COVID-19: Difference between revisions
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==Differential Diagnosis==
==Differential Diagnosis==
*[[Influenza]]
*[[Pneumonia]]
*[[Pneumonia]]
*[[Sinusitis]]
*[[Sinusitis]]
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{{ILI DDX}}
{{ILI DDX}}


==PPE==
==Evaluation==
===During Intubation===
===Patient rooming===
*Evaluation of patients does not need to occur in the hospital and can easily occur outside the ED if the patient is not in extremis
*Although negative pressure rooms are preferred due to the droplet precautions, a non-negative pressure room is acceptable
===Viral Test===
*In the United States, the US Centers for Disease Control is distributing the CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel to public health labs through its International Reagent Resource<ref>https://www.internationalreagentresource.org/</ref>
*Internationally the WHO has distributed kits based on the RT-PCR platform<ref>Sheridan, Cormac . "Coronavirus and the race to distribute reliable diagnostics". Nature Biotechnology https://www.nature.com/articles/d41587-020-00002-2</ref>
*BIOFIRE RESP PANEL Corona Virus assay does NOT detect this subtype - DO NOT USE
 
==Management==
===Personal Protective EquipmentE===
====During Intubation====
*[[N95]] or [[PAPR]]  
*[[N95]] or [[PAPR]]  
*Surgical Mask over N95
*Surgical Mask over N95
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**If no hooded suit available, sterile disposable cap
**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
*2 pairs gloves, 1 under sleeves of bunny suit or gown and 1 over, under-layer gloves would ideally be long cuffed
===Clinical Assessment===
 
====Clinical Assessment====
PPE for evaluating a patient clinically should include:
PPE for evaluating a patient clinically should include:
*N95
*N95
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*The video below indicates the proper order for donning and doffing PPE for clinical evaluation of a patient
*The video below indicates the proper order for donning and doffing PPE for clinical evaluation of a patient


{{#widget:YouTube|id=exV5hEG62CY}}
==Evaluation==
===Patient rooming===
*Evaluation of patients does not need to occur in the hospital and can easily occur outside the ED if the patient is not in extremis
*Although negative pressure rooms are preferred due to the droplet precautions, a non-negative pressure room is acceptable
===Viral Test===
*In the United States, the US Centers for Disease Control is distributing the CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel to public health labs through its International Reagent Resource<ref>https://www.internationalreagentresource.org/</ref>
*Internationally the WHO has distributed kits based on the RT-PCR platform<ref>Sheridan, Cormac . "Coronavirus and the race to distribute reliable diagnostics". Nature Biotechnology https://www.nature.com/articles/d41587-020-00002-2</ref>
*BIOFIRE RESP PANEL Corona Virus assay does NOT detect this subtype - DO NOT USE
==Management==
===Respiratory failure===
===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
*[[NIPPV]] may increase the spread of viral particles via droplets making early [[intubation]] the preferred airway management strategy in patients with respiratory distress/failure
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*https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html
*https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html
*https://emcrit.org/emcrit/some-additional-covid-airway-management-thoughts/
*https://emcrit.org/emcrit/some-additional-covid-airway-management-thoughts/
==Video==
{{#widget:YouTube|id=exV5hEG62CY}}


==References==
==References==
<references/>
<references/>

Revision as of 20:17, 16 March 2020

Background

  • Also known as "2019 Novel Coronavirus"
  • First detected in Wuhan, China

Specific Coronavirus Sub-Types of Clinical Importance

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

Influenza-Like Illness

Evaluation

Patient rooming

  • Evaluation of patients does not need to occur in the hospital and can easily occur outside the ED if the patient is not in extremis
  • Although negative pressure rooms are preferred due to the droplet precautions, a non-negative pressure room is acceptable

Viral Test

  • In the United States, the US Centers for Disease Control is distributing the CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel to public health labs through its International Reagent Resource[2]
  • Internationally the WHO has distributed kits based on the RT-PCR platform[3]
  • BIOFIRE RESP PANEL Corona Virus assay does NOT detect this subtype - DO NOT USE

Management

Personal Protective EquipmentE

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

PPE for evaluating a patient clinically should include:

  • N95
  • Face mask
  • Surgical Gown and gloves
  • The video below indicates the proper order for donning and doffing PPE for clinical evaluation of a patient

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
  • Due to the viral spread risk early intubation is the preferred means of airway managment

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

  • Mild cases for perons under investigation for Covid19 awaiting a positive test result can self quarantine at home in conjunction with the local Public Health Dept
  • If admitting, needs to be placed in negative pressure isolation room with airborne and droplet precautions

Complications

See Also

External Links

Video

{{#widget:YouTube|id=exV5hEG62CY}}

References

  1. ↑ Criteria to Guide Evaluation and Laboratory Testing for COVID-19 https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html
  2. ↑ https://www.internationalreagentresource.org/
  3. ↑ Sheridan, Cormac . "Coronavirus and the race to distribute reliable diagnostics". Nature Biotechnology https://www.nature.com/articles/d41587-020-00002-2
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