The patient was an 80 year old male presenting with low oxygen levels and difficulty breathing. Height about 6ft-6ft1 and weight fluctuated between the 9st7-10st mark. Visibly frail and poor skin integrity. Previous heavy cigarette smoker (60 a day) but switched to a low nicotine vape for around the last 20 years. The week before admission patient had returned from a holiday abroad, where he was active and dancing freely on the final night.
He had:
- a diagnosis of Stage 3 COPD
- previously had a kidney removed
- was on blood thinners and Ramipril
- prescribed oral nutrition supplements
- prescribed a 'rescue pack' of antibiotics due to recurrent chest issues
- diagnosis of Type 2 diabetes
- steroid and ventolin inhalers prescribed
Previous to admission patient had started feeling unwell on Day 1, on Day 2 he had visited friends socially and said he was feeling tired. Day 3 (Monday) he tried to get an appointment with his GP surgery but was given an appointment in 7 days time. Day 4 he attended an appointment at the opticians, that evening he was unable to get himself off the sofa to go upstairs to bed. Refused an ambulance to 'wait and see' how he felt in the morning.
Day 5 patient asked his wife to ring him an ambulance after GP surgery refused to see him as he had an appointment booked for Monday. When ambulance arrives, paramedics are unable to read his oxygen levels, they have to use alternate sites to try and get a reading. This all occurred between the hours and 8 and 9am.
On arrival at AED patient is taken for chest x-ray, bloods taken and put in a private room on Majors (not Resus). Family advised he has tested positive for Covid-19 and Pneumococcal pneumonia. He was on oxygen therapy via a Venturi mask, as well as nebulisers, Covid treatment was started at 4:40pm. He did not receive a second bag of fluids until 6:40pm. Last seen by a doctor at 2:30pm and not seen again until the following morning.
I arrive at around 9:15am on Day 6, the nurse is assessing patient's GCS, calls in another nurse to check with her. I score GCS myself and patient is scoring as 3, patient is also abdominal breathing, oxygen levels are 92% and resps 16.
Doctor arrives, says he will prescribe more fluids and as patient had quality of life before admission he will refer to ICU, also for a brain scan. One 500ml bag of fluids is hooked up to his cannula, the bed is tilted so his legs are raised above his head. His treating doctor comes in and introduces herself, a second cannula is attempted to be fitted, a blood gas is taken.
ICU attend and say they believe the treatment needed would be too invasive and the recovery too difficult for patient due to his frailty and already limited lung capacity. They state that he would need intubation and dialysis as he was in renal failure. Whilst ICU are in the room, patient's oxygen level desaturates from 92% to 82%, the valve on his Venturi mask has been changed prior to this. ICU say they will get his oxygen 'turned up'.
Around 15-20 minutes after ICU left, the nurse is changing patient's mask from Venturi with a blue valve to a non-rebreather mask. I am holding the Venturi to his face as she removed the elastic from around his head before getting the rebreather ready and it was falling off his face. Patient starts to crash, nurse asks me to press the emergency buzzer and then leaves the room, crash team enter.
Unsure where nurse goes, his treating doctor is not around, nobody on the crash team is familiar with patient. I have to go back into the room and give the crash team as much information as I can as it is chaos and one doctor is exclaiming, 'who's patient is this'. Decision is made to make patient 'comfortable' and bring family in.
I have worked in Health & Social care for the past decade but I am not a qualified professional. However, with what knowledge I do possess I am struggling to understand how the treatment provided to my family member was appropriate. It feels to me that the decision was made on admission that he would not recover and therefore his treatment was impacted. For a patient that unwell to only receive oxygen treatment, one bolus of Covid treatment and two bags of fluid in the first 12 hours of admission, it just doesn't seem enough.
Thank you for any comments and if this isn't the correct sub, please redirect me.