The information in this blog post is not for personal medical advice. Please consult with your doctor for more information.
PART ONE.
I am a physiotherapist currently working with patients infected with COVID-19 in a hospital in South Africa. Throughout my working career, I’ve had many people complain that they do not know what to ask the doctor about the progress of their loved one while admitted into hospital.
The pandemic has changed so many things about the hospital experience of our patients with one of them being the lack of visitation and support during their recovery and rehabilitation. Many patients infected with COVID-19 have been isolated throughout their hospital stay and the most interaction that they receive with their loved ones is a video call via the hospital tablet.
My goal is to give you six questions that you can ask the doctor or nurse that is caring for your loved one to see the improvement in their health. Read the realistic example below and the questions that follow that will help you.
You call Dr Smith and he answers the call after a few rings, “Hello Dr Smith speaking”. “Hi there, this is Mr Frank Stanley’s daughter calling. I would like to have an update on my father’s condition since his admission this morning. I know that he was admitted to the PUI unit to be tested for COVID and he had terrible shortness of breath. Is he feeling better?” you ask.
“Ah yes Ms Stanley, I was about to call you to give you some feedback on your father’s condition. He’s been diagnosed with bilateral COVID pneumonia and we’ve had to intubate him. The ventilator is doing 100% of the work to allow his lungs to recover. He came in with a severe infection and his blood pressure was dropping so we had to put him on inotropic support. He also is not passing urine so he is on continuous dialysis until he recovers. He is in critical condition and only time will tell as to how he recovers” reports the doctor.
…”Ms Stanley, are you still there?” asks the doctor.
“Yes… Sorry, this is all a lot to take in.” says Ms Stanley.
“I understand. We will be taking blood samples every 8 hours and taking a chest x-ray daily to see how your father responds to the treatment and then we will reassess and adjust the management.” says Mr Smith, “the nurses will update you with further information when you phone in”.
Ms Stanley asks, “Dr Smith, when can I visit my dad?”
“Unfortunately, no visitors have been allowed at the hospital in over a month and especially not in the red zones. Potentially when your father is no longer infectious and the green zones are permitting visitors then you may visit” responds the doctor, “if that will be all, I must go. Goodbye.” -CLICK-
You leave the conversation feeling scared and confused. When you last saw your dad, he wasn’t in such a terrible condition and now he is fighting for his life. Now what?
1. Bilateral COVID-19 pneumonia… What is that?
All the medical jargon can be very confusing, especially when a lot of information is given at once. Let’s break it down and see what the problem actually is.
Bilateral = both sides
COVID-19 = a unpredictable viral infection that can complicate in 15-20% of all cases
Pneumonia = an infection in the lungs that causes inflammation in the tiny air sacs
COVID-19 can complicate into a single pneumonia and double pneumonia. It causes severe inflammation in a person’s lungs that can lead to acute respiratory distress syndrome (ARDS). Sometimes the walls of the alveoli (air sacs) become thick and make it very difficult for a person to breathe.
2. Is my loved one breathing on room air?
People with COVID-19 require various forms of additional oxygen. They can breathe on room air (independently), nasal cannula, a polymask, high flow nasal cannula, non-invasive ventilation and invasive ventilation. These are in the order of least dependent to most dependent forms of oxygen and will vary throughout your loved one’s hospital stay. The aim is for the patient to use the minimum amount of oxygen as possible at the time of discharge.
With regards to invasive ventilation, there are different modes that vary from most controlled to patient controlled. We aim for the patient to move from APRV to SIMV to BIPAP and then CPAP.
Depending on the amount of time ventilated, your loved one may need to undergo a surgical procedure to allow the ventilator to work through their throat. It is called a tracheostomy.
Usually patients that have COVID pneumonia start off with a high concentration of oxygen and are gradually weaned to a lower amount of oxygen before the ventilator is removed. We aim for this to be 35% before removing the tube.
3. What is my loved one’s oxygen saturation and PaO2?
Oxygen saturation tells us the degree to which oxygen is bound to haemoglobin. Haemoglobin is a blood component that is important for transporting oxygen to the different tissues around the body.
Oxygen saturation is measured using a probe on one finger or on an earlobe. A loved one that is in the ICU will have one of these probes so that the nurses are able to monitor their oxygen saturation regularly.
The ideal oxygen saturation is about 97% but usually with acute COVID pneumonia above 90% is considered acceptable.
The PaO2 is a measurement of oxygen concentration in a person’s arterial blood. This is tested every 4-12 hours in ICU so that oxygen supply can be adjusted appropriately.
We expect a decrease in PaO2 in moderate to severely affected individuals with COVID19 and we support them by adjusting the amount of oxygen received.
In ideal circumstances, we expect the PaO2 to be above 100mmHg.
TO BE CONTINUED...
Look out for Part 2 that will be released next Wednesday at 8am.
Contact us if you need some rehabilitation after having COVID-19.
Call 076-102-6422 for an appointment.