This is a bit of a trick question. The case has nothing to do with Covid. It is about the challenges of information overload that face every EM doc every shift.
On an average day, I am in charge of about 40-50 patients on a 12-hour shift, and 2 or 3 of them will be very sick. When you review this patient’s labs, CXR, and EKG, it is likely that you see nothing scary. Take a closer look at the EKG. What is the rhythm? It is not sinus. Not every QRS has a P in front of it. It is very easy to miss this finding if you are not looking at it carefully. It’s not an easy EKG to interpret; the key is to recognize it as abnormal and figure out why it’s abnormal. Is it carditis related to Covid? Does the patient have an underlying conduction defect? Does this have to do with the patient’s BP meds that he doesn’t know the name to?
I read the EKG as junctional tachycardia with AV dissociation, RBBB, and VPCs. His trops were negative, an echo was mostly unremarkable. After a few days, he went back into sinus. It was never clear what caused the rhythm abnormality. The patient got better from his Covid and went home.