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A 26 year old male patient came to casuality with c/o SOB Since 2 days, cough and fever since 2 days

History of present illness:

Patient was apparently asymptomatic 2 days back following he then developed SOB  initially grade 2  now progressed to grade 4 associated with cough, non productive not associated with blood.

fever since 2 days 

He’s third born child with normal vaginal delivery with meconium aspiration and was diagnosed to be dextrocardia on 4th day of delivery as he was sick they referred to many hospitals and was discharged after relieving symptoms

His earliest recall of events when he was studying 9th class during his lunch break, he felt severe breathlessness with sputum expectoration which is yellow in colour and non foul smelling.

He continued to feel breathlessness throughout his teens and needs to rest often it was associated with palpitations(which were lasting for 1-2 hrs and aggregated on lying down)

He often developed respiratory tract infections with history of cough and running nose which relieved on taking medication 

5 months back under influence of alcohol he had a history of fall from bike. Sustained head injury with no history of loss of consciousness, and he denied going to hospital as he was alright and developed fever on subsequent day which subsided on medication 

4 months back he presented to OPD with chief complaints of shortness of breath and pedal edema (he developed breathlessness post alcohol binge)

History of past illness:

K/C/O ?kartageners syndrome with dextrocardia 

H/o similar complains 4 months back for which he got admitted.

Not a K/C/O HTN or DM.

Personal History 

Diet Mixed

Appetite :Normal

Bowel and Bladder moments regular

Occasionally consumes alcohol 

General examination:

Patient consious, coherent, cooperative.

No pallor, icterus, clubbing, lymphadenopathy, edema

Vitals: 

Temp: afebrile

Pr: 104 bpm

Rr: 38 cpm

Bp: 90/60

Spo2: 60% at RA and 92% at 1c5 liters O2  

Grbs- 132 mg/dl

Systematic examination:

CVS: S1 and S2 heard

RS: B/L crepts present, IAA

P/A: soft , non tender.

CNS: NAD

ABG:

RFT:

LFT:

Hemogram

ECG

HRCT (4 months back)

Provisional Diagnosis 

Kartagener Syndrome 

Chronic cor pulmonale sec to bronchectiasis 

Treatment:

1. Nebulisation budecort 12th hourly 

Ipravent 8th hourly 

2. Inj LASIX 20 mg iv bd

3. Inj. PAN 40 mg iv od

4. Inj. DOBUTAMINE  1 Amp in 40 ml NS at 5 ml/ hr/ iv

5. Tab. PCM 650 mg po SOS

6. Intermittent CPAP

7. BP/PR/Temp/SpO2 monitoring