Correct!
3. Perform ECG
The patient has no defined risk factors for venous thromboembolism and testing along these lines is probably not required, particularly given that he has a focal abnormality on his chest radiograph which can be explained on the basis of infection, as can his symptoms; the focal appearance of chest radiographic abnormality would be very atypical for thromboembolic disease. The elevation of his D-dimer is potentially attributable to his COVID-19 infection. As noted above, chest CT is not routinely indicated for COVID-19 infected patients, particularly when chest radiographic abnormalities have already been noted. Given that the patient is being admitted and has known COVID-19 infection, the admission should not be “routine;” rather protective measures, such as a respirator for the patient to wear, or admission to a room capable of providing negative air pressure, is required. Furthermore, hospital staff caring for the patient should also be appropriately protected through the use of a combination of airborne precautions. Given that hydroxychloroquine and chloroquine has been approved to treat COVID-19 infected patients by the Food and Drug administration under an emergency use authorization, and that these medications can be associated with dysrhythmia owing to prolongation of the Q-T interval, obtaining an ECG prior to the initiation of hydroxychloroquine and chloroquine is appropriate.
The patient was admitted to an intermediate care unit for monitoring and, given his wheezing, albuterol therapy was initiated. The patient was empirically started on azithromycin and ceftriaxone therapy, and an ECG was performed, after which hydroxychloroquine treatment was begun, following consultation with infectious disease. Testing for various respiratory pathogens was initiated as was testing for tuberculosis. Unenhanced chest CT was also recommended by infectious disease (Figure 3).
Figure 3. A-I: Representative images from the axial unenhanced chest CT displayed in lung windows. Right: video of unenhanced chest CT in lung windows.
Which of the following statements regarding the chest CT is most accurate? (Click on the correct answer to be directed to the ninth of twelve pages)