Case study Part 3a

This scenario presents a 67-years-old male with suspected COVID-19 admitted from the Emergency Department. The patient was admitted to 1 hour ago.

The patient’s respiratory rate appears to be increasing despite the oxygen therapy. On arrival his oxygen saturation was 89% on Room Air. Since he started on oxygen via nasal cannula his oxygen saturation is only 91% on 8 litres oxygen per minute. The patient has deteriorated and now has increased shortness of breath.

Diagnostic tests: Chest X-ray

Arterial Blood Gas Analysis

  • Before oxygen administration: pH 7.31, PaCO2: 55 mmHg, PaO2: 45 mmHg, HCO3-: 27 mEq/
  • On nasal cannula: pH 7.31, PaCO2: 55 mmHg, PaO2: 45 mmHg, HCO3-: 27 mEq/L (no change)
  • If trying non-invasive ventilation: pH 7.26, PaCO2: 67 mmHg, PaO2: 40 mmHg, HCO3-: 27 mEq/L
  • Post-intubation and on ventilator: pH 7.33, PaCO2: 46 mmHg, PaO2: 67 mmHg, HCO3-: 27 mEq/L