Patient Case Review: Dr. Audrey Lim

Audrey Lim was a patient in episodes 2×10/2×11 Quarantine.

In this episode, two patients with a rash on their neck are brought to the ER, both having been on the same flight to San Jose from Malaysia. Dr. Lim was one of the doctors treating both patients in the ER. The male patient died in the ER while they were trying to rescucitate him.

When it was suspected that a fast spreading viral infection might be at play, the female patient was quarantined in a negative flow air pressure room, and the medical staff treating her all made sure to wear protective gear. Still, one of the EMTs who had brought in the patients was also infectioned, and eventually Dr. Lim started showing the same rash.

She was then quarantined, together with Tyler, the EMT. Both the female patient from the flight and Tyler died in quarantine from the virus infection and the damage to their organs. Dr. Lim started developing a fever from the viral infection, and as it progressed, she collapsed from it.

They started treating Dr. Lim, but she deteriorated steadily. CDC recommendation for treating the viral infection was antivirals, steroids, inhaled nitric oxide and anti-TNF receptor antibodies. They treated the two initial patients with that regimen, who both died, but they were hoping that Dr. Lim would respond better since they caught her infection earlier.

Lim’s oxygen saturation at that point was 92%, her respiratory rate was down to 16. She asked Dr. Reznick to use conservative fluid management to keep pulmonary edema (build-up of fluid in the lungs) to a minimum and asked to be treated with furosemide to bring her CVP (central venous pressure) under 8. (CVP reflects the amount of blood returning to the heart and the ability of the heart to pump the blood back into the arterial system.)

When Dr. Lim’s status got worse, they started bronchodilators (medication to get more air into her lungs), but her oxygen saturation was still dropping, so they intubated her. Dr. Reznick was getting resistance when she was bagging, and Dr. Lim was given hyoscine to improve the effect of the artificial respiration. Dr. Lim’s lungs weren’t inflating as they were filled with fluid and secretions and she went into full respiratory failure.

Dr. Andrews said she needed more pulmonary support and suggested putting her on BiPAP (breathing support administered through a face mask, nasal mask, or a helmet). Dr. Reznick suggested to put her on ECMO (extracorporeal membrane oxygenation) instead to oxygenate her blood outside her body.

While on ECMO, Dr. Lim’s MAP (mean arterial pressure) was holding steady at 65, but she was going into serious hypoxia (deprivation of oxygen). However, she shortly thereafter improved and regained consciousness. When the quarantine was lifted, she was admitted to the hospital ward and eventually recovered fully.

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