COVID-19
Background
- Also known as "2019 Novel Coronavirus"
- First detected in Wuhan, China
Clinical Features
Broad Testing Recommendations
The CDC has expanded testing beyond the initial travel to china recommendations[1]
- Test any person who has fever or respiratory illness AND had close contact with a known COVID-19 patient
- Test any person who has fever or respiratory illness AND a history of travel to CDC-classified high risk areas or areas with recent significant community spread
- Test any person who has severe respiratory illness AND is being admitted to the hospital
- Test any hospitalized person who has respiratory illness AND no alternative diagnosis
- Consider testing any person who has respiratory illness AND lives in a residential facility such as a nursing home or recently returned from a cruise
Differential Diagnosis
PPE
During Intubation
- N95 or PAPR
- Surgical Mask over N95
- Goggles that surround eyes with facial contact, face shield, or full joint-replacement-hood with visor
- Bunny suit, preferably with hood or disposable fluid-proof gown
- If no hooded suit available, sterile disposable cap
- 2 pairs gloves, 1 under sleeves of bunny suit or gown and 1 over, under-layer gloves would ideally be long cuffed
Clinical Assessment
The video below indicates the proper order for donning and doffing PPE for clinical evaluation of a patient {{#widget:YouTube|id=exV5hEG62CY}}
Evaluation
- BIOFIRE RESP PANEL Corona Virus assay does NOT detect this subtype - DO NOT USE
Management
Respiratory failure
- NIPPV may increase the spread of viral particles via droplets making early intubation the preferred airway management strategy in patients with respiratory distress/failure
- Using 2 viral filters attached to a 2 tube NIPPV circuit in a negative pressure room may sufficiently prevent viral spread
- During BVM, if needed, use a viral filter
- The endotracheal tube should also have a viral filter attached
Mild Cases
- Supportive care is mainstay of therapy for patients with mild viral symptoms
- Most patients will do well enough for discharge home
- Discuss with Dept of Public Health, who will guide testing and, if discharging, help patient remain in isolation at home
Disposition
- Usually home, but decision needs to be made in conjunction with the local Public Health Dept
- If admitting, needs to be placed in negative pressure isolation room with airborne and droplet precautions
See Also
External Links
References
- ↑ Criteria to Guide Evaluation and Laboratory Testing for COVID-19 https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html