4th April 2020
Telemedicine for home monitoring of discharged patients and other complaints is in full use as numbers in Italy start to trend south.
Point of Care Pulse Ox assessment at triage should identify silent Hypoxia Assessment via rest and stress check after one-minute walk.
Order Labs and X-ray Chest.
An inconclusive chest X-ray should prompt plain CT of the chest. If the CT is positive then the patient is admitted.
Negative CT Chest should prompt an evaluation to rule out COVID Myocarditis / PE as COVID has shown to have cardiac effects and thrombotic tendencies.
CTA is done when there is a high suspicion for PE. Additional POCUS Cardiac exam is done. D-Dimer routinely is high in COVID patients.
The PE algorithm should be followed keeping in mind that AKI and dehydration can be present.
GFR and trending the creatinine in last 7 weeks is good enough to evaluate the kidney status in addition to creatinine.
High Sensitivity Troponin is an efficient marker to r/o myocarditis.
The emphasis was that other pathologies do exist and we have to keep that in mind as we evaluate COVID patients and vice versa.
Hematological / Metabolic Markers
Neutropenia, Lymphopenia, Hypokalemia and High Fibrinogen levels have been found in COVID19 patients.
Routine dosing that the experts recommended for patients admitted.
Extra-Pulmonary manifestations of COVID19
AMS / Seizures / Delirium / Encephalopathy / Myocarditis / N / V/ D / Rhabdomyolysis / AKI / Thrombosis / Embolism were the major manifestations mentioned by experts.