COVID

Question 1

Intubation in COVID:

Answer 1

• Early decision to intubate (avoid NIV/HFNP)
• Negative pressure room, HEPA filter, minimal staff in room, buddy system
• PPE incl N95 + double-glove.
• Most experienced operator
• RSI, high dose paralytic(avoid cough, spont vent)
• Video- operator can stand further back
• Avoid bagging. LMA for rescue rather than BVM.
• Cuff up ASAP
• Limit vent disconnects. Only do at end-expiration with ETT clamped

Question 2

COVIC incubation period:

Answer 2

Most 2-7 days
Up to 14 days (1%)

Question 3

Hospital-level measures for reducing COVID spread:

Answer 3

• Screening/questionnaire for early ID
• Cohorting
• Neg pressure rooms
• HEPA filters
• Regular equipment/ surface cleaning
• Minimising staff contact with + cases
• Social distancing of staff (eg. tearoom)
• Telehealth/ remote technologies
• Audits/ quality improvement
• Education
• Signage for staff/visitors

Question 4

Definitions of COVID severity (adult):

Answer 4

ASYMPTOMATIC/ MILD

MODERATE
LRTI evidence: Dyspnoea, XR changes, mildly low sats.

SEVERE
RR >30
O2 requirement or sats <92% RA
Lung infiltrates >50%
PaO2/FiO2 ratio <300mmHg

CRITICAL
Ratio <200, ARDS, tubed, shocked, ALOC, organ failure.

Question 5

What are the Risk Factors for Progression/ Poor Outcomes in COVID:

Answer 5

• Age >65 or Age > 50 and ATSI
• Immunocompromised
• Pregnant
• Not vaccinated (+ not infected in last 3 months)
• Comorbidities:
  –> BMI >30
  –> Resp disease
  –> CVD incl HTN
  –> Diabetes
  –> Renal failure
• Remote/ vulnerable

Question 6

Drug treatments in COVID:

Answer 6

MILD/ MOD
Nothing, if well + low risk.

Consider inhaled corticosteroid if RISK FACTOR/S
- eg. Budesonide (within 14 days)

Consider antiviral therapy if RISK FACTORS and UNVACCINATED
- Eg. Remdesivir (within 7 days)

_______

SEVERE/ CRITICAL
Give steroid if on OXYGEN
- Dexamethasone PO/IV

Give a ‘mab
- Eg. Tocilizumab

ALSO give an antiviral, IF NOT INTUBATED:
- Eg. Remdesivir

** These particular options all okay for pregnant/ breastfeeding **

+VTE prophylaxis

Question 7

Multisystem Inflammatory Syndrome (post COVID)

Answer 7

Adult (MIS-A) and paediatric (MIS-C) types.

Occurs 4 weeks approx. post infection

Complex diagnostic criteria.
Essentially need:
- Fever, inflamm markers
- Evidence of recent COVID infection/ contact
- 2+ organ systems involved
- No other cause

Management is supportive (incl. VTE prophylaxis)
Outpatient: steroids
Inpatient: IVIG

(Bit like Kawasaki)

Question 8

CXR in COVID:

Answer 8

Normal does not exclude

No specific findings: just that of viral pneumonia / ARDS

• Bilateral opacities
• Usually more peripheral and basal
• ‘Consolidation’, or, ‘ground-glass’

May get areas of collapse/ atelectasis. Pleural effusion is rare.