From the quarantine diary of an emergency physician: the coronavirus and the dysautonomic storm
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From the quarantine diary of an emergency physician: the coronavirus and the dysautonomic storm Simone Vanni1 · Peiman Nazerian2 · Giancarlo Bini3 Received: 31 March 2020 / Accepted: 18 April 2020 © Società Italiana di Medicina Interna (SIMI) 2020
The preparations are fervent, the organizational changes are many and rapidly evolving, meetings follow one another. I go up and down the stairs with my mask and I seem to be struggling more than usual, is it the mask? When I talk and I get excited about a subject I feel like I have to finish the sentence first, is it the tension? I spend 12 h in the hospital, in the evening at home I find G. (15 years old) who has fever and diarrhea. I notice that the other two have an insistent dry cough; B. (54) has a sore throat… Saturday morning (March 14th) I wake up exhausted, but I have to go to work… The road in the car has less traffic than usual. The sunny morning seems promising, but my strength is lacking, I need to get home early. I have a feeling. I tell my family that many colleagues have gone to sleep on their own and I get the kids to prepare a bed in the study and I lie down and try to sleep. I can’t, even though I feel very tired. I stay in bed, it’s snack time, you hear the news about the pandemic, the tension rises. I feel I have a temperature, a feeling of warmth in my face with cold extremities, but no shivers. I take my temperature repeatedly, 36.1–36.2 °C. Is it my impression? Nonetheless, my face is hot, and I am tachycardic (90–100/min, usually 60–70). I have an oxymeter at home, 98%. After dinner, I try to sleep but I can’t, a polyuria starts. Clear, abundant urine, one, two, three times. Maybe it’s anxiety? During the night around one o’clock I finally get a high-temperature (38–39 °C); this is, at last, an objective sign of my malaise. Tachycardia 120/min. I stay in bed, I have a headache and cervical pain as if from meningism. * Simone Vanni [email protected] 1
Emergency Medicine Unit, San Giuseppe Hospital, Azienda USL Toscana Centro, Empoli, Italy
2
Emergency Medicine Department, Azienda Ospealiero Universitaria Careggi, Firenze, Italy
3
Internal Medicine Unit, Santo Stefano Hospital, Azienda USL Toscana Centro, Prato, Italy
Even Lasegue’s sign also seems slightly positive. I feel a sense of anterior thoracic oppression, which changes with the movement of the body-trunk and increases while lying down. Pericarditis? I’m addled by questions, I’m worried about my family, and I’m isolated in the study. I wait until 6:30 then I call my friend and colleague Dr. P. at the hospital and announce that I’m driving to the emergency room (ER). I park 6–700 m from the ER, it’s a beautiful Sunday, the air is fresh, I walk, I feel strong but my head is light, I feel a bit skiddy. At the ER they are waiting for me, immediately they make me walk quickly for another 30 m, the oxygen saturation (SaO2) holds, always 98–99%, heart rate (HR) 110/min. The respiratory rate is normal (16–17/min). They accompany me to the COVID
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