Jump to content

IOM Covid removing restrictions


Recommended Posts

  That download didn't look right. This might be better

 COVID-19 – QUICK GLANCE GUIDE
For management of adult non-ITU patients at UHBFT
BACKGROUND
• COVID-19 is a respiratory illness caused by the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)
• Stay up-to-date with the latest guidance which will be posted on the Coronavirus Microsite https://www.uhb.nhs.uk/coronavirus-staff/clinical-info-pathways/key-clinical-info.htm • Travel histories should be recorded for all patients. Patients who have travelled outside the UK in the last 10 days may require isolation and should be flagged to the IPC team - Link
    SIGNS AND SYMPTOMS
• Fever (intermittent)
• Fatigue, myalgia, anorexia, anosmia, ageusia (loss of taste)
• Lower respiratory symptoms – SOB, cough
• “Silent hypoxia” – Sats < 94% without breathlessness esp in elderly
• Other symptoms e.g. GI may be present
• May present in hospitalised patients as a hospital-acquired pneumonia
DIAGNOSIS – VIROLOGICAL
• Test ALL patients at admission; and (if negative) further re-tests at 3 and again 5-7 days after admission or asap if patient develops possible COVID symptoms
• Rapid testing is available in all admission areas (Results in ❤️ hrs)
• Sensitivity is not 100%, one negative swab does NOT rule out COVID. Repeat if suspicion high
    RESPIRATORY SUPPORT Oxygen
Maintain Sats 92 - 96%
(88-92% in known COPD with CO2 retention)
Nasal Cannulae 1-5 litres/min
Face mask 5-10 litres/min
Non rebreathe mask 10-15 litres/min
Reserve
Fixed performance Venturi masks (40%-60%) for those at risk of hypercapnia
Respiflo humidified system 28% – 98% for sputum retention/upper airway dryness
Proning
Prone positioning may assist oxygenation in some patients –
Link
INVESTIGATIONS
See PICS COVID blood panel / ICE bundle
• FBC, U&Es, LFT (with LDH), CRP, Troponin, HbA1c
• Coagulation profile – includes D-Dimer, PT, Ferritin and Fibrinogen
• ABG – Gas exchange, Lactate
• Blood cultures
• Blood borne virus screen
• Other microbiological specimens – as required
• ECG
CRP is usually high and not indicative of bacterial infection Lymphocyte and eosinophil counts are usually low
IMAGING
• CXR – all patients
• CT Thorax – rarely required in uncomplicated COVID pneumonia
• Imaging findings can be non-specific and overlap with other infections / presentations
• CTPA indicated when PE suspected (recognised complication)
POTENTIAL COMPLICATIONS
• Respiratory Failure
• Arterial and venous thromboembolism • Arrhythmias/Heart Failure/Myocarditis • Sepsis +/- Septic Shock - Link
GENERAL MANAGEMENT
• Admit patients to an appropriate COVID area
• Empirical antibiotics for suspected bacterial pneumonia until viral pneumonia confirmed
• Dexamethasone* 6mg oral (or IV) for 10 days if requiring oxygen or ventilated (cease on discharge)
• Thromboprophylaxis – Link
• Consider single dose Tocilizumab for patients with Oxygen requirements and raised CRP (≥75 mg/L) with consultant’s approval- Link
• Remdesivir may be useful in severe disease - Link
* USE OF DEXAMETHASONE
• If dexamethasone is prescribed, monitor patients closely for adverse effects (e.g. psychiatric effects, hyperglycemia, secondary infections)
• Consider gastro-protection (e.g. low dose PPI) if risk of GI upset (previous history, aspirin/NSAIDs)
• Start QDS blood glucose monitoring - If two consecutive CBGs >12 mmol/l in 24 hours = check ketones / exclude DKA; start/Increase insulin - Link
FLUID MANAGEMENT
• AVOID vigorous fluid resuscitation (may lead to ARDS) but Do Not Run Patients "Dry"
• Prevent avoidable AKI through effective risk recognition, investigation, management and referral - NICE guidance & Link • IV fluid to cover insensible losses (high Temp and RR) - max 2L/day Daily review of IV fluid management plan
Acute Kidney Injury – Link
ONGOING WARD CARE
DISCHARGE
• Provide clear instructions to patients on discharge
• Patients should be advised to self-isolate as per National Guidelines.
• Organise any follow up imaging if indicated (e.g. 3 month CXR and write to patient with results)
• For more information patients (and HCPs) can consult Link • Assess individual patient risk factors for VTE (cancer, obesity, diabetes, mobility etc) and consider prescription to complete 7 days of prophylaxis
        • Use structured ward round templates to facilitate holistic care and comprehensive handover
• Observations – Respiratory Rate (assessed for at least 30 seconds), Saturations, Temperature, BP and HR at least 4 hourly
• Pay early attention to nutritional requirements – involve nutrition and dietetics team
• Titrate Oxygen (both up and down) to maintain Sats in target range (see above)
• Monitor Blood glucose regularly in patients with diabetes mellitus, impaired glucose tolerance and those receiving dexamethasone – manage and/or refer according to guidance Link • Blood tests should be repeated only when clinically required (change in condition) or according to AKI guidance
• Start discharge planning early – home when off Oxygen 24 hours with Sats >92% and any mobility and Social Care needs are met.
  ESCALATION TO INTENSIVE CARE
Patients with severe COVID-19 disease who are for escalation should be referred to the Critical Care COVID Assessment Consultant when their disease is severe as indicated by any one of:
RR>30; SBP <90mmHg
O2 required at >50% to maintain SpO2 ≥ 92%
Reduced level of consciousness
If intubation is required the CAC will initiate this with the COVID Intubation team
The ISARIC 4C mortality score may be helpful in making escalation decisions - www.isaric4c.net/risk
ADVANCED TREATMENT OPTIONS
Other specific treatments / procedures must be supported by good evidence Enrolment in clinical trials is the best way to gather this evidence
PALLIATION and END OF LIFE CARE (Link)
• Patients with severe COVID-19 disease outside ITU may require palliation
• Reassurance and emotional support are key in the dying phase and early
involvement of the palliative care team is advised
• Prescribe anticipatory medication via PICS structured prescribing
   CALLING THE ICU COVID ASSESSMENT CONSULTANT: Mobile phone via switchboard
ANTIBIOTICS IN COVID-19 when clinically suspected of bacterial co-infection
• Bacterial co-infection is very uncommon in patients presenting with COVID-19 infection. Do not start antibiotics unless there is clinical or microbiological evidence of bacterial infection. Refer to Antimicrobials guidelines for more information Link.
• Use CURB 65 for choosing the correct antibiotics when suspecting bacterial pneumonia co-infection:
• REMEMBER ANTIMICROBIAL STEWARDSHIP: Whilst antibacterials may be given in the initial stages, treatment must be reviewed once the diagnosis of viral pneumonia is confirmed. • Stopping antibiotics is appropriate if: COVID swab +ve; symptoms, blood tests and imaging consistent with COVID; bacterial cultures -ve; AND fever resolved or settling.
• If antibiotics are continued, review their need regularly and give them for a total of 5 days, then stop them unless there is a clear indication to continue.
   Additional guidance
• Delirium is a frequent complication of COVID-19, particularly in and after Intensive Care - Link • Respiratory support summary - Link
• Use of Oxygen at end of life - Link
 Version 8; Dated 22nd February 2021
TO BE READ IN CONJUNCTION WITH SPECIALTY SPECIFIC COVID- 19 GUIDANCE
 Ensure early decisions are made, and documented (DNACPR/TEAL or RESPECT form) about Ceiling of Care for all patients Link Ask yourself “Would intensive care, ventilation and organ support be successful in this patient?”
 

  • Like 1
Link to post
Share on other sites
  • Replies 36k
  • Created
  • Last Reply

Top Posters In This Topic

  • Banker

    2712

  • TheTeapot

    1466

  • Gladys

    1364

  • Nom de plume

    1100

Top Posters In This Topic

Popular Posts

OK. For what it's worth I'm going to try and explain why genomics is important in a ssRNA virus epidemic. No doubt it will end up being recited badly at a briefing, but, well, whatever. You read it he

Rachel has tried every which way to re-offer her services. This last tweet wasn't the first time she's reached out. Government has made it very clear they do not want her to be involved. I want h

I think you'll find most so called anti-government rhetoric is focused on government-stupidity and government-selfishness. In recent times - under Brown, Bell and now Quayle - all too many govern

Posted Images

47 minutes ago, horatiotheturd said:

Its ace that I have a huge backlog of work most of which I could be doing perfectly safely.

While I sympathise with your lack of current income flow, would it not be that you could use the current lockdown to allow you to do some of that UK work you profess available.

When the current lock down was announced, 21 days! More realistically 28 or 35 days, could you not have taken yourself off to the UK to do a week or so's work and get back to the |Island within the lockdown legnth, doing your personal lock down as a returning resident within the national lock down?

Viola, you get your work and you don't have to isolate longer that anyone else in lockdown???

You get your work done  or you visit family in that first week of lockdown and then just slip into lock down re strictures on your return,which is not any different from the restructures  on those who have not left the Island!!!

To summarise , we announce an 21 day lock down, YOU say get over there and do those jobs in the UK, expand my Island business, I'm quids in............but if you don't, who is to blame???

  • Like 1
  • Haha 1
  • Confused 2
  • Sad 1
Link to post
Share on other sites
6 minutes ago, CowMan said:

Is that the recommended extra mix for plastering a ceiling? 

May as well be for all the use it is in combating covid.

There is SO MUCH BULLSHIT out there about covid, and treatments etc. Fuck the USA and their asshole people, its not Russian troll factories pumping out fake news people need to be concerned about, its them.

That chart Apple posted, I dont know of its context, but mentioned on it is Baylor University. That's a private baptist university in Texas. 

There's your problem right there.

Edited by TheTeapot
  • Like 2
  • Thanks 1
  • Confused 1
Link to post
Share on other sites
1 minute ago, TheTeapot said:

May as well be or ll the use it is in combating covid.

There is SO MUCH BULLSHIT out there about covid, and treatments etc. Fuck the USA and their asshole people, its not Russian troll factories pumping out fake news people need to be concerned about, its them.

That chart Apple posted, I dont know of its context, but mentioned on it is Baylor University. That's a private baptist university in Texas. 

There's your problem right there.

Seems like there’s loads of self claimed highly qualified covid experts doesn’t it? I wonder how it will all end? 

  • Like 1
Link to post
Share on other sites

 

7 minutes ago, TheTeapot said:

t recommends hydroxychloriquine for a start.

https://www.bmj.com/content/369/bmj.m2378

This from the bmj says the jury may still be out.

If there is a more relevant treatment guide then it would be useful to see it.

The issue is about what pathways for treatment we are using here and who determines that. 

Link to post
Share on other sites
9 minutes ago, Kopek said:

While I sympathise with your lack of current income flow, would it not be that you could use the current lockdown to allow you to do some of that UK work you profess available.

When the current lock down was announced, 21 days! More realistically 28 or 35 days, could you not have taken yourself off to the UK to do a week or so's work and get back to the |Island within the lockdown legnth, doing your personal lock down as a returning resident within the national lock down?

Viola, you get your work and you don't have to isolate longer that anyone else in lockdown???

You get your work done  or you visit family in that first week of lockdown and then just slip into lock down re strictures on your return,which is not any different from the restructures  on those who have not left the Island!!!

To summarise , we announce an 21 day lock down, YOU say get over there and do those jobs in the UK, expand my Island business, I'm quids in............but if you don't, who is to blame???

Ah yeah.  Why didn't I think of that?

So simple when you say it.

I am so stupid.

  • Like 1
  • Haha 1
Link to post
Share on other sites
44 minutes ago, Apple said:

That s why GPs often have their eyes focused on the computer when you go and see them

.............and there was I thinking that's why they went to med school for 6 years when all along we could do it ourselves via google.

  • Like 2
Link to post
Share on other sites
4 minutes ago, Apple said:

 

https://www.bmj.com/content/369/bmj.m2378

This from the bmj says the jury may still be out.

If there is a more relevant treatment guide then it would be useful to see it.

The issue is about what pathways for treatment we are using here and who determines that. 

That's from June last year, i'm sure it has been thoroughly dismissed as a viable treatment for covid now.

I don't know what is being used here, and thinking about it, you're right, we probably should know. I know that that steroid mentioned in that nhs guidance you've shared above is being used in some cases, but other than that..?

My concern is for you, don't get dragged down the path of dubiousness is all. There is currently no magic cure, and anyone selling you one is lying.

Link to post
Share on other sites
11 minutes ago, CowMan said:

Seems like there’s loads of self claimed highly qualified covid experts doesn’t it? I wonder how it will all end? 

You are right there @CowMan and what I am asking is what we do on the IOM. If people don't know then fine. 

The UK NHS and some of the hospitals there produce many of their own treatment guidance and also show who their medical teams are, including their clinical histories and qualifications. Sometimes they even prod local audit result.

(Actually that would we could do the same).

We can always refer to the UK guidance or does NICE provide any? 

 

Link to post
Share on other sites
Just now, TheTeapot said:

My concern is for you, don't get dragged down the path of dubiousness is all. There is currently no magic cure, and anyone selling you one is lying.

That’s an interesting statement. So in the next 8 weeks what’s your likely source of optimism given this scientific revelation? Finding the cure for covid and managing our exit route out of this through detailed scientific analysis or doing a few ceilings to top up your MERA? 

Link to post
Share on other sites
2 minutes ago, TheTeapot said:

I don't know what is being used here, and thinking about it, you're right, we probably should know.

I appreciate that. That is the only point I am making.

 

3 minutes ago, TheTeapot said:

There is currently no magic cure, and anyone selling you one is lying.

Yes, I know, and I have met the muppets believe me.

As I say, the more we can know, and the more that can be shared, the better the outcomes can be. That is certainly the lesson from the politics.

Link to post
Share on other sites
1 minute ago, CowMan said:

That’s an interesting statement. So in the next 8 weeks what’s your likely source of optimism given this scientific revelation? Finding the cure for covid and managing our exit route out of this through detailed scientific analysis or doing a few ceilings to top up your MERA? 

Can't really do ceilings, theyre all in peoples houses, be illegal. Might go do a patio and dig a pond if the weather improves.

  • Like 1
Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...

×
×
  • Create New...