A 65-year-old man presents with complaints of increasing fatigue, dyspnea on exertion, and unintentional weight loss within the last 6 months. On examination, he is noted to have macroglossia and peripheral edema. Crackles are audible bilaterally on chest auscultation. What do you think how should we proceed for treatment?

Respiratory Failure Definition: Clinically respiratory failure is defined as PaO2 <60 mmHg while breathing air, or a PaCO2 >50 mmHg. Type 1 respiratory failure - low PaO2 & low or normal PaCO2. -Type 2 respiratory failure -low PaO2 & raised PaCO2 _TYPES OF RF:_ 1. Acute hypoxia without hypercapnia - acute type 1. 2. Chronic hypoxia without hypercapnia - chronic type 1. 3. Acute hypoxia with hypercapnia - acute type 2. 4. Chronic hypoxia with hypercapnia -chronic type 2. Clinical Features: -Cyanosis -Unoxygenated hemoglobin 50 mg/L -Dyspnea: secondary to hypercapnia and hypoxemia -Paradoxical breathing -Confusion, somnolence and coma -Convulsions -Circulatory changes: tachycardia, hypertension, hypotension -Polycythemia: chronic hypoxemia-erythropoietin synthesis -Pulmonary hypertension: Cor-pulmonale or right ventricular failure. ACUTE TYPE 1 RF: _Causes_: -pneumonia. -pulmonary edema. -acute respiratory distress syndrome. -pulmonary embolism. - pneumothorax. _Management:_ -Treat underlying condition. -High conc of oxygen. -Artificial ventilation. CHRONIC TYPE 1 FAILURE: _Causes:_ -diseases associated with pulmonary fibrosis. -chronic chest wall or neuromuscular diseases. -chronic pulmomary edema pulmonary thromboembolism. _Management:_ -Treat underlying cause. -Oxygen therapy. -Artificial ventilation. -Venesection to reduce haematocrit for polycythemic. -Diuretics to reduce peripheral edema. ACUTE TYPE 2 RF: -Causes:_ -depressant drugs like diazepam, opiates & alcohol. -brainstem damage from stroke & trauma. -disorders of nerves & neuromuscular transmission like GBS. -Disorders of muscles like acute polymyositis. -severe airflow obstruction. -chest injuries resulting in tension pneumothorax-flial chest. _Management:_ -treat underlying condition. -oxygen therapy 24% oxygen. -removal of secretions by coughing or emergency bronchoscopic aspirations. -bronchodilators. -assisted ventilation.   CHRONIC TYPE 2 PF: _Causes:_ -COPD. -Chestwall abnormalities like gross kyphoscoliosis. -central hypoventilation. _Management:_ -treat underlying cause. -oxygen therapy carries the risk of rise in PaCO2 resulting in confusion, drowsiness. -measure ABG levels before oxygen therapy. -do not give more than 24% oxygen. -give oxygen continously not intermittently at a rate of 1-2 litre/min. -stimulant drugs advocated like doxapram hydrochloride. -mechanical ventilation reserved for non respondant. -supportive treat includes antibiotics, nebulisers,clearing secretions by coughing, suction. Mechanical Ventilation (MV): -Non invasive with a mask. -Invasive with an endobronchial tube. -MV can be volume or pressure cycled                             -For hypercapnia: •MV increases alveolar ventilation and lowers PaCO2, corrects pH. •Rests fatigues respiratory muscles. -For hypoxemia: •O2 therapy alone does not correct hypoxemia caused by shunt. •Most common cause of shunt is fluid filled or collapsed alveoli (Pulmonary edema). Positive End Expiratory Pressure: -PEEP increases the end expiratory lung volume (FRC). -PEEP recruits collapsed alveoli and prevents recollapse. -FRC increases, therefore lung becomes more compliant. -Reversal of atelectasis diminishes intrapulmonary shunt. -Excessive PEEP has adverse effects •decreased cardiac output •barotrauma (pneumothorax, pneumomediastinum) •increased physiologic dead space •increased work of breathing

A 46 year old woman presents with complaints of heart palpitations which begun few months back, but have more frequent recently. She is also feeling extremely anxious, sometimes for no reason at all and is concerned that she may be having hot flashes of menopause because she feels he and begins sweating even when no one else there feels hot. she has lost nearly 9kg in the last 2 months even without any major change in diet or exercise. O/E fine tremor of the extended hands

History of grazing on crop field residues before 3 days, difficulty in standing, lean on wall with head and neck. On first approach, there was profuse salivation, difficult breathing, incordination, ataxia, almost blind.Temp. 100.5 ०F Symptomatic treatment (Atropine,Dexamethasone,Isoflupredone acetate) , fluid therapy, liver extract-B complex, Cal-mg-borogluconate have been done but no improvement. Please suggest diagnosis & treatment.

60/m DIABETIC SUCH ERUPTIONS ON HEAD AND FACE INFLAMMED BUT NOT MUCH ITCHY DURATION 10 DAYS NO SIMILAR LESIONS ANYWHERE IN BODY NO SYSTEMATIC COMPLAINTS HELP ME WITH DD AND RX