Ambulance called for 74 y/o male suffering from difficulty b | Figure 1

Ambulance called for 74 y/o male suffering from difficulty breathing.

On arrival:

• ambulance met by wife of the patient who informs us that the patient is covid positive.
• wife seems calm and helpful. She states that she was going to transport him privately however she was worried that he would collapse.
• after donning PPE and entering the home, patient is found seated on the edge of his bed sitting in a tripod position and appears ashen grey and severely diaphoretic.
• patient denies any chest pain or discomfort stating that he just feels very "hot" and is struggling to breathe properly.
• patient is only on anti-hyperlipidemia medication.

On exam:

• patient is extremely tachypnoeic with respirations between 36 - 40.
• GCS 15/15 talking 2 word sentences.
• BP is 140/90 manual.
• HR is 158 with narrow complex tachycardia on the 3-lead ECG.
• HGT is 9.0
• Sp02 is 85% RA and 86% NRB @ 10L/min
• air entry was clear bilaterally even though patient has been diagnosed with covid 4 days ago and allegedly diagnosed with pneumonia according to wife.

After placing patient on a stretcher in a high semi fowlers position, we loaded him into the ambulance and called for ALS backup. IV started with 200ml Nacl and 18G to right ACF.

Consult with ALS done telephonically and we agreed patient may need to be cardioverted.

We met with our ALS en route to hospital and patient was assessed again. Vitals are as follows:

• GCS 11/15
• BP unobtainable / radial pulse absent
• RR 26
• HR 161
• Sp02 84% 15L/min NRB
• pale and diaphoretic skin

ALS prepared adenosine when suddenly patient went unconscious and heart rate slowed into a PEA rhythm.

CPR initiated and hospital updated. SGA placed and compressions continued.

CPR continued in hospital for 10 min before efforts were ceased. This case happened in south africa and highlights the lethality of the south african covid-19 strain. According to the wife he wasn't so bad earlier in the morning.

I would like to find some more ideas from peers, anything else we could have done or any other learning material we can use.

We are well aware that you shouldn't resuscitate a covid patient but this was a witness arrest and we would have had a hard time from our ethics committee if we didn't.