PRIVATE EM WRITES

Collaboration between two hospitals during COVID-19 Pandemic

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Dr MAN Ka Ki

Resident Consultant

Hong Kong Baptist Hospital, 24-hour Out-patient Clinic

A 96 years old lady with known history of well controlled hypertension and asthma attended our out-patient centre for shortness of breath and orthopnea since 3 days ago.

Physical examination found her body temperature 34 degree of Celsius, which is mild hypothermia.  Her blood pressure and pulse were 173/68mmHg and 55 per minute respectively.  She was found to be dyspneic and in desaturation with a SpO2 of 84% in room air upon arrival.  Generalised oedema including her face and lower limbs were found.  On auscultation, crepitations were heard over bilateral lungs.     

 

Her H’stix was 12.1.  ECG found sinus bradycardia, 58 per minute without ST elevation.

Her chest X-ray revealed that the left hemithorax was completely opacified and there was mild right pleural effusion.

Her medical condition was stabilised with prop-up in 30 degree with 6L/min oxygen via face mask. Intra-venous Lasix 20mg, Ceftriaxone 1g and Dopamine infusion were given.  Her nasopharyngeal swab for COVID-19 was negative.  The sensitivity of COVID-19 PCR test was 85.7% (1), therefore it was not a sure non-COVID case. According to the hospital guideline, she was required to admit an area with negative pressure facility.  Owing to the only ICU bed with negative pressure facility in our hospital was occupied, she was transferred to an intensive care unit with negative pressure room provision in another private hospital with my medical escort via an St. John’s ambulance.

 

This case demonstrates that the lack of negative pressure facility among private hospitals limited the provision of medical care to patients during the pandemic.  Secondly, good communication, support and trust among colleague in private hospitals can provide good patient care under constraints.  Thirdly, I would like to say thank you to the charitable organisation, Hong Kong St. John’s Ambulance, which provides ambulance service to local citizens and especially during this difficult time. 

 

Hope and do the best for our local medical system! 

Reference: Elisa Kortela Real-life clinical sensitivity of SARS-CoV-2 RT-PCR test in symptomatic patients PLOS ONE May 21, 2021