4th April 2020
Telemedicine
Telemedicine for home monitoring
of discharged patients and other complaints is in full use as numbers in Italy
start to trend south.
Hypoxia
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.
Kidney
Dysfunction
GFR and trending the creatinine
in last 7 weeks is good enough to evaluate the kidney status in addition to
creatinine.
Myocarditis
High Sensitivity Troponin is an
efficient marker to r/o myocarditis.
Non-COVID
Pathologies:
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.
LMWH
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.
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