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REPORTright side, and a normal two-dimensional echocardiograph study was performed.Empirical antibiotics, nebulization, and supportive care were administered.There was an improvement in the patient's consciousness levels, and the fever subsided.The next day, the patient had an acute episode of AF with absent p-waves and fast ventricular rate of 195 bpm on electrocardiogram accompanied with hypotension to BP of 70/40 mm Hg, immediate synchronized cardioversion with 100 J followed by 150 J, reverted to heart rate 92 bpm, BP 110/80 mm Hg.Injection amiodarone infusion, low molecular weight heparin and tablet metoprolol were initiated.Similar episodes of AF with hemodynamic compromise recured for five episodes within 24 hours, which got settled with synchronized cardioversion of 150-200 J. Upon reassessment, there was reduced air entry on the right side in chest auscultation.Ultrasound of the lung suggested right lung collapse with minimal effusion, which was reconfirmed on an emergent chest X-ray (Fig. 1).After obtaining procedural consent, flexible fiberoptic bronchoscopy was performed under sedation with fentanyl and continuous oxygen support with a high-flow nasal cannula with 0.6 FiO 2 .A mucus plug was seen below the level of the carina, obstructing the right main bronchus.It was sucked out
Kumar et al. (Fri,) studied this question.