Fever in Fiji!

His blood results are shown below and he was admitted for observation and hydration.

FBC: Hb 12.3 g/dL HCt 38% MCV 83fL WCC 8.6 x 109/L platelets: 26 x 109/L
U&E: Ur 6.4 mmol/L Cr 133 μmol/L Na 135 mmol/L K 4.1 mmol/L Chloride 101 mmol/L eGFR 72

After 18 hours he was noted to be dyspnoeic with a respiratory rate of 30. He was sent for an X-ray as shown below:

Describe his chest X-ray findings and list your differential diagnosis.

What other important history has not been mentioned?

While awaiting review, he became more tachypneic (RR-60) and started desaturating at 50-60% on high flow oxygen. He also had an episode of frank haemoptysis. ABG was done as shown.

pH 7.412 pCO2 3.3 kPa pO2 6.49 kPa BE -9.2mmol/l

What do the blood gas show and what action would you take?

The patient was intubated with 7.5ETT with 150mg ketamine and 100mg Suxamethonium. During intubation a lot of blood was suctioned from the pharynx and it was difficult to ventilate the patient. He was desaturating to 60% on 100% O2. Post intubation ABG was taken as shown below.

pH 7.191 pCO2 46.5mmHg pO2 31.4mmHg BE -10.8mmol/l
HCO3 17.4mmol/l

The patient was manually ventilated with bag valve mask and PEEP of 10cmH20 before being transferred to ICU. The patient was sat up at 45 deg and regular endotracheal suction improved his saturation to 90 %.

CT head was performed as he remained GCS 3 despite no sedation.

What does the CT head show and what is your diagnosis for the patient?