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General Documents

Agency Resources

Protocols

UW Medicine COVID-19 Protocols: https://buff.ly/2xrFYc2

UK King’s College Rapid Sequence Induction using simulation. Protocols included. https://www.youtube.com/watch?v=pv5A0l3p0zs

Capacity Planning Tool:  https://pennchime.herokuapp.com/

ORs to ICU rooms: https://docs.google.com/document/d/1eXZbtr9WiUi8hbwQ2UWasZpjrTlPxXIu3spOGqU6TxM/edit

3D printing Venti Valves https://buff.ly/2wXCpu8

Triage Protocols

EMS Medical Director Resources

Findings on Examination

  • Normal auscultation
  • Severity in China: https://buff.ly/2Qme6wT
  • 81% mild
    • without pneumonia or mild pneumonia
  • 14% severe
    • shortness of breath
    • respiratory frequency ≥ 30/minute
    • blood oxygen saturation ≤ 93%
    • PaO2/FiO2 ratio <300
    • lung infiltrates >50% within 24-48 hours
  • 5% critical
    • respiratory failure
    • septic shock
    • multiple organ dysfunction
  • 2.3% died (super critical)
    • None become zombies
  • Critical cases: Fever, dry cough no coryza https://buff.ly/2Wfo8Uj
  • How does you dog smell? https://buff.ly/3bdeUfx
  • 2-10 days incubation https://buff.ly/2Q8ygKB

Lab Findings

  • WBC normal, with low Lymphocytes
  • Mild Thrombocytopenia (> 100K)
  • Moderate hypoxemia
  • ABG: Mild acidosis with normal lactate and severe base deficit 
  • Elevated LDH, Very high CRP, Elevated CK
  • Normal Procalcitonin (If elevated, may mean bacterial involvement)
  • D-Dimer may be elevated (no fucking shit)
  • LFTs elevated in 30% pts
  • Low PTT in 30% pts
  • DO NOT TRUST NEGATIVE COVID19 SWAB if x-ray positive or pneumonia symptoms

Co-Infection of patients with COVID19 and another Virus

CXR

  • RADIOLOGY SIRM https://buff.ly/2Q3xrCJ
  • Bilateral interstitial pneumonia
  • Bilateral infiltrates common with gravitational distribution
  • Asymmetry if bacterial superinfection (secondary bacterial infection is uncommon)
  • Non-survivors vs. Survivors  https://buff.ly/3cO1Puu

Chest CT 

  • CT precedes? positive RT-PCR https://buff.ly/2U1jlmG
  • Roentgenology  https://buff.ly/2TK8uhH
  • Ground-glass opacities (GGO) (86.1%)
  • Mixed GGO and consolidation (64.4%) 
  • Vascular enlargement in the lesion (71.3%).
  • Peripheral distribution (87.1%)
  • Bilateral involvement (82.2%)
  • Lower lung predominant (54.5%)
  • Multifocal (54.5%)

Lung Ultrasound

  • From GiViTI COVID19 Meeting document (10 March 2020) 
  • LUS daily to evaluate the lungs
  • PATTERN 1: Diffuse B-line profile = Responds to PEEP
  • PATTERN 2: Basal PLAPS
    • points showing consolidation
    • parapneumonic effusions
    • atelectasis where front areas ventilated
    • rear areas atelectatic = Responds to Proning
  • Useful in evaluating the effect of high PEEP and managing recruitment manoeuvres
  • Lung ultrasonography https://buff.ly/2W7huze
  • Thickening of the pleural line with pleural line irregularity; 
  • B lines in a variety of patterns
    • focal
    • multifocal
    • confluent;
  • Consolidations
    • multifocal small
    • non-translobar
    • translobar
    • mobile air bronchograms; 
  • Appearance of A lines during recovery phase; 
  • Pleural effusions are uncommon.
  • Doctor with COVID19 his own lungs https://twitter.com/yaletung

Clinical Course

Critical Care 

PPE

Medications

COVID-19 Swab Tests

Specialties

Telemedicine

Journal Articles

Helpful Tips & Testimonials

Helpful Info for Patients

Healthcare workers well-being