A 54 year old man is brought to ED by his 2 sons with complaints of increasing drowsiness , distress and confusion.
They also bring a chest X ray done 1 day ago. According to his son , he has been unwell since 4 days but they provided him treatment at home.
You attach him to a cardiac monitor. His oxygen saturation propped up on air is 42 percent and on right lateral position is 55 Percent and left lateral position is 48 percent.
You put on high flow oxygen of 6 litre with non rebreathing mask and reach a saturation of 68 percent.
1. What is the most likely Diagnosis?
2 . What are your next steps in management of this patient?
Answers given in comments section.
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1. What is the most likely Diagnosis?:
Severe Acute Respiratory Distress Syndrome secindary to Covid 19 Pneumonitis
2 . What are your next steps in management of this patient?
The patients oxygen saturation is not improving more than 80 percent on high flow oxygen .
He should be intubated and put on a ventilator to support his ventilation and shifted to designated Covid ITU with further management including giving Dexamethasone , Tocilizumab, Remdesivir and monitoring of vitals signs and inflammatory parameters like CRP , Procalciltonin and Interleukin 6 levels with care given to treatment of Acute kidney injury as well.
A ventilator pumps air,usually with extra oxygen, into patients' airways when they are unable to breathe adequately on their own. If lung function has been severely impaired—due to injury or an illness such as COVID-19 patients may need a ventilator. It is also used to support breathing during surgery.If the body’s immune system does not fight off the infection, it can travel to the lungs and cause a potentially fatal condition called acute respiratory distress syndrome (ARDS). In ARDS, the alveoli (tiny air sacs that allow oxygen to reach the blood stream and remove carbon dioxide) fill with fluid, which diminishes the lungs’ ability to provide vital organs with enough oxygen.
ARDS entails severe inflammation of the lungs, but the main problem is that it makes portions of the lungs unusable, Normally, when someone takes a breath, their chest wall expands, which creates negative pressure (i.e., a vacuum) inside the lungs that draws air in. When a person is sick and weak and can’t pull the breaths in on their own, a ventilator creates positive pressure that forces air into the lungs. The first step in putting a patient on a ventilator is general anesthesia. Then, a medical professional will place a tube into the mouth or nose and snake it into the windpipe. This is called intubation.
The tube is connected to an external machine that blows air and oxygen into the lungs. The machine can help do all or just some of the breathing, depending on the patient’s condition. The ventilator can also help hold the lungs open so that the air sacs do not collapse.
While patients are on a ventilator, doctors will monitor their heart and respiratory rates, blood pressure, and oxygen saturation. Other tests, such as X-rays and blood draws, may be done to measure oxygen and carbon dioxide levels (sometimes called blood gases). For more useful information , read the link
below : https://www.yalemedicine.org/news/ventilators-covid-19
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