Question normal

74-year-old lady who, according to her daughter, the main carer, and later confirmed by the patient herself, had suffered from lethargy and nausea for 2 weeks. Also, of concern was one episode of nocturnal confusion, always on daughter’s account, all being unusual. Nothing else. No fever, cough, dyspnoea, diarrhoea, sore throat, rhinitis, conjunctivitis, aches, abdominal pain, headache, anosmia, or loss of taste. Her appetite remained unaltered. Remote anamnesis was unremarkable other than for obesity and dyslipidaemia. On examination the patient, in bed, appeared to be talkative, slightly pale, no cyanosis, obese, body temperature 36.8C, normocardic and normopnoeic, with BP 120/75 mmHg, pulse regular at 87 bpm. Heart sounds were normal with no added sounds and no murmurs. There was no peripheral oedema. Despite a respiratory rate of 18 bpm, she was relaxed and talkative without subjective or objective dyspnoea, and in absence of previous COPD of IPF, her SatO2 was 89%. Chest inspection, palpation and percussion were essentially normal, but on auscultation crackles were audible across all the fields on both sides. Abdomen was normal. Admission later confirmed clinical suspect of Covid19 pneumonia.
By no means a video-encounter could have anticipated those findings and, in fact, may have triggered prescribing of antiemetic, for instance.
Two main points emerge from this case: particularly in the elderly patients expect the unexpected and value SatO2 as a key parameter to have in hand when undertaking remote consultations. That is to say that a pulse oximeter should be a most valuable gizmo in every household and a must have in rest and nursing homes thereby facilitating remote encounters and patients’ monitoring.