ChrisPAinED Posted June 10, 2022 Share Posted June 10, 2022 So had a interesting case a little while ago. Few small details changed for privacy and no patient identifiers. Patient was a male mid 50s with a "fever" but during triage vitals were as followed HR 110, BP 150/90, O2 90%, RR 25, temp 105.!. ROS: No headache No sore throat Yes cough No chest pain No abd pain No abnormal bowl or urination issues And yes fever and chills So time for investigations: Influenza A neg Influenza B neg COVID pos Elevated CRP Elevated WBC Low sodium Low potassium Low magnesium We gave some fluids and fever wouldn't budge over a few hours so patient was admitted. A left a few things out of treatment for fellow PAs to call out. Also any questions? Any thoughts? Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 11, 2022 Moderator Share Posted June 11, 2022 How many days of sx?(this determines if he can get either PO or IV monoclonal antibodies). Previous covid vaccinations or infections? I assume he got tylenol, ibuprofen, oxygen, K, Mg, blood cultures, lactic acid, etc 1 Quote Link to comment Share on other sites More sharing options...
ChrisPAinED Posted June 11, 2022 Author Share Posted June 11, 2022 2 hours ago, EMEDPA said: How many days of sx?(this determines if he can get either PO or IV monoclonal antibodies). Previous covid vaccinations or infections? I assume he got tylenol, ibuprofen, oxygen, K, Mg, blood cultures, lactic acid, etc Day 6 of fever came in because it got to its highest. No vaccine but had the infection in early 2020. And correct on all assumptions. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 11, 2022 Moderator Share Posted June 11, 2022 1 minute ago, ChrisPAinED said: Day 6 of fever came in because it got to its highest. No vaccine but had the infection in early 2020. And correct on all assumptions. Day 6 they could still get IV monoclonal antibodies. PO Paxlovid is only for days 1-5 1 Quote Link to comment Share on other sites More sharing options...
ChrisPAinED Posted June 11, 2022 Author Share Posted June 11, 2022 11 minutes ago, EMEDPA said: Day 6 they could still get IV monoclonal antibodies. PO Paxlovid is only for days 1-5 There are now inpatient so I am sure the internal medicine physician will consider it. Quote Link to comment Share on other sites More sharing options...
jmj11 Posted June 11, 2022 Share Posted June 11, 2022 I would be curious about the differential. I don't work in the area but with COVID so common these days, I would want to make sure that a positive COVID wasn't masking another unrelated infection. 2 Quote Link to comment Share on other sites More sharing options...
ChrisPAinED Posted June 11, 2022 Author Share Posted June 11, 2022 1 minute ago, jmj11 said: I would be curious about the differential. I don't work in the area but with COVID so common these days, I would want to make sure that a positive COVID wasn't masking another unrelated infection. We checked for Flu and Cov by lab and I didn't mention it but we did a CXR that showed a opacity of the RLL. Patient was admitted for more investigations and treatment. Quote Link to comment Share on other sites More sharing options...
jmj11 Posted June 11, 2022 Share Posted June 11, 2022 My choice of "unrelated" was not the best word. I suspect a bacterial secondary or unrelated (to COVID) pneumonia. 1 Quote Link to comment Share on other sites More sharing options...
greenmood Posted June 16, 2022 Share Posted June 16, 2022 On 6/10/2022 at 11:06 PM, ChrisPAinED said: There are now inpatient so I am sure the internal medicine physician will consider it. Not if he's hospitalized for Covid pneumonia. Contraindication for monoclonal antibodies. Might get other treatment, although oxygen saturation of 90% on room air without respiratory distress removes him from consideration for some of those as well. With control of his fever he may have totally disqualified himself from pharmacologic treatment. If I was a betting person... hospitalist finished his labs (ferritin, D-dimer, liver function), attempted a sputum, and scanned him for PE (borderline O2 sats, probably has some other risk factors in his medical history such as obesity etc and we know these patients clot for no reason at all) unless his kidneys absolutely didn't allow it. Then they treated him for superimposed bacterial pneumonia and discharged him. 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted June 17, 2022 Moderator Share Posted June 17, 2022 I know many places are not using remdesivir anymore(and I know it's an antiviral, not a monoclonal), but some of my hospitalists still use it. 1 Quote Link to comment Share on other sites More sharing options...
dphy83 Posted July 10, 2022 Share Posted July 10, 2022 Legionella? Covid just a coincidence and a red herring? Quote Link to comment Share on other sites More sharing options...
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