Thread by @MedEd_PA

Middle aged pt, no PMH; fever, flulike sx x 1 week. 6lpm NC, sats ~92%. No dyspnea. Presenting CXR unremarkable. No shock. Given 1L IVF and empiric abx. Initial dispo to floor for monitoring and COVID testing. #POCUS to follow

R anterior lung

R lateral lung

L anterior lung (similar throughout)

8 hours later, significant desaturation and placed on NRB. New film:

36 hours later #COVID19 positive, intubated, paralyzed, proned, on 2 pressors

Lessons for me:

Respect low sat even in the absence of dyspnea, tachycardia, tachypnea.

Intubate early? Up for debate but I’m thinking yes.

These pts decompensate FAST & rapidly desaturate during intubation

Scan & triage whole chest w #LUS #POCUS - CXR findings lag behind

And - now more than ever - remember your critically ill patients are people first.

Give them a chance to talk to their loved ones if you can.

Update families daily.

Hold a hand. Reassure them. People are alone - and there IS a treatment for that ❤️

https://twitter.com/drhamedkamali1/status/1243043114782253057