This is a 70-year-old patient I received in my medical practice in a village 20 km from the nearest public hospital. The patient, who was widowed by his condition, was accompanied by his two daughters. Medical history: left facial paralysis, type 2 diabetes and arterial hypertension. The ongoing medical treatment: Medzar 50mg (1-0-0) and Diamicron(2-0-0). Reason for consultation: Respiratory difficulties, productive cough, extreme asthenia, loss of appetite. The patient has also difficulty ensuring his transfers and sleep disorders(insomnia). This symptomatology had been evolving for more than a week according to the patient’s daughters
At the examination: I note that the patient came on foot assisted by his two daughters, from the car that took him to my office. The patient was wearing diapers, conscious, no temporal-spatial disorientation, smiling, no signs of dehydration, no skin crease. GSC: 15/15 , Arterial pressure: 17/8.5 Blood sugar: 117mg/dl , heart rate: 75 BPM. No oximeter in my medical office. the patient has resting dyspnea without orthopnea. Axillary temperature :37°C No oedema of the lower limbs, peripheric pulses present and bilateral. Pulmonary auscultation: crackling in both lung fields and sibilants in the left lung field. ECG: Atrial extrasystole.
My diagnosis hypothesis: Acute lung edema, pneumonia or pulmonary embolism
Patient received a Dexamethasone 4mg intramuscular injection and was immediately referred to a public hospital in Tangier.
The Family chose a private clinic where a Thoracic CT and blood sample were done, here are the results: Blood count: Hyperleucocytosis, neutrophil polynucleosis , lymphopenia. C-reactive protein=155.70mg/dl ,D-dimer=3772ng/ml
Thoracic CT: Aspect in favor of severe Covid 19 pneumonia involving between 50% and 75% of the pulmonary parenchyma.
The clinic advised the family to transfer the patient on their own to the public hospital that treats Covid-19 patients.
It should be noted that the clinic physician after reading the diagnosis on the chest CT authorized the patient to return home pending the result of the blood sample.