JS, a 79-year-old COVID patient was admitted to the hospital in December. Initially, he required 2L of oxygen support, transitioned to room air for 2 days, then progressively declined, requiring additional oxygen/ventilation support moving onto BiPap two days later; even after receiving Remdesivir and CPT. Two days later, we attempted to transition the patient off BiPap and onto a non-rebreather. This would work for a short period of time but still required the BiPap. Weaning attempts continued for a week. On this day Crista was assigned to this patient; the Doctors were commenting their concern for why the patient was not improving, and one stating "I am very concerned with this one, why he's not getting better. I think likely tonight we will have to send him to the ICU." It was at this time that Crista asked if she could have some lab work drawn, including a D-Dimer. Initially, on admission, the patient's D-Dimer resulted at 1.40. The result on this day, D-Dimer was (greater than) >20.00*!! The patient had been on Lovenox since the admission date. Crista quickly reported this to the doctor team, and she requested both an Ultrasound of the Lower Extremities and a CTA Chest, which the doctors agreed to. The results were "SIGNIFICANT RIGHT & LEFT PERONEAL VEIN DVT. PARTIAL LEFT POPLITEAL DVTSIGNIFICANT RIGHT & LEFT PERONEAL VEIN DVT. PARTIAL LEFT POPLITEAL DVT", and "1. MOTION LIMITED STUDY. BILATERAL PULMONARY EMBOLI, 2. EXTENSIVE GROUNDGLASS INFILTRATES INVOLVING BOTH LUNGS."
Because of Crista's critical thinking, we were able to discover the patient was worsening due to having extensive DVTs and Pulmonary Emboli. The patient was then transferred to the ICU where he required intubation. Thank you, Crista, for keeping on the alert during these COVID challenges, and not conforming to "this is just the course of action."