I was back in the covid ICU last night. I was assigned my youngest patient since I have been here. A 20 year old male. I was 1 on 1 with him because he was extremely critical but still a full code, meaning if he were to go into cardiac arrest we would do everything we could to save his life. A lot of the patients I have had have not been full codes. Once people start to deteriorate we talk to the family and the family usually agrees not to try anything if the family member goes into arrest. This patient is young enough that efforts to sustain life could have a better outcome. The report I got on this patient was " 20 YOM history of diabetes, hypertension, kidney disease and covid positive. Once he got infected his organs started to crash and he was in complete kidney failure and had bilateral pneumonia and ARDS (acute respiratory distress syndrome) The pt's potassium was 8.0 (very high) and went into a 15 minute run of Vtach (bad heart rhythm that ends in death a lot of the time) They gave all the meds that you usually give to correct potassium but nothing worked until he actually received hemodialysis. When I arrived the patient was showing signs of DIC (Disseminated intravascular coagulation) a very complicated clotting issue that causes severe bleeding. He was bleeding out and around every IV, central line, foley cath, fistula ports. His MAP (blood pressure marker we want about 65) was around 50 and his HR was 130 wide complex sinus tach and his o2 sats were 83% with 100%FIO2 (max o2 delivery) and a PEEP of 16. His was on levophed 5mcg and Neosynephrine at 200 mcg/min. I went up to 7mcg on the Levo and his MAP jumped to 75. I had to play with this all night but for the most part kept his MAP above 65. His o2 sats were a different story. I suctioned and played around as much as I could but could never really get his saturation's above 85%. at 0600 in the morning we finally called the PRONE team and they placed him face down. In a matter of minutes his sats increased to 98%. I have mentioned this therapy before and I have seen it work like this, however the last couple of time the patients ended up deteriorating because of organ failure. So it's a risk/benefit type therapy. The prognosis for this patient is very poor.
More about this patients history that I found interesting... NOT A POLITICAL post or an opinion one way or the other......... This patient was transitioning from Male to Female. He was on progesterone and estrogen. These medication along with his hypertension, diabetes and kidney issues caused a cerebral vascular accident (stroke) before the covid-19 infection happened. This put him at extreme risk and vulnerable to the infection. Talking with an anesthesiologist he stated the coagulation affects of hormones are understated and someone with his medical history probably should not have been allowed to take those medications and should have found alternative ways to reach his goals.
I am hoping he (pronoun his family requested we used) is still around when I get there tonight. He was the most work I have put into one patient over a shift.