Covid-19 Evidence-based treatment or diagnostics

Instructions: Read the elements of the case and each day’s events. For your initial reponse, provide a brief summary of your understanding of the case and evidence-based treatment or diagnostics that you would recommend (100 words). Provide rationale from the textbook, evidence-based protocol, or research article. Remember the advocacy presentation from Module I and remember our responsibility to advocate for patients as an ethical necessity.
Purpose: Discuss standards of practice for the evidence-based care and treatment of the patient admitted to the emergency department in August 2021.
Data is provided from an actual patient case which occurred in the United States in 2021.
Acknowledgements: During the COVID-19 pandemic crisis, healthcare providers were placed in oftentimes impossible situations, endured extreme stress, and were forced to make difficult decisions based on limited resources. At the end of the discussion, additional information about the patient’s case will be shared.
EMERGENCY DEPARTMENT
8-17-2021: Admission Shortness of Breath
54 year old white male admitted via ambulance from home at 0745. Diagnosed with COVID-19 via PCR test on 8-13-2021 by primary care provider. The patient was receiving Vit D3 10,000 units, Zinc 25 mg, Quercitin, NAC, Vitamin A, Vitamin C 2000 mg, Ivermectin, Prednisone, Z-pack, Aspirin 325 mg,
Albuterol nebulized treatments every 2 hours, and Budesinide nebulized treatments twice daily.
• COVID +
• CXR indicates pneumonia/infiltrates
• CT Scan without contrast is consistent with COVID pneumonia
• This was day 4 of COVID, patient was ruled “not a candidate” for monoclonal antibodies
• Bipap
• Remdesivir IV started at 1315
• Regular diet
• Bedrest
• Voiding per urinal
• See vital signs and labs flowsheet
8-18-2021
• 2 doses lovenox (30mg and 80 mg)
• See vital signs and labs flowsheet
8-19-2021
• CXR minimal improvement
• One dose of Lovenox today
• See vital signs and labs flowsheet
8-20-2021
• CXR overall stable exam (lung aeration is overall stable)
• See vital signs and labs flowsheet
MOVED TO TELEMETRY FLOOR AT MIDNIGHT
8-21-2021
• Report: calm and pleasant, oxygenating well sat 90s on Bipap, eating small amount
• CXR interstitial infiltrates, stable chest
• Patient video calls family. Family states patient thinks everyone has given up on him. Family requests pastoral care visits and wants to sit with patient.
Family not allowed to stay with patient per hospital rules during COVID-19 pandemic.
• See vital signs and labs flowsheet
8-22-2021
• CXR a.m. interstitial infiltrates, stable chest
• 1445 Rapid response, stated O2 sat back up, was sitting on side of bed eating & took mask off, difficulty putting mask back on, was now stable with O2 sat
95%
• 2045 Rapid response, patient found lying across bed, bipap mask slightly off face, patient blue and “jerking” when discovered according to nurse, Neuro
consulted, remained on telemetry floor
• See vital signs and labs flowsheet
TRANSFERRD TO ICU OVERFLOW (1ST FLOOR)
8-23-2021
• Nurse practitioner at bedside. Called wife and stated patient “did not look good” and needed intubation
• Intubated 0900 and transferred to ICU overflow COVID unit
• Report: holding O2 sat “ok” on vent, will take some time to see improvement, initiated prone positioning, peak inspiratory pressure 35, Vent: VT 500, Assist
control rate 24, FiO2 80
%, PEEP 10
• Chart info
o CXR 1049 a.m. diffuse infiltrates, ETT in place (2 cm above carina). Bilateral breath sounds.
o CXR 3:03 p.m., left PICC inserted, no pneumo
o Abdominal XRAY: gaseous distention of small and large bowel loops. Mild ileus or gastroenteritis. No clear obstruction or free air.
o See vital signs and labs flowsheet
8-24-2021
• Report: holding, O2 sat ok on vent, will take some time to see improvement, continuing prone positioning (O2 sat 95%)
• Chart info
o EEG performed, supports presence of severe encephalopathy
o CXR no improvement
o See vital signs and labs flowsheet
8-25-2021
• Report: holding, O2 sat ok on vent, will take some time to see improvement, proning
• Chart info
o CXR stable chest
o See vital signs and labs flowsheet
8-26-2021
• Report: holding, O2 sat ok on vent, will take some time to see improvement, proning
• Chart info
o CXR a.m. no improvement
o 2230 received a call that oxygen saturation suddenly dropped. Emergency response called.
o See vital signs and labs flowsheet