1-, remarkable presentation, just to add on I would recommend the physician if he/she can consider treating the patient with hyper baric oxygen in order to increases oxygenation to the tissue, improves circulation and blood flow, to increase the ability of neutrophils to kill the Mucar and to decreases the pain and swelling.
Thank you
2-There really isn’t enough information to determine if this patient really warrants an ICU admission. Where I work, our Progressive Care Unit could most likely manage this patient. Depending on the presentation, such things to consider are vitals, face to face assessment data, respiratory efforts, heart rate and rhythm. The chest xray does show white out of the mid to lower left fields but is clear at the left apex and to the right. Hard to determine the appropriate level of care based on the limited data provided.
3-Hyperbaric oxygen would help this patient because hyperbaric therapy increases oxygenation to the tissue, improves circulation and blood flow, boosts white blood cells especially neutrophils, enhances effectiveness of antibiotics, and decreases pain and swelling
(Latham E., 2018). However, there is some precaution while taking this treatment “the fire hazard” because the use of oxygen is always high risk to fire explosion. so, any material that can explode fire is prohibited in the treatment room, for instance nurses must make sure that the patient is not using a hair spray, deodorant, electric devices or cigarette lighter and proper education should be given to the patient (Latham E., 2018).
Reference
Latham E. (2018) Hyperbaric Oxygen Therapy retrieved [online] from: https://emedicine.medscape.com/article/1464149-overview
4-I enjoyed reading your post. Over the years, I have had many diabetic patients that are diagnosed with pneumonia, but never with Mucor. You stated, “Mucor is most commonly found in uncontrolled diabetics, transplant patients, cancer patients, and others who are immunocompromised (Centers for Disease Control and Prevention, 2015).” It is interesting to know that Mucor is commonly found in uncontrolled diabetics. However, I found that there have also been cases found in well controlled diabetics. According to Panigrahi,M., Manju,R., Kumar, S.V. & Toi, P.C. (2014) “Uncontrolled diabetes, particularly diabetic ketoacidosis, predisposes patients to the development of mucormycosis; however, cases have been described even in patients with well controlled diabetes mellitus.”
Panigrahi,M., Manju,R., Kumar, S.V. & Toi, P.C. (2014). Pulmonary Mucormycosis Presenting as Nonresolving Pneumonia in a Patient With Diabetes Mellitus. Retrieved from http://rc.rcjournal.com/content/59/12/e201
5-I agree, a sputum or tissue sample like biopsy is needed to identify the fungal infection. However, amphotericin B, posaconazole or isavuconazole iv are very effective treatments if started early and aggressively. In addition to this and an excision of the infected tissue or organ is also needed to save the rest of the tissue or organ and life as well. Nice post.
6- Nice post, I agree, once patient is on bed rest and NPO, pantop and low molecular weight heparin needed to be started as gastric and DVT prophylaxis. And this patient is going to be very unstable so needed to be admitted in ICU for monitoring and further management.
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