I was called first thing in the morning to run to the COVID-19 triage area. A woman had come in with chest pain, cough, and slightly low oxygen. She also had known TB with recurrent pleural effusions. I donned my PPE’s, most of them made in the hospital, with a bit of trepidation. It is a bit concerning to walk into the unknown, but I felt relatively confident that I was in the place I was supposed to be. She was sitting alone in obvious pain, some hyper-ventilation – mostly from the pain, but no fever, and no cough. So she had few symptoms of COVID-19. I questioned her and it became clear that this was likely a recurrent pleural effusion that she has been dealing with for months. When her lung fills, she has pain, she gets it tapped, and then she feels better. I listened to her lungs with no breath sounds heard on the right side. I gave her a shot of morphine for the pain, and then I tapped her lung. Four liters of milky fluid was relieved, and she became a different person. No longer did she feel short of breath. Her pain was gone. She felt great, hopped out of the bed, and told me she wanted to go home! She has TB, and does not likely have COVID based on her history. Either way, at this point she did not meet our admission criteria of respiratory distress and hypoxia. I let her go home with a follow up in a week so that we can recheck that effusion sooner. She states that since starting TB treatment, the need for drainage has become less frequent. I hope it continues to get better! It actually looks like what is called a chylothorax, and I think it may need further surgical intervention to heal all the way. But if she is getting better by her history, I thought we could wait. I hope I am right! This was also a chance to try out our hospital made PPEs. I think I look like an old woman.
Feel free to click the pictures above for a better look! 🙂