Case Study part 3b

[Illustration of Mr Cello in the ICU]

Mr. Cello, is a 67-years-old male who was diagnosed with Covid-19 two days ago. He was transferred to the ICU and has been paralysed & sedated to improve ventilation. In the last hour, the patient has deteriorated, and the team is considering proning the patient.

[Physical Assessment?Illustration of patient lying on his back with assessment points showing results] Neurological: Patient is sedated, Cardiovascular: The patient is tachycardiac, hypotensive, febrile at 39 degrees, pale at peripheries, CVP at 8 mmHg, Respiratory: ETT 8.5 cm 22 cm at the Lips, Volume Control, rate (ventilated) 20 bpm, Tidal volume target is 420 mL, PEEP 10 cmH20, some secretions when suctioning, Gastrointestinal: Nasogastric feeding stopped and on free drainage bag, Bowels sounds present.

[Diagnostic tests]

  • Covid-19 swab: positive
  • Arterial Blood Gas Analysis: On volume control ventilation: pH 7.11, PaCO2: 70 mmHg, PaO2: 55 mmHg, HCO3-: 22 mEq/L Patient is deteriorating: pH 7.10, PaCO2: 72 mmHg, PaO2: 47 mmHg, HCO3-: 22 mEq/L Just after patient turned to prone position: pH 7.10, PaCO2: 72 mmHg, PaO2: 46 mmHg, HCO3-: 22 mEq/L Patient settling after turned to prone position: pH 7.21, PaCO2: 60 mmHg, PaO2: 55 mmHg, HCO3-: 24 mEq/L