Good morning everyone, thank you for being here and we hope everyone is in good health.

Thank
you for providing your valuable time for our discussion today.

Allow me to introduce myself, I’m Xina, one of the general practitioner on duty in the COVID ICU this
morning, and I’ll be presenting the case for our discussion today.

Slide 1

Case presentation, Intensive Care Unit, University of Indonesia Hospital

Slide 2

Here’s our patient’s identity, Mrs W, Female, fourty seven years old, registration date blabla

Slide 3

Patients were admitted to emergency room with severe dyspnoea and desaturation up to SpO2 35%.
Current complains includes Dyspneu on Exertion (+), Cough (+) and no Paroxysmal nocturnal
dyspnea (-), Fever (-), loss of consciousness (-), Chest pain (-)

Patient had previously been to another hospital and advised for ICU treatment and intubation, but
the family refuses

The patient present with positive antigen swab results on August 21st

Patient medical history includes type 2 DM, Hypertension, Fatty Liver, Obesity , Nephrocalcinosis

• Current Medications includes Metformin 500 mg two times a day, no history of Surgery or
Allergy, alcohol consumption or smoking

• Family History : unknown

Slide 4

Primary Survey and Physical Examination in ER

Blabla

Slide 5

Patient assessment includes Probable Covid critical ill with pneumonia

• ARDS

• Sepsis

• Acidosis respiratory susp. ec type 2 ARDS

• Type 2 DM

• Hypertension

• Obesity

For patient treatment, we’re using ringer acetate five hundred cc/ 8 hours

• Antivirus : Remdesivir H1 1x200mg H2-5 1x100mg IV

 • Antibiotic : Meropenem 3x1g IV

• Antihyperglycemic : RI 1U/jam IV

• Antihypertension : Candesartan 1x16 mg IV

• Steroid : Dexamethasone 2x5mg IV

• Anticoagulant : Heparin 2x7500IU SC

• Resfar 1x5g IV

• Vit C 2x500mg PO

• Vit D 1x2000IU PO

• Zinc 2x20mg PO

• Recolfar 2x0.5mg PO

Slide 6

• Here’s the time of event for patient history, starting with patient were intubated in the ER
on 27 august, and then patient were admitted to the ICU on 29th august and undergone first
hemodialysis on 31st of august. Patient then undergone echochardiography with LVEF result
if 71%, mild tricuspid regurgitation, Normal LV & RV systolic, and Normal LV diastolic.

• By 2nd September was carried through her second patient hemodyalisis along with
hemoperfusion and bronchoscopy with the result that all bronchial branches are narrow. On
third September the patient’s left fingers looked cyanotic, and by fourth September we
carried the patient through her 3rd hemodyalisis.