Intensive Care Unit 11/13-11/23/2021

11/13 The patient had asphyxia - getting of an oxygen was decreasing, the patient doesn't feel this symptom. There is no sufficient aid from oxygen mustache. Airvo's (some kind of machine to produce an oxygen) Litres increasing provoked strong cough and during this oxygen saturation dropped under 80 %. The patient did not approve to use the oxygen mask, because it blocked airways. Transferred to the intensive care unit where a patient got aid by breathing apparatus.

11/18 Patient got intubation, because of low oxygen value.

11/22 Extubation

11/23 Moved back to lung department Treatment Time - Intensive Care Unit 11/13-11/23/2021, three days in breathing apparatus.

Lung diseases ward 54. 11/10-11/13. and 11/23-11/26/2021

Need of the treatment
Covid-19 virus infection symptoms, treatment, shortness of breath
Activity of the treatment
Researches and treatments
- Monitoring - blood pressure, pulse, breathing frequency, oxygen saturation and temperature
- Blood sugar 4 times per day - Insulin treatment

Medication
- Home medication
- Ventoline Inhaler
- Antibiotic, cortisone, Inhixa shot to prevent clots
- Started insulin Levemir for treatment of cortisone, because measured high blood sugar values

Breathing
- The goal of saturation 92%
- Supplemental oxygen according need
- 24.11 supplemental oxygen by Multivent mask 50%
- 25.11 supplemental oxygen 6-7 litres per minute.

Daily functions and independent initiative
- Self-acting / assisted, sober
- Rollator as implement of moving

Fluid balance / nutrition
- Eat by himself with help of raised bed end
- Soft food
- Overall quantity of fluid 3000 millilitre
- Monitoring fluid by list

Result of the treatment

Infection has calm down. Isolation cancelled 25.11. Needing still supplemental oxygen. The patient can go toilet with the help of rollator. Oxygen saturation decreasing to some extent in exertion. Breathing is easy with supplemental oxygen. Started insulin Levemir, because of cortisone treatment, because measured high blood sugar values. Cortisone changed to go through the mouth 11/26. The patient has good appetite. Fluids have gone very well through the mouth.

The Plan

The patient needs addition treatment in health care center. The patient is moved to Sysmä's health care center ward to addition treatment. Estrange from supplemental oxygen, rehabilitation and possible to finish insulin treatment. X-ray photographic control after 2 months. The lung doctor checks the photograph and call to patient.



Date 11/10/2021 - 11/26/2021

Service Unit Päijät-Hämeen Health Municipality Syndicate
Diagnoses
J12.9 Undefined viral pneumonia
U07.1 COVID-19-virus infection, assured by laboratory research

Diagnose
U07.1 COVID-19-virus infection, assured by laboratory research
Primality: Side dg/tmp
Permanence: Temporary
Risk information

Microbes and need of isolation

Droplet isolation / U07.1 COVID-19-virus infection, assured by laboratory research
Diagnose
J12.9
Undefined viral pneumonia
Primality: Side dg/tmp
Permanence: Temporary
Actions
FB1BD
Lungs extensive TT-angio / angiogram
Final estimation / medical case summary
57 years old male, who has been earlier health, sporty, non-smoker, medical report is mention about asthma, only when needed to use Ventoline. Not vaccinated against Covid-19. Diarrhea began 11/9. After that high fever, pain on the side and some breathing difficulties. For this reason went to emergency duty. On Emergency duty oxygen saturation 90% with air in room, improved with supplemental oxygen, moved to the lung department to addition treatment. When came in the hospital CRP 111/inflammation value and X-ray photograph both sided Covid-pneumonia suitable infiltrations. Started antibiotic treatment Cefuroxime. Thrombosis prophylaxis Inhixa and duration of disease and based on supplemental oxygen need Dexamethasone 60 mg x1. In the surveillance of lung department the need for supplemental oxygen increased, given RoActemra 11/11. Despite of it the situation has worsened that the patient was moved to intensive care unit 11/13.

In the beginning of intensive care unit monitoring in 5 days on high-flow oxygen mustache, but when the situation has not improved the action of intubation was carried out. On respirator machine 3 days. On intensive care treatment was given large amount of cortisone, which raised blood sugar and then began Levemir insulin. When the situation stabilizes moved back lung department.

On lung department supplemental oxygen amount decreased, 4-6 litrer per minute flowing saturate 92-96%, without supplemental oxygen saturation is moderate 88%.

Current inflammation values are low, hemoglobin is improving 133. No fever.

Plan

Transferring to Sysmä Health Care Center for further rehabilitation. The goal of oxygen saturation is over 90%, efforts are made to estrange from supplemental oxygen, active rehabilitation under the guidance of a physiotherapist is desired. The lung photograph is still quite full of pneumonic infiltrate, the lung photograph will be checked after 2 months, and a call from the lung department. It is recommended that Inhixa be continued at a dose of 40 mg x1. 2 weeks after returning from the health care center. Dose reduction of prednisol is in progress, now 30 mg, 29.11. time from 20 mg x1, this can be continued for e.g. 5 days, followed by 10 mg for 10 days, and after that ending of prednisol. Insulin requirements are likely to be reduced and may be discontinued.

Other note(Distribution)

Sysmän health care center (EPAL +)

CARE WORK SUMMARY
Department of Lung Diseases 54
11/26/2021 Final evaluation (epicrisis)
Medical work
Came 11/10 for the treatment of Covid-19 infection and pneumonia in the lung department.

The patient has asthma. Does not smoke or use alcohol.