Virtual Morning Report - June 10, 2026 - Acute On Chronic Cough With Expectoration

Approach to acute pulmonary syndrome: subacute episodic→ can be similar illness from before vs new syndrome on top of an underlying lung disease eg., bronchiectasis.

Patient with autoimmune disease-> think about medication side effect/autoimmune flare/superimposed manifestation of the disease/secondary autoimmune disorder.

Important to get ambulatory saturation to see if they are hypoxemic, if at baseline, they are saturating at 90-92% on RA

Bibasilar crackles: wet or dry? Pulmonary edema vs ILD etc.

Immunocompromised pt + pulmonary symptoms + high LDH = important to do an infectious workup including PJP. Dx & Tx approach: pulmonary workup (respiratory viral panel, AFB, bronch and BAL if feasible), broad spectrum abx, PJP prophylaxis, HFNC, escalation of care given oxygen requirement and acuity of case. Albumin is a negative acute phase reactant. CT scan of the chest helps to understand the etiology ILD vs DAH vs other. Findings on the CT & timestamp approach: Honeycombing (chronic), bronchiectasis (subacute), GGO (acute)

Reason for Code Blue? PE, aspiration, Vfib arrest? Stabilise pt first.

Think about pneumothorax in pt with sharp CP and PJP PNA (vulnerable cysts).

ICH, midline shift, herniation of brain (unequal pupils on exam) iso of sepsis could be DIC.