Viral Pneumonia Secondary to COVID-19

 

A 35 Y/O Male with Viral Pneumonia Secondary to COVID-19 

 

Introduction: This is an online E-log Entry Blog to discuss, understand and review the clinical scenarios and data analysis of patients so as to develop my clinical competency in comprehending clinical cases, and providing evidence-based inputs. 

Note: The cases have been shared after taking consent from the patient/guardian. All names and other identifiers have been removed to secure and respect the privacy of the patient and the family.

CASE 1

Here, 

  A 35 year old male was admitted into the Covid ICU ward with the chief complaints of:-

1. Fever since 5 days.
2. Dry Cough since 5 days.
3. Shortness of Breath since morning of the same day as hospital visit.

HISTORY OF PRESENTING ILLNESS

The patient was apparently asymptomatic 5 days back when he developed:

1. Fever which was insidious in onset, low grade, intermittent in nature and which increased in the evening hours. The fever was not associated with any nausea and vomiting, burning micturition, chest or abdominal pain.                   
2. Dry cough since 5 days, not associated with sputum or blood or vomiting.
3. He also developed Grade 2 type of dyspnea on the morning of the same day as the hospital visit. The shortness of breath worsened with each episode of cough.
4. No history of chest pain or any discomfort.

  The patient got tested for Covid-19 and his RTPCR report was positive.

HRCT CORADS - 5

CTSI - 6/25

HISTORY OF PAST ILLNESS

Patient is not a known case of - Hypertension, Diabetes Mellitus, Asthma or any other chronic disorder. 

PAST HISTORY

No similar complaints in the past.

PERSONAL HISTORY

• Married 
• Sleep - Adequate
• Bladder- Normal
• Bowel- Regular but loose stools
• Appetite - Normal
• Diet - Mixed
• No known allergies
• No addictions 

FAMILY HISTORY

Insignificant.

TREATMENT HISTORY

Insignificant.

GENERAL EXAMINATION

The patient was examined in a well lit room after taking informed consent.

He was conscious, coherent and cooperative at the time of examination.

• Moderately built and well nourished
• Pallor : Absent
• Icterus : Absent
• Cyanosis : Absent
• Clubbing : Absent
• Koilonychia : Absent
• Lymphadenopathy : Absent
• Edema : Absent

Vitals upon Admission on 14-05-2021

1. Pulse Rate - 82 beats per minute.
2. Blood Pressure - 110/60 mmHg.
3. Temperature - Afebrile 
4. spo2 on RA - 87% (RA- breathing in room air) 

SYSTEMIC EXAMINATION

1. Cardiovascular System - S1 and S2 heart  sounds heard, no murmurs.
2. Respiratory System - Normal Vesicular breath sounds heard and bilateral air entry present.
3. Per Abdomen - soft, no tenderness, no palpable mass, no organomegaly. Normal bowel sounds heard.
4. Central Nervous System - Intact.

                         

Investigations done on the day of admission: 14-05-2021 at 3:04 pm.

Day 1 : 14-05-2021

1. Complete Blood Picture 

interpretation: normal

2. Liver Function Tests 

3. Renal Function Tests 

interpretation: normal

4. ECG 

Day 2 : 15-05-2021

Vitals

1. Temperature - afebrile.
2. Pulse Rate - 89 beats per minute.
3. Blood Pressure - 110/70 mmHg.
4. Sp O2 - 99% on 15 litres of oxygen.

Day 3 : 16-05-2021

Vitals 

1. Temperature - 98.4° F.
2. Pulse Rate - 86 beats per minute.
3. Blood Pressure - 120/80 mmHg.
4. Sp O2 - 98% with 10 litres of oxygen.

Investigations 

Day 4 : 17-05-2021

Vitals 

1. Temperature - afebrile.
2. Pulse Rate - 80 beats per minute.
3. Blood Pressure - 110/70 mm Hg.
4. Sp O2 - 96% with 2 litres of oxygen.

Chest X-ray

Day 5 : 18-05-2021

Vitals 

1. Temperature - afebrile.
2. Pulse Rate - 76 beats per minute.
3. Blood Pressure - 120/80 mmHg.
4. Sp O2 - 98% with 4 litres of oxygen.

Day 6 : 19-05-2021

Vitals 

1. Temperature - afebrile.
2. Pulse Rate - 84 beats per minute.
3. Blood Pressure - 110/70 mmHg.
4. Sp O2 - 95% in room air.
5. HBA1c - 7.4% ( elevated ) 

Day 7 : 20-05-2021

Vitals 

1. Temperature - afebrile.
2. Pulse Rate - 80 beats per minute.
3. Blood Pressure - 110/70 mmHg
4. Sp O2 - 95% in room air. 

PROVISIONAL DIAGNOSIS 

Viral Pneumonia Secondary to COVID-19 Infection.

TREATMENT REGIMEN (14-05-2021 TO 21-05-2021)

1. Head elevation.
2. Oxygen inhalation to maintain spO2 > 90%.
3. IVF at 75ml/Hr.
4. Nebulization with BUDECORT + DUOLIN every 6th hourly.
5. Tab. PAN 40mg IV/OD.
6. Tab. MVT PO/OD.
7. Tab. LIMCEE PO/OD.
8. Tab. DOLO 650mg PO/SOS.
9. Inj. DEXAMETHASONE 8mg/IV/BD.
10. Inj. CLEXANE 40mg SC/OD. 
11. Syrup GRILLINCTUS 2 TSP 1-1-1
12. Temperature charting every 4th hourly.
13. Pulse rate, BP, Sp O2 monitoring hourly.

Additional Medications

 19-05-2021:

• Inj. HAI S/c.
• Inj. NPH 14U S/c.
• Tab. GLIMIPERIDE 1mg PO/OD.
• Inj. Dexamethasone STOPPED.

 20-05-2021:

• Tab. GLIMIPERIDE 1mg PO/OD 0-1-0.
• Inj. Dexamethasone STOPPED. 

PLAN FOR DISCHARGE

Vitals at the Time of Discharge 

1. Temperature - afebrile.
2. Pulse rate - 86 Beats per minute.
3. Blood Pressure - 120/60 mmHg.
4. Sp O2 - 95% on room air.

Advice on Discharge 

1. Tab. PAN 40mg PO/1-0-0 × 1 Week.
2. Tab. MVT PO/0-1-0 × 1 Week.
3. Tab. LIMCEE PO/0-1-0 × 1 Week.
4. Tab DOLO 650mg PO/SOS. 
5. Tab. GLIMIPERIDE 1mg PO/ 1-0-0 × 1 Week.
6. Syrup GRILLINCTUS PO/ 10ml-10ml-10ml × 1 Week. 
7. Review after 1 week. 

 Patient discharged on 20-05-2021 at 4:45 pm.