We’re seeing so many Covid cases that we don’t need a blood test or a cxr to make the diagnosis anymore.
Most admissions are obvious – patient is hypoxic, looks like crap, or they have an endotracheal tube in their mouth. There are many Covid patients that are well who do not need to be admitted. There are also many well-appearing Covid patients who will get worse after discharge. Covid bounce-backs are inevitable, and it is very likely that a well-appearing Covid discharge will come back critically ill. It is unavoidable. You cannot admit every Covid patient for observation because there are not enough beds in the hospital.
There are many of us EM docs out there now trying to figure this out. It’s a good way for a statistician to help the cause. Hopefully, you’ll see preliminary data from non-approved studies soon (these studies are generally “exempt”, but who’s going to wait for IRB approval?).
I’ve already had two patients bounce back (2-3 days later). Neither patient was intubated (yet).
Some typical cxr findings.
Patient 1. 40s M, sick for a week, hypoxic to 80, deteriorated after 4-5 hours in ED, repeat cxr after intubation.
Patient 2. 40s M, fever x 4 days, SOB, sat of 97, looks well. He was the only Covid patient I discharged that day because he was the only only patient who can do a test-lap in the ED without going down. He returned to the ED 2 days later feeling worse, slightly more hypoxic, and was admitted for oxygen / observation.
DOH is telling us not to send Covid tests on discharges. If you’re discharging a patient that you know have Covid (especially a patient with cxr findings), send the test. This way, the diagnosis will be known should the patient bounce back and decompensate. If the cxr is negative, they probably don’t need to be tested for Covid (if they are being discharged).
The cxr doesn’t seem to be a reliable triage / prognostic tool. Some patients are terribly sick with a not-so-bad cxr. Some patients are running laps with a yucky cxr.
Patient 1
Patient 2
