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reza
Family Medicine

covid19 pneumonia 40 years old, Iranian ,male patient (bank employee) with a history of coughing for 2 weeks , becomes febrile 2 days before presentation, the fever is responsive to acetaminophen, then chills and myalgia becomes apparent and he develops dyspnea on exertion. when he presented to our emergency department, he was ill looking , fever and chills were significant, his vitals were PR 100, RR 20, peripheral O2 sat 85%, BP 140/90 , sublingual Temp 39.5 ... he had DOE and on chest exam he had coarse crackles all over both lungs... we immediately admitted this patient giving him nasal oxygenation by cannula, IV fluids, paracetamol IV administration , ABG was done pCO2 42, HCO3 22, pH 7.38, paO2 83 .. which one may ask himself how is this possible ?! we requested a chest CT scan and yup , multiple patchy ground glass opacities infiltrating the peripherals , thus the patient was isolated immediately, multiple nasal swab specimens were sent for rtPCR. CBC was done . mild leukocytosis with no lymphopenia , no thrombocytopenia ... procalcitonin undetectable.. crp 2+ ... renal, hepatic and cardiac markers were all within normal ranges . the patient was then marked as covid19 pneumonia after second rtPCR test.( first one negative) hydroxychloroquine 400 mg bid then 200 mg bid and azithromycin 500 mg stat and 250 mg daily were continued for 10 days ... no ecg abnormality was noted . the patient remained in a plateau phase, fever disappeared after 5 days, nasal oxygenation discontinued, only some mild dyspnea and mild cough was noted before discharge ( after 10 days) ... if you ask me, as an emergency physician, i say he was lucky, as i have seen many people with this presentation undergoing intubation and have poor outcome . so this is it . a viral disease ... a gambler disease. thanks for your attention.