COVID

Question 1

A 45 year old male presents with increasing dyspnoea over 4 days, cough, fever, fatigue and anosmia. How would you manage this patient?

Answer 1

Impression
Given features of infective respiratory illness over 4 days, provisionally concerned about COVID-19 infection.

Ddx
- Resp: pneumonia (viral, infective), influenza, other viral LRTI/URTIs; COPD/Asthma
- Cardiac: CHF, APO

Goals
- administer RAT/PCR test to confirm diagnosis
- conduct appropriate assessment in COVID-safe manner
- Supportive and definitive Mx

Question 2

COVID - Assessment

Answer 2

Assessment
- conduct assessment in safe manner; require donning appropriate PPE including fit-tested N-95 face mask, goggles, gloves, and gown.
- Administer self-performed RAT test for confirmation

3 main questions
- vaccination status
- immunocompromised (>75, chronic medical condition, steroid requirement, etc)
- oxygen requirement (low SP02)

• Conduct A to E assessment to ensure HD stability and no indication for escalation of care in the acute setting

Question 3

COVID - History

Answer 3

History
- sx: cough, fevers, myalgia, malaise, rash, SOBOE, headaches, anosmia, etc
- distinguish bacterial based on phlegm production, acute onset, high fevers
- RISKS: vaccinations status, immunocompromised, respiratory co-morbidities (asthma, COPD, etc). ATSI.
- PMHx, FamHx, medications, allergies
- SNAP
- psychosocial: living circumstances, ability to self-isolate

Question 4

COVID - Examination

Answer 4

Examination
- Vitals
- appearance
- resp exam: creps, consolidation, vocal resonance, percussion notes

Question 5

COVID - Investigations

Answer 5

Investigations
Key/Diagnostic
- RAT/PCR test

Pending result, further tests based on clinical indication on Hx/Ex

Severe:
- CXR +/- CT Chest for evidence of ARDS
- ABG
- ECG

Question 6

COVID - Management

Answer 6

Management
Majority of COVID now managed on outpatient basis. Predominantly supportive with;
- antipyretics
- analgesia
- fluids
- DVT prophylaxis
- isolation for 7 days
- PHU notification

Hospital admission for moderate to severe presentations, recommendations are rapidly evolving with increasing knowledge;
- ID consult for drug regimens according to specific patient and disease factors and updated treatment guidelines. Severity is based primarily on oxygen requirement.

Specific considerations include;
o Coticosteroid administration, either IV or inhaled (dexamethasone) - this is recommended treatment
- Consider anti-viral medications (remdesivir)
- Monoclonal Antibodies for severe illness/immunocompromised (Tocilizumab, etc)
- proning 3-4 hrs per day

Mild
- Supportive
- MDI budesonide

Mod
- 02 <94
- corticosteroids (IV dex)
- antivirals
- once 02 requirement gets to 6L then they go to ICU as they have a high risk of rapid deterioration

Sev
- 02 <90
- corticosteroids