Clinical
Common signs of infection:
- Resp (cough, SOB, ±pneumonia)
- Fever
- Anosmia / hyperosmia
- GI upset
- ARDS and organ failure in severe cases
Prevention
- Regular hand washing.
- Surgical mask & glasses with any patient contact
- Surgical mask on all patients in ED
- Minimise contact (even in PPE) with ? covid patients
CUH ED approach
| Category | O2/Resp. support & steroid Mx |
|---|---|
COVID Resp scale ASpO2 >94% RA RR < 20 on RA or ≤3L/min |
Does patient require admission? Can be managed on designated general medical wards. O2: Room air or ≤3L/min via prongs. Not for steroids unless other indication (ie bronchospasm). |
Category BSpO2 <94% RA RR >20 but responds well to O2>3L/min or 24-60% via Venturi |
Can be managed on designated general medical wards. May escalate to C1/C2/D quickly. Discussion with respiratory at morning handover. O2: Tight-fitting Venturi (eg 40% red valve) at flow rate to maintain O2 sats >94%. Steroids (for 7-10 days) once COVID confirmed (Dexamethasone 6mg OD Dexamethasone 6mg OD PO or Dexamethasone 8mg OD IV). |
Category C1SpO2 <94% Poor response to O2 at 8-10L/min via Venturi |
To be managed initially on designated COVID isolation ward in close consultation with ICU colleagues. Discussion with respiratory at morning handover. O2: Airvo/HFNO 30L/min FiO2 >70% via NC or mask. Titrate to target sats >90%. Steroids once COVID confirmed. |
Re-evaluate within 1 hour. If RR > 20 or SpO2 <90% on Airvo – escalation as appropriate. If suitable for intubation, request anaesthetic review. |
|
Category C2SpO2 <94% Poor response to Airvo |
O2: NIV with CPAP via TRILOGY. Initial settings 8-10 cm H2O with FiO2 70%. Titrate to O2 sats >90% but do not ‘over-oxygenate’. Titrate PEEP if needed to 10-15cm H2O. Ventilate using HOOD if possible to minimise aerosolisation. Type 2 resp failure:Bilevel ventilation as per usual practice in COPD patients – HOOD where possible. Steroids as above once COVID confirmed. Evaluate after 1 hour with escalation as appropriate. |
Category DPoor response to NIV, worsening resp diustress, unable to maintain sats >90% |
Inform ICU on call immediately – for ventilation if deemed appropriate. Patients to be managed in ICU. Steroids as above once COVID confirmed. |
Further Mx - consider in all
| Anticoagulation | Weight-based LMWH prophylaxis as per protocol (COVID-19 Thromboprophylaxis page). Therapeutic if clinical suspicion for PE. |
|---|---|
| Antimicrobials | If suspicion of bacterial co-infection refer to nchd.ie for hospital guidelines for pneumonia. |
| Bronchodilators | Consider Salbutamol 100mcg x 10 INH via spacer QDS. |
| Antiviral | Remdesivir if available under ID/respiratory guidance. Consideration for clinical trial. |
| Mucolytic | Carbocisteine 750mg TDS PO. |
| Antipyretic | Paracetamol 1g TDS PO/IV. |
Links
- HSE Interim Guidance for the Pharmacological Management of Patients with COVID-19 (August 2022)
- HSE video course Donning & Doffing
- Infectious diseases notification forms
- Donning and doffing PPE video.
- HPSC section on Coronavirus
- HSE video - donning/doffing PPE
- Patient sheet - New close contact letter
- Patient sheet - Casual contact letter
- Patient sheet - Self care list
Links CUH
- CUH Donning monitors checklist
- CUH Doffing checklist
- CUH - Paed. path - Blackwater
- CUH - Paed. path - Abdo pain
- CUH - Paed. path - Interim orders
- CUH - Adult - Decision support tool
- CUH - Adult - Initial Assmnt & Mx proforma