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Hypoxia in a Patient With COVID-19


Case Study

A rapid response code was activated for a patient who developed acute dyspnea. On arrival of the condition team, the patient was found to be a 75-year-old male with a known history of chronic obstructive pulmonary disease (COPD), who was admitted to the hospital one day earlier for cough and fever secondary to coronavirus disease 2019 (COVID-19) pneumonia. The patient’s oxygenation had been stable on room air since admission. He had ambulated to the bathroom 30 min before the rapid response event and was having difficulty catching his breath since then.

Vital Signs

  • Temperature: 101.3 °F, axillary

  • Blood Pressure: 160/90 mmHg

  • Heart Rate: 120 beats per min (bpm)

  • Respiratory Rate: 35 breaths per min

  • Oxygen Saturation: 85% 4 L nasal cannula, 100% on a non-rebreather face mask

Focused Physical Examination

After donning proper personal protective equipment (PPE), a quick exam showed an elderly male in visible respiratory distress, using accessory muscles of respiration. The patient was unable to speak in complete sentences. The lung exam was significant for inspiratory crackles and expiratory wheezing in all lung fields. The cardiac exam was notable for tachycardia but was unremarkable otherwise.

Interventions

A cardiac monitor and pads were attached to the patient. A stat chest X-ray was ordered, and labs including complete blood count (CBC), electrolytes, and arterial blood gas were obtained. Chest X-ray showed multi-focal infiltrates that were worse than seen on the X-ray obtained admission ( Fig. 24.1 ). Labs were significant for a pH of 7.22, pO 2 of 259, pCO 2 of 95, and lactate of 3.4. The patient was given a dose of IV ceftriaxone, IV azithromycin, and IV dexamethasone per institutional protocol. The patient was transferred to the intensive care unit for a trial of non-invasive ventilation.

Fig. 24.1, Chest X-ray in the anteroposterior view showing bilateral infiltrates, consistent with multi-focal pneumonia. https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-critical-care-and-airway-management-issues .

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