SESSION TITLE: Medical Student/Resident Critical Care Posters
SESSION TYPE: Med Student/Res Case Rep Postr
PRESENTED ON: October 18-21, 2020
INTRODUCTION: The Novel Coronavirus, COVID-19, has brought new challenges to medicine. It originally presented in Wuhan, China with virulence and deadly with many young individuals progressing to respiratory failure requiring mechanical ventilation. (1,2) As the United States saw cases, description of presentation in the literature defined very rigid requirements. Additionally, testing by nasal swab was limited. (1,2) As this pandemic progressed, it became evident that rigid testing criteria led to a significant number of COVID-19 cases being missed. These missed cases resulted in many healthcare workers exposed, falling ill and even deaths. This case report describes a missed case of COVID-19 that lead to large exposure of medical staff, which may have been prevented with moe liberal testing.
CASE PRESENTATION: 56-year-old male, with shortness of breath and cough for several days presented to local urgent care. He was diagnosed with pneumonia and given a course of amoxacillin-clavulonic acid. A few days later, he developed lethargy and respiratory distress requiring emergency medical services (EMS). On EMS evaluation, the patient was in serve respiratory distress requiring intubation. He was then brought to our emergency room (ER). Upon arrival, labs were drawn and chest X-ray performed. Chest X-ray showed diffuse patchy airspace infiltrates. Laboratory studies showed elevated white count, no lymphopenia, elevated procalcitonin, and bandemia. Infectious disease was contacted for approval for swabbing as the ER felt there was a strong concern for COVID-19. Due to the nature of conservative swabbing and the possible bacterial etiology, Infectious Disease denied COVID-19 testing and he was transferred to the intensive care unit. The following morning, patient’s ventilator requirements began to climb with oxygenation becoming more challenging and renal failure developing. Twenty-four hours following admission the patient was tested for COVID-19 and found to be positive. He was then placed in appropriate quarantine, but not after large scale exposure of medical personnel.
DISCUSSION: COVID-19 has presented many diagnostic challenges in light of its nonspecific variable inflammatory and chest imaging signs. (1,4) This case highlights the diagnostic challenges and emphasizes the need for a more liberal approach. By having a rigid diagnostic criterion or requiring a positive test result with a known hihg false positive sensitivity, the consequence can be mass exposure and endangerment of health care workers. (3)
CONCLUSIONS: Following this case and others, we feel the optimal approach to protect front line workers is to consider the entire picture to determine the likelihood of positivity for COVID-19 and need for protective precautions. We believe this approach in future pandemics will lead to better protection of our most critical resource, the healthcare worker.
Reference #1: 1.Guan, Wei-jie, et al. “Clinical Characteristics of Coronavirus Disease 2019 in China: NEJM.” New England Journal of Medicine, 7 May 2020, www.nejm.org/doi/full/10.1056/NEJMoa2002032.
Reference #2: 2.Jin, Yuefei, et al. “Virology, Epidemiology, Pathogenesis, and Control of COVID-19.” Viruses, MDPI, 27 Mar. 2020, www.ncbi.nlm.nih.gov/pubmed/32230900.
Reference #3: 3.Zitek, Tony. “The Appropriate Use of Testing for COVID-19.” The Western Journal of Emergency Medicine, Department of Emergency Medicine, University of California, Irvine School of Medicine, 13 Apr. 2020, www.ncbi.nlm.nih.gov/pubmed/32302278. 4.“Management of Patients with Confirmed 2019-NCoV.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 20 May 2020, www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html.
DISCLOSURES: No relevant relationships by Simon Meredith, source=Web Response
No relevant relationships by Jennifer Shuemaker, source=Web Response