Recommended Citation
Warren B, Villa E, Griffith J. COVID-19 persists: A case report. Presented at: Midwest Anesthesia Residents Conference (MARC); April 26, 2025; Indianapolis, IN.
Presentation Notes
Presented at: Midwest Anesthesia Residents Conference (MARC); April 26, 2025; Indianapolis, IN.
Abstract
Introduction: Coronavirus-19-Disease (COVID-19) gripped the world starting in 2019. New vaccines, regulations, and mandates have been implemented, and the virus itself continues to be studied. A fearful comorbidity that often leads to mortality is the hypercoagulable state COVID-19 induces. According to the American Society of Hematology, patients with COVID-19 are at increased risk of thrombotic complications, despite the in-hospital use of standard- or escalated-dose thromboprophylaxis [1]. While critical illness is known to cause a hypercoagulable state due to immobilization, mechanical ventilation, central venous access devices, and nutritional deficiencies, COVID-19 appears to cause a hypercoagulable state through mechanisms unique to SARS-CoV-2 and centers around the cross-talk between thrombosis and inflammation [2]. Case Presentation: A previously healthy 26-year-old male presented to an outside hospital (OSH) on 01/02/25 complaining of three days of shortness of breath and one day of bloody sputum. On arrival, the patient was noted to be hypoxic with SpO2 of 70%. CT PE revealed extensive bilateral pulmonary emboli with saddle pulmonary emboli at the distal right and left main pulmonary artery with extension to the lobar, segmental, and subsegmental branches. He was transferred to AIMMC for surgical intervention. He was intubated prior to the operating room due to worsening respiratory status and frothy secretions. Upon arrival to the operating room, the patient was hypotensive with a heart rate of 140bpm and he was started on norepinephrine. An arterial line was placed, and the first ABG revealed a pH of 7.15, potassium of 6.1mmol/L, glucose of 184mg/dl, and a base deficit of 9mmol/L. Over the course of the next hour, the patient was given 3 amps of bicarbonate, 2 grams of calcium gluconate, and 10 units of regular insulin. The patient subsequently underwent aspiration thrombectomy of large volume of thrombus removed from the right pulmonary artery. ABG before patient transport to the ICU showed a pH of 7.43, potassium of 4.5mmol/L, glucose of 110mg/dl, and a base deficit of 1mmol/L. He was extubated on 1/3 and was transitioned from heparin drip to Eliquis on 1/4. He was also treated for community acquired pneumonia with IV ceftriaxone and doxycyline. He was discharged on 01/06/25 in good condition. Conclusion: Despite a greater understanding of the disease, COVID-19 remains a dangerous threat. While it is well-documented in causing significant morbidity and mortality in at-risk populations, all individuals should remain vigilant in protecting oneself from the disease. Even previously healthy patients can have significant morbidity when affected with COVID-19 and can present a challenge, even to the most experienced anesthesiologist. 1. Fien A. von Meijenfeldt, et al. (2021) Blood Adv 5 (3): 756–759. 2. Abou-Ismail MY, et al. (2020) Thromb Res 194:101-115.
Type
Oral/Podium Presentation
Affiliations
Advocate Illinois Masonic Medical Center