indoor public places unless necessary, to keep indoor air fresh at home, and to open windows frequently for ventilation. If coughing, coughing, chest tightness, shortness of breath and other uncomfortable symptoms occur after discharge from the hospital, you should go to the hospital in time for early diagnosis and treatment to avoid delaying the disease.
V. Personal insight
This case is a relatively typical case of acute respiratory distress syndrome due to severe influenza, which belongs to patients with more serious lung diseases. In addition, Mr. Wang was fat, with a BMI of 30.4, and had diabetes, hypertension and other underlying diseases for many years, so he belonged to the high-risk group prone to severe influenza. From the treatment of this case, we learned that firstly, early diagnosis of influenza is necessary, especially for people with high-risk factors, and early diagnosis and treatment can greatly reduce the occurrence of complications such as pneumonia. Recovery.