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April 10, 2020
TL;DR Quick Reference
Pre-Hospital Civilian Guidance (not EMS)
- Social mitigation works.
- Physical distancing of 6 feet or 2 meters.
- Don’t share houses.
- Family units only.
- Wash your hands.
- Early.
- Often.
- Well.
- Don’t touch your face.
- Fingers to mouth and eyes
- Wear home made masks.
- train the hands.
- free up N95 for staff.
- keeps virus in carrier
- There is no prophylaxis.
- Exercise is okay.
- Walking 2m spacing.
- Jogging 5m spacing.
- Social Media
- Do not engage trolls and hoaxers.
- Watch Tik Tok
- High risk personnel should isolate from family
- If not possible review 1 to 4.
- Kids 0-14 years are at LOW risk.
- Elders are at HIGH risk.
- Immunocompromised are at risk.
- Use Tele-docs before ER.
- Go to hospital if short of breath.
In Hospital – Triage Guidance
- Triage rapidly to protect staff and patients.
- Clinical Covid is Covid. Full stop.
- Droplet PPE for all encounters.
- Ignore anti-PPE pencil pushers.
In Hospital – Treatment Guidance
- Protect Staff.
- Clinical Covid is Covid. Full stop.
- Ignore anti-PPE pencil pushers.
- PPE Spotters for don and doff.
- There are no cures.
- Treat early with Supportive care.
- Oxygen therapy.
- Safe HFNO2.
- ROX (SpO2/FiO2)/RR <3.85 Failure.
- Empiric Antibiotics.
- Restrict Fluids.
- Conscious patient self proning.
- Watch Closely.
- Pts deteriorate fast.
- Investigate Early
- CXR chest at least.
- CT chest even better.
- URT and LRT tests.
- Repeat URT and LRT tests.
In ICU – Treatment Guidance
- Protect Staff
- Learn Donning and Doffing.
- Always have a spotter.
- Protected Intubation is the rule.
- Clinical Covid is Covid. Full stop.
- Ignore anti-PPE pencil pushers.
- Usual Critical Care
- Restrict Fluids.
- Early vasopressors.
- Differentiate Type L from H
- Type L compliant, normal weight lung.
- Type H non-compliant, edematous heavy lung.
- CT scan
- HFNC Trial
- ROX INDEX (SpO2/FiO2)/RR <3.85 High risk
- Conscious patient self proning.
- Intubate early
- RSI and Indirect visualization
- Clamp Tube
- Low tidal volumes.
- High PEEP
- Consider prone ventilation.
- Consider ECMO.
Disposition – Decreasing level of care
- Standard critical care
- Extubate as per standard guidelines.
- Know clinical course.
- Day 0 = Symptom onset
- Day 3-5 Shortness of breath
- Day 10 Intubation
- Day 20 Death
- Consider Age.
- Consider co-morbidities.
- Consider home supports.
Unknowns
- Are pet’s vectors.
- Like tigers?
- Efficient way to sort types L from H.
- Waiting on hydroxy chloroquine evidence.
- Will there be enough ventilators?