IF nothing is working in sub-acute context...
of the most difficult challenges for us...)
The patient is going to die from lung disease. Both pneumonia
and PCP treatment are not active... severe dyspnea/polypnea... with
or without symmetrical auscultation... with or without bronchospasm,
with or without cyanosis...
Disease is too acute to be a "normal"
TB and not generalized enough to be milliary TB...
A last challenge is to be made because
in dyspneic context, without morphine, "palliative cares"
is not an operational concept (see "Introduction") and because without a lab, in such context,
hope is always permitted if the patient still has a strong body...
Now, after many bad experiences, our policy is:
- Stop all drugs, including TB treatment
- Lincocin IM 300mg.x2-3 + fluconazole
- Symptomatic cares as needed, including dexamethasone... (knowing
that dexa is dangerous in CMV infection... emergency is emergency, patient
is already going to die!)
+ fluconazole or even metronidazole
can be alternative challenges...
but for us more failure...