key: cord-0896019-thia28sh
authors: Aminlari, Amir; Quenzer, Faith; Hayden, Stephen; Stone, Jennifer; Murchison, Charles; Campbell, Colleen
title: A Case of COVID-19 Diagnosed At Home with Portable Ultrasound and Confirmed with Home Serology Test
date: 2020-10-12
journal: J Emerg Med
DOI: 10.1016/j.jemermed.2020.10.022
sha: 2d2e6ceb14af75c22b49e80881ed832e86bd8e65
doc_id: 896019
cord_uid: thia28sh

Background The COVID-19 pandemic has pushed us to find better ways to accurately diagnose what can be an elusory disease, preferably in a way that limits exposure to others. The potential for home diagnosis and monitoring could reduce infectious risk for other patients and healthcare providers, limit use of finite hospital resources and enable better social distancing/isolation practices. Case Report We report a case of an otherwise healthy Emergency Physician diagnosed with COVID-19 at home using portable ultrasound, pulse oximetry and antibody testing. Her clinical picture and typical lung findings of COVID-19 on ultrasound, combined with a normal echo and negative DVT study, helped inform her diagnosis. She then monitored her clinical course using pulse oximetry, was able to self-isolate for four weeks and had an uneventful recovery. Her diagnosis was confirmed with a positive IgG antibody test after three weeks. Conclusions Novel times call for novel solutions and our case demonstrates one possible path for home diagnosis and monitoring of COVID-19. The tools used, namely ultrasound and pulse oximetry, should be familiar with most modern emergency physicians. Ultrasound in particular was helpful in eliminating other potential diagnoses, such as pulmonary embolus.

Portable ultrasonography has been shown to be valuable adjunct tool, along with pulse-oximetry 39 and the physical examination, in diagnosing both COVID-19 and its associated severe cardio-40 pulmonary complications such as pneumonia and cardiomyopathy 1 

The decision to keep her at home, despite the mild hypoxemia of 88% was influenced by the 86 fact that she was able to receive continuous pulse-oximeter monitoring, providing confidence 87 that worsening hypoxemia would be detected. The home serology test, which is approved by 88 the Food and Drug Administration (FDA), was convenient and reassuring that the diagnosis was 89 correctly made 5 . The patient was able to stay in home quarantine, continue observation of vital 90 signs, and treat herself symptomatically until the resolution of her illness.

This case was particularly unique in that the patient and her husband were both emergency 93 physicians with the requisite skillset to perform a portable point-of-care ultrasound at home to 94 correctly make the diagnosis and also to rule out other worrisome conditions such as DVT, right 95 heart strain from a massive PE, pericardial effusion and lobar pneumonia. We recognize that a 96 portable ultrasound machine and the skillset required for its use outside of the hospital setting fast approaching, we must be willing to consider all treatment options and pathways that are patients in the general population, the combination of a pulse-oximeter and home serology test is useful to diagnose COVID-19, and decide if and when to go to the emergency room, thereby 105 alleviating stress on our healthcare system. serological-test-validation-and-education-efforts. 

ASE State-109 ment on Point-of-Care Ultrasound (POCUS) During the 2019 Novel Coronavirus Pan-110 demic

Doctors in Italy, Spain using ultrasound for COVID-19

Accuracy of point-of-care multiorgan ultraso-118 nography for the diagnosis of pulmonary embolism

Coronavirus (COVID-19) Update: Serological Test Validation