WLA VA:COVID19 - Revision history

Rossdonaldson1: Redirected page to COVID-19

2022-08-31T22:02:28Z

Redirected page to COVID-19

← Older revision		Revision as of 22:02, 31 August 2022
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	~~The fantastic information on this page that was not site-specific has been consolidated with other~~ COVID-19 ~~pages on WikEM. SWLA VA Site specific information can be found at: [[WLAVA:COVID19 ED Operational Updates]]~~		#REDIRECT[[COVID-19]]

	~~Please join us in editing and updating all non-site-specific COVID information on the following WikEM pages:~~

	~~{{COVID see also}}~~

	~~[[Category:Admin~~]]

Rossdonaldson1 at 22:00, 31 August 2022

2022-08-31T22:00:28Z

← Older revision		Revision as of 22:00, 31 August 2022
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	{{COVID see also}}		{{COVID see also}}

			[[Category:Admin]]

Rossdonaldson1: Replaced content with "The fantastic information on this page that was not site-specific has been consolidated with other COVID-19 pages on WikEM. SWLA VA Site specific information can be found..."

2020-03-21T12:00:03Z

Replaced content with "The fantastic information on this page that was not site-specific has been consolidated with other COVID-19 pages on WikEM. SWLA VA Site specific information can be found..."

Show changes

Andygrock: /* Infection Prevention */

2020-03-21T10:53:37Z

Infection Prevention

← Older revision		Revision as of 10:53, 21 March 2020
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	**** Entire pump should be entirely disinfected per manufacturer recommendations between each feed		**** Entire pump should be entirely disinfected per manufacturer recommendations between each feed

			==RESOURCES==
			*Johns Hopkins COVID Case Map (Live):https://coronavirus.jhu.edu/map.html

			*WHO COVID-19 Situation Dashboard (Live): https://experience.arcgis.com/experience/685d0ace521648f8a5beeeee1b9125cd

			*CDC https://www.cdc.gov/coronavirus/2019-ncov/index.html

			*California Emergency Medical Services Authority Resource Portal
			https://emsa.ca.gov/covid19/

			*Oxford Journal of Travel Medicine COVID19 Resources https://academic.oup.com/journals/pages/coronavirus?cc=gb&lang=en&

			*EM:RAP Corependium COVID-19 (open access) https://www.emrap.org/corependium/chapter/rec906m1mD6SRH9np/Novel-Coronavirus-2019-COVID-19?MainSearch=%22covid%22&SearchType=%22text%22

			*Uptodate COVID 19: https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19?search=covid%2019%20imaging&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H3937614273

			*Reporting Los Angeles County DPH Acute Communicable Disease Control:
			**Positive COVID-19 lab results from clinical labs (not PHL) must be reported by healthcare providers within one day.
			**Complete and fax a Medical Provider COVID-19 Report form to 888-397-3778 or 213-482-5508 or call 888-397-3993.
			**For consultation call 213-240-7941.

			*Long Beach Health and Human Services:
			**Weekdays 8am-5pm: call 562-570-4302.
			**After hours: call the duty officer at 562-500-5537.
			*Pasadena Public Health Department:
			**To report a case of COVID-19, fill out the COVID-19 Report Form here and fax to 626-744-6115, and call 626-744-6089 [Weekdays 8am-5pm (closed every other Friday) or after hours call 626-744-6043].

	[[Category:Admin]]		[[Category:Admin]]

Andygrock: /* Special Population: Pregnant Women */

2020-03-21T10:51:47Z

Special Population: Pregnant Women

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 * Restrict non-essential workers (painters, pet therapy)
 * Limit patient movement within hospitals/clinics
 ==Special Population: Pregnant Women==
 ===Background Epidemiology===
-* 34 pregnant women reported with COVID
+* 34 pregnant women reported with COVID, 0  deaths reported.
 * Median age: 30 years (mostly 2nd and 3rd trimester -- median gestation 36 weeks)
 * Symptom onset within 13 days prior to, and 3 days after, delivery
 * Infants of affected mothers all tested negative
-* No maternal/pregnant deaths reported from COVID
 ===Bottom Line for Pregnant Patients===

Andygrock: /* Decision To Hospitalize */

2020-03-21T10:46:53Z

Decision To Hospitalize

← Older revision		Revision as of 10:46, 21 March 2020
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	*** 2 other trials are investigational open-label trials testing different dosages for moderate or severely hospitalized patients		*** 2 other trials are investigational open-label trials testing different dosages for moderate or severely hospitalized patients
	* Ritonavir also being used but no data available. Same for chloroquine.		* Ritonavir also being used but no data available. Same for chloroquine.

	~~==Decision To Hospitalize==~~
	* Mild symptoms may go home and self-isolate/quarantine
	** Note: symptoms may worsen over 2nd week of illness
	* Hospitalize: Respiratory distress/failure, multi-organ failure, rapid disease progression requiring escalating supportive care
	* May consider discontinuation of hospital isolation when:
	** Resolution of fever without anti-pyretic, resolution of symptoms, and negative COVID19 testing

	==Decreasing Hospital Transmission==		==Decreasing Hospital Transmission==

Andygrock: /* Treatment */

2020-03-21T10:45:52Z

Treatment

← Older revision		Revision as of 10:45, 21 March 2020
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	'''General:'''		'''General:'''
	* No specific treatment currently available		* No specific treatment currently available
	* ~~Non-pharmaceutical~~ interventions will be most important		*Epidemiology interventions will be most important
	** Spread Prevention		**Spread Prevention
	** Mitigation strategies		**Mitigation strategies
	* High-dose corticosteroids should be AVOIDED (due to progression of viral replication reported from prior coronaviruses; e.g. MERS, SARS)		*High-dose corticosteroids should be AVOIDED (due to progression of viral replication reported from prior coronaviruses; e.g. MERS, SARS)
	* Avoid nebulizers as they are generally ineffective may aerosolize virus		*Avoid nebulizers as they are generally ineffective may aerosolize virus
	** Albuterol with spacer is safer, though probably ineffective unless co-occuring reactive airway disease		**Albuterol with spacer is safer, though probably ineffective unless co-occuring reactive airway disease
	* Generally avoid BiPAP and high-flow nasal oxygen as ~~these~~ may increase ~~viral~~ spread		*Generally avoid BiPAP and high-flow nasal oxygen as theseaerosolize the virus)and may increase spread
	** WHO cautiously states that high flow oxygen may be occasionally indicated.		**WHO cautiously states that high flow oxygen may be occasionally indicated.

	~~'''~~Intubation~~:'''~~
	* High risk procedure for aeresolization		Intubation
	** Patient ideally in negative pressure room. Limit individuals in room to essential staff only.		*High risk procedure for aeresolization
	** PPE for all in room: N95, gown, gloves, eye shield		**Patient ideally in negative pressure room. Limit individuals in room to essential staff only.
	** ~~Minimum PPE for provider intubating: same as above (N95, gown, gloves, eye shield)~~		**PPE for all in room: N95, gown, gloves, eye shield
	** Optional PPE for provider intubating: PAPR, double glove, double gown~~, shoe covers, buddy system for donning/doffing~~		**PPE for provider intubating: Consider PAPR, double glove, double gown
	* ~~Use~~ BVM with viral filter		**BVM with viral filter. If not viral filter do NOT BVM
	* Use sufficient paralytics to prevent coughing gagging		*Use sufficient paralytics to prevent coughing gagging
	* Most experienced provider should perform intubation.		*Most experienced provider should perform intubation.
	* ~~Ventilate using~~ ARDSnet protocol (https://www.~~wikem~~.org/~~wiki~~/~~EBQ~~:~~ARDSnet_Trial)~~		*Ventilator settings for Covid-19 Patients => ARDSnet protocol (see table below)
			**Mode: Volume-Assist Control
			**Volume: 6-8ml/kg of Ideal Body Weight (based on height/sex). NOT actual Body weight.
			**Respiratory Rate: 15 breaths/min
			***Increase if pre-intubation ABG/VBG shows significant acidosis
			***Adjust based on ABG PaCO2/pH results
			**PEEP: 5 (titrate via ARDSnet)
			**FiO2: 40% after intubation and monitor O2 saturation.
			***Goal SaO2 > 88%
			***If SaO2 < 88% on FiO2 of 40%, see ARDSnet and increase PEEP first.
			*Alarming Vent? See (https://rebelem.com/rebel-cast-ep-46b-vent-management-crashing-patient-haney-mallemat/)
			**DOPES = Displaced ET tube or cuff, Obstructed ET tube: pt biting tube, kink in tube, mucous plug, Pneumothorax, Equipment: Tube from ETT to Vent, Stacked breaths: auto-PEEP (typically asthma/COPD, results from decreased ability to expire air)
			**DOTTS = Disconnect from vent (can push down on pt’s chest if concern for auto-PEEP), FOR COVID-19 SKIP Oxygenate with 100% BVM (evaluates for ETT dislodgement, bilateral breath sounds, cuff leak, crepitus, difficulty bagging), Tube check for mucous plug or kink or dislodgement, Tweak vent for autoPEEP (decreased RR, decreased inspiratory time with changing E:I ratio), Sonography for pneumothorax.
			**Peak Vs Plateau Pressure
			***Super important to keep alveolar pressure low to prevent barotrauma
			***Peak Pressure is pressure of entire system (vent, ET tube, trachea, bronchus, bronchioles, alveoli). High peak pressure does not equal barotrauma
			***Plateau pressure - check with button on vent (may say plateau pressure or end-inspiratory hold)
			***High Peak and Normal Plateau - problem with vent, ET tube, bronchoconstriction (reactive airway disease/asthma/COPD).
			***High Peak and High Plateau - Compliance issue (pneumothorax, problem with alveoli like ARDS, fluid overload). Need to decrease pressure to prevent barotrauma.
			***Plateau pressures should be kept < 30mmHg if possible.
			[[File:ardsnet.jpg\|400px]]
			http://www.ardsnet.org/files/ventilator_protocol_2008-07.pdf

			[[File:ardsnet2.png\|400px]]
			Vent basics resource: https://emcrit.org/wp-content/uploads/2010/05/Managing-Initial-Vent-ED.pdf

	'''Experimental/compassionate use treatments:'''		'''Experimental/compassionate use treatments:'''

Andygrock: /* Testing: Turnaround Time */

2020-03-21T10:40:03Z

Testing: Turnaround Time

@@ Line 216: / Line 216: @@
 * LA County Public Health Lab (PHL) = ~ 2 business days
 * Commercial lab = ~ 3-4 business days
 ==Treatment==

Andygrock: /* Precautions For Healthcare Workers */

2020-03-21T10:36:55Z

Precautions For Healthcare Workers

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 *Persons diagnosed with COVID-19 are considered cleared after 14 days from symptom onset or 3 days after resolution of fever and improvement of other symptoms, whichever is longer.
 *CDC: Reasonable to isolate patients with unexplained fever and respiratory symptoms (and no travel history) at this time
 ==Isolation==

Andygrock: /* General Prevention Recommendations */

2020-03-21T10:35:03Z

General Prevention Recommendations

@@ Line 176: / Line 176: @@
 *Persons diagnosed with COVID-19 are considered cleared after 14 days from symptom onset or 3 days after resolution of fever and improvement of other symptoms, whichever is longer.
 *CDC: Reasonable to isolate patients with unexplained fever and respiratory symptoms (and no travel history) at this time
 ==Precautions For Healthcare Workers==