key: cord-0788840-suu1blzz
authors: Kamboj, Ravneet; Shin, Richard D.
title: Elderly male with hypoxia
date: 2021-01-18
journal: J Am Coll Emerg Physicians Open
DOI: 10.1002/emp2.12374
sha: f9f3aaecb32c9c7012f006602e2830589f28e80d
doc_id: 788840
cord_uid: suu1blzz

nan

An 89-year-old male with a past medical history of hypertension, hyperlipidemia, and dementia presented with hypoxia during the COVID-19 pandemic. The patient's vital signs were heart rate (HR) 60, respiratory rate (RR) 21, oxygen saturation (SpO 2 ) 90% on room air, blood pressure (BP) 123/84, and temperature 36 • C. His examination was at baseline with no significant findings including extremities with normal perfusion. The patient tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and was discharged to continue oxygen at a skilled nursing facility. After 14 hours, the patient returned with acrocyanosis of the upper and lower extremities. Repeat vital signs were HR 73, RR 24, BP 165/71, temperature of 35.4 • C, and SpO 2 100% on oxygen. Physical examination was significant for bilateral upper and lower distal extremity cyanosis that were cool to the touch with diminished pulses (Figure 1-2) . Laboratory analysis revealed D-dimer 58,017 ng/mL reference range (≤ 209 ng/mL); creatinine 6.10 mg/dL reference range (0.70-1.30 mg/dL); and troponin 0.116 ng/mL reference range (0.010-0.030 ng/mL). These rapid changes and acrocyanosis were owing to micro thrombosis and disseminated intravascular coagulopathy related to COVID-19 disease. 1

This case report highlights a rare but known complication of diffuse microthrombosis and acrocyanosis associated with COVID-19. 2 for markers of disseminated intravascular coagulopathy may persuade clinicians to consider initiation of anticoagulation early.

Microvascular thrombosis and ischaemic limb losses in critically ill patients

Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy

How to cite this article: Kamboj R, Shin RD. Elderly male with hypoxia