Lew Felicia H, Chang Kevin M, Singares Eduardo Smith
Elson S Floyd College of Medicine at Washington State University, Spokane, WA, United States of America.
Trauma & Emergency Surgical Services, Elson S Floyd College of Medicine at Washington State University & Kadlec Medical Center, Richland, WA, United States of America.
Trauma Case Rep. 2022 Oct;41:100687. doi: 10.1016/j.tcr.2022.100687. Epub 2022 Aug 1.
COVID-19 has become a global pandemic. It has affected patients the world over, and when minimally symptomatic, it can be an incidental finding in trauma patients. It may also make the diagnosis of other rare conditions more difficult due to clinical finding superimposition.
A 23-year-old male was transferred to our Trauma Center in hemorrhagic shock after sustaining multiple gunshot wounds in the upper back. Imaging showed a retained projectile in the right pharyngeal area, a right upper lobe contusion, and a right hemopneumothorax; with additional infiltrates on both lungs suggestive of atelectasis. After intubation, a propofol infusion was started for sedation. Shortly thereafter worsening acidosis, refractory hypoxia, and hypotension with additional laboratory anomalies ensued, as the PCR screening for SARS-CoV-2 returned positive. The clinical findings suggested COVID-19 pneumonia with possible superimposed Propofol Infusion Syndrome. The drug was stopped, and the symptoms improved.
A high index of suspicion is necessary to manage unusual pathologies and difficult differential diagnoses, and this is especially true during the ongoing pandemic.
新型冠状病毒肺炎已成为全球大流行疾病。它影响了世界各地的患者，在症状轻微时，可能是创伤患者的偶然发现。由于临床发现相互叠加，它也可能使其他罕见疾病的诊断更加困难。
一名23岁男性因上背部多处枪伤后出现失血性休克被转送至我们的创伤中心。影像学检查显示右咽区有一枚滞留弹丸、右上叶挫伤和右侧血气胸；双肺还有额外的浸润影，提示肺不张。插管后，开始输注丙泊酚进行镇静。此后不久，随着严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的聚合酶链反应（PCR）筛查结果呈阳性，酸中毒、难治性低氧血症和低血压加重，并出现了其他实验室异常。临床发现提示新型冠状病毒肺炎，可能叠加丙泊酚输注综合征。停用该药物后，症状有所改善。
对于处理不寻常的病理情况和困难的鉴别诊断，必须保持高度的怀疑指数，在当前的大流行期间尤其如此。
