Covid 19 Flashcards
when do symptoms appear after infection with COVID-19 cap
afetr 6 days
early symptoms of disease cap
cough
malaise
anosmia
headache
myalgia
level of severity
absence of signs of severe or critical disease
non severe
level of severity
sp02 less than 90% on air
resp rate above 30
raised resp rate in children
signs of severe resp distress
severe
level of severity
requires life sustaining treatment
acute respiratory distress syndrome
sepsis
septic shock
critical
symptoms of severe covid pneumonia
severe breathlessness
rr over 30
saturation below 90
x rays can show basal atelectasis, what does this mean
collapsed lungs
what might you see in a ct in severe covid
ground glass infiltrates
what biomarkers would be raised
crp
fibrinogen
d dimers
ldh
ferritin
true or false, covid is not prothrombotic and does not increase clot risk
false
what causes cytokine storm
body inflammatory response
asiatics have greater expression of x which is associated with poorer outcomes
tyk2
asiatics have lower x which is associated with poorer outcomes
IFNAR2
elevated x is associated with increased mortality and thrombosis
d dimer
what does inf reduce
inflammation
what prevents the use of inf
cost
how can proning help patients with covid
less shunting in lungs
alveoli expand
name a mab that clocks viral entry into health cells and clears infected cells from sars cov 2
sotrovimab
sotrovimab is reserved for use in which px
high risk
vit d deficiency means more likely for hypocalcaemia, what benefit can it have for covid
correct low calcium at worst and help immune system at best
steroids may benefit patients, what 2 ppis may be given alongside for gastro protection to stop gi bleeds
lansoprazole or omeprazole
oxygen can be given at 4-6ml/min in order to gets sats of
92-96%
continuous positive airway pressure - cpap machines help control pressure and amount of o2 given to aid breathing, why do staff require high levels of ppe with suitable masks
aerosols putting healthcare workers at risk
imv requires pt to be sedated and a breathing tube is put into where
windpipe
(intubation)
why do some patients on ventilation benefit from proning
opens up more of lung and allows for better gas exchange between air and bloodstream
ecmo allows lungs to be rested and acts as artifical lung giving them a better chance to heal, what is a setback
small number of specialist centres in the uk
different ways to deliver oxygen in order of escalation
nasal cannula
non rebreather mask
cpap
imv
ecmo
haematological increases in lab results
d dimer
fibrinogen
crp
ldh
ferritin
haematological DEcreases in lab results
lymphocytes
(hypo)calcaemia
name some groups of high risk px
organ transplant
chemo/ antibody tx for cancer and immunotherapy
intense radiotherapy
leukemia, lymphoma, myeloma
severe lung condition
dialysis
immunosuppressed/ high steroid dose
what percentage of anti retrovirals does a patient have to take to treat hiv effectively
90%
what dose of enoxaprin is needed for pe
1.5mg/kg od or 1mg/kg bd
what does apixaban inhibit to work
factor xa
why is apixaban a better choice than enoxaparin on discharge
equally effective
better compliance
less painful
no routine monitoring
how would you manage a patient as on 80% o2 cpap and poor sats below 90%
increase to 100% o2 cpap and dexamethasone iv 6mg od and stat dose of toclizumab 800mg iv od
if a patient had high lactate what changes would you make to their metformin therapy and why
stop because it causes lactic acidosis (rare)
why would bendrofluazide not be appropriate for a bp of 180/110
not strong enough as patient at risk of heart attack or stroke
what drug and dose if px has bp 180/110 and hr 110 bpm
amlodipine 5mg ng as can not crush MR nifedipine
what drug would you use to stop breast milk to reduce engorgement and risk of mastitis
cabergoline 1mg stat
name a reversal agent for paralysis
neostigmine
suitable drug to paralyse patients quickly at 50mg stat dose then 0.6mg/kg/hr and still metabolises in low kidney or liver function
atracurium
vit d levels below x is deficient
25
alfacalcidol is only used in x patient
renal failure
how does baricitinib work in covid 19
modulates janus kinase enzyme to reduce cytokine storm
other therapeutics for COVID-19
remdesivir, tocilizumab, baracitinib
how long does it take the pfizer vaccine to be effective
21 days
first line NRV novel antiviral for high risk px
paxlovid
molnupiravir - outpx
