Management of the older person with COVID-19: a view throughout Europe |
VIGNETTE
A 87 year old man is complaining of coughing, increasing shortness of breath and chest pain and had a positive COVID-19 PCR the day before presentation on the emergency department. He has been staying in a nursing home following a hip fracture 4 months ago. His medical history reveals a mild vascular dementia, multiple percutaneous coronary interventions in the previous years, chronic heart failure (treated with medication and currently stable) and cataract surgery on both eyes. The clinical frailty score is estimated at 6. He partly regained mobility since his hip fracture but he needs help for all activities outside and because of cognitive problems he also partly needs assistance for ADL activities inside.
The symptoms started 7 days ago, his temperature is 37.8°Celsius, heart rate 81/min, BP 152/77, respiratory rate 20/min and SpO2 91% without additional oxygen. The patient is conscious, but slightly incoherent in speech. He is able to answer with “yes” or “no” when asked straightforward questions. The referring letter from the nursing home reveals that the patient has three children. On physical examination, crackles and rhonchi are heard. The patient does not show signs of imminent respiratory distress. The urine in his urine catheter, inserted during his stay in the Emergency Room, is clear. The rest of the clinical examination is unremarkable. In his medical file, no advance care plans are described, the patient does not seem to comprehend questions regarding this topic. Chest X-ray shows bilateral infiltrates. CRP is 90 mg/L (normal value <9 mg/L), D-dimers 250 mg/L (normal value <0.5 mg/L).
The symptoms started 7 days ago, his temperature is 37.8°Celsius, heart rate 81/min, BP 152/77, respiratory rate 20/min and SpO2 91% without additional oxygen. The patient is conscious, but slightly incoherent in speech. He is able to answer with “yes” or “no” when asked straightforward questions. The referring letter from the nursing home reveals that the patient has three children. On physical examination, crackles and rhonchi are heard. The patient does not show signs of imminent respiratory distress. The urine in his urine catheter, inserted during his stay in the Emergency Room, is clear. The rest of the clinical examination is unremarkable. In his medical file, no advance care plans are described, the patient does not seem to comprehend questions regarding this topic. Chest X-ray shows bilateral infiltrates. CRP is 90 mg/L (normal value <9 mg/L), D-dimers 250 mg/L (normal value <0.5 mg/L).