The WACEM Second Special Global Web Conference on “ Emergency Shock , Resuscitation in COVID19”

Date: 28/3/20

With gratitude to all our global participants today for sharing your experiences and advice.

1) Multi-use Ventilator-Patient Dyssynchrony : 

Consider the major problem of ventilator triggers when optimizing use for multiple patients. Adequate sedation is key.

2) ECMO

- Should be used in conjunction with CVTS and experienced team/units.

- Consider outcome potential, with best potential in young, otherwise fit individuals. Older patients with co-morbidities and multi-organ failure are poor candidates for consideration of this limited resource.

3) Aggressive Diagnostic CT

Consider balancing the use of your CT resources with the time and resource limiting factors. 

4) POCUS 

Bedside POCUS use by trained operators.

5) CRP/Procalcitonin 

There are of more value in serial measurements than to use as absolute diagnostic or discharge criteria.

6) Neutrophil to Lymphocyte ratio

FOAMed resource: https://emcrit.org/pulmcrit/nlr/

Paper: https://www.medrxiv.org/content/10.1101/2020.02.10.20021584v1

7) Co-infection

COVID-19 is being diagnosed as either the primary or the co-infection in cases of Sepsis / Trauma / Cardiology presentations. To be kept in mind. ACLS / ATLS should be done as per protocol.

Broad spectrum antibiotics for at-least 48 hours until negative cultures obtained if Sepsis protocol is being followed. Do not forget Non COVID19 Sepsis and other pathologies continue to exist and cannot be missed. Fluid management and Ventilator support should follow ARDS protocols.  

8) PCR sampling 

Of more use in milder infections and targeting health care professionals than a wider use screening tool. 

9) OP/NP sampling

Moderate sensitivities shown. Potential for late positives. Efforts should be made to reduce sampling errors.

10) Disaster preparedness

Countries/regions with good disaster preparedness protocols and experience are fairing better than those without. Successful models or successful features from developing models should be shared and inculcated into global practice.

10) Discharge Criteria

Silent Hypoxia is the major factor which can impede discharge from ED. Other factors like Fever and Low Lymphocyte count should take presence / Absence of Hypoxia as a Major criteria to discharge or admit the patient.

Please read post covering previous meeting talking points for completeness.