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This one was a doozy

Another day, another case.

30 something years old presented with 5 days of progressive dyspnea, chest pain, dry cough and subfebrile temperatures. His preexisting medical conditions are asthma, polyposis.

No muscle aches, headaches, no changes in his smell or taste, no gastrointestinal symptoms.

He came to ER. Of course, they were thinking COVID.

His CRP was somewhere in the middle ranges, leukocytosis, neutrophilia, leukopenia and what was interesting was eosinophilia. They did the quick PCR test which was negative. His chest x-ray showed rather massive bilateral pneumonia v.s. COVID according to the radiologist.

They gave him corticosteroids and some inhalations with minor improvement.

He was admitted to my floor as suspected COVID. I did not approve of this admit, my older colleague did. But something at the back of my mind was like

During the admit his pressure was fine, his oxygen levels were fine. He looked tired. He was complaining of chest pains. When listening to his lungs u could hear rattling sounds.

Now let me explain why my spidey sense was tingling.

A 30-year-old normosaturated patient, who in the past spent some time in hospitals (as he was an asthmatic fella), would not go to the hospital just bc he was feeling under weather.

He was vaxxed, he still could have gotten Omikron and I get why that was the working diagnosis.

But the doc in the ER did not do ECG bc apparently the patient is young and without any preexisting conditions, according to him, his chest pain was due to asthma (?) and/or covid. Ok still…I kinda get it. But ECG should be the ducking base with chest pain no matter how old the patient is.

Anyway, he was admitted. My younger coworker was assigned to his case. He asked me to go and look at this patient bc he suddenly developed a nonpruritic rash on his head, arms and torso. He was tachypneic. His pressure was 110/70 90 pulses. Sat. 91 on room air.

I asked for ECG. Eyes were rolled.

This is his ECG, sorry for the bad quality