Week 4: COVID 19 and ARDS

Question 1

What is COVID

Answer 1

new infectious disease from the coronavirus family that causes acute respiratory distress and syndrome
most people experience mild to moderate symptoms without hospitalization
elderly and immunocompromised are more susceptible to infection and serious conditions
aerosol and droplet transmission
infectious period of 7-14 days
infection can be limiting for 80% of people

Question 2

What is the Pathogen That Causes COVID

Answer 2

SARS-CoV-2

Question 3

Long Term Effects of COVID

Answer 3

mostly unknown as pandemic is still ongoing, but can last form weeks to months of effects

Question 4

Corona Viruses

Answer 4

subfamily of RNA viruses that often cause resp and GI infections that can range from limiting to mild symptoms to more severe
viral envelope with positive sense single stranded RNA genome in helical nucleocapsid

Question 5

What is a Viral Envelope

Answer 5

lipid biolayer, membrane, envelope, spike and occasionally hemagglutinin esterase

Question 6

What is the Spike Virus for COVID

Answer 6

membrane, envelope and spike proteins that are critical to viral effects
spike proteins has a receptor binding ability to bind to ACE-2 receptor
viral membrane fuses with cell membrane to release RNA host cell
fusion membrane is where fusion peptide is exposed after the spike is cleaved by proteases

Question 7

Intracellular Viral Replication Cycle

Answer 7

expression of RNA and replication of full genome RNA and simultaneous transcription of protein
normally replicated RNA is packages in viral particles and undergo exocytosis and is then released

Question 8

What are Variants

Answer 8

changed or mutated viruses that are common in coronaviruses

changes include transmissibility, virulence, vaccine efficacy and diagnostics

Question 9

What are the COVID Variants

Answer 9

Alpha from the UK, Beta from South Africa, Gamma from Brazil, Delta from India and Omnicron from South Africa

Question 10

Where is COVID Mostly Found

Answer 10

bronchoalveolar lavage fluid, sputum and saliva

Question 11

Phases of COVID

Answer 11

Early Infection - 1-14 days can last but the average length is 5-6 days, peak viral load in 4 days and symptoms start on day 5
Pulmonary Phase - typically avoidable unless the disease progresses; SOB, difficulty breathing, and is typically 5 days post symptom onset with pneumonia and SOB on CXR. Requires hospitalization
Optional Hyperinflammatory Phase - 6% of cases progress to this where the pt is critically ill with sepsis, pneumonia, acute respiratory failure, renal failure and MOD (average LOS is 10 days)

Question 12

Recovery of COVID

Answer 12

long term effects are largely unknown

lasts 2-8 weeks with fatigue, heart problems, activity intolerance, muscle weakness and lung damage

Question 13

Importance of ACE-2 in COVID

Answer 13

receptor it binds to cause the effects of the virus that makes 1/2 of extracellular peptides like angiotensin II and COVID depends on the receptors to spread

Question 14

COVID Effects on Kindey

Answer 14

mild proteinuria, hematuria, and increased creatine levels with COVID pt but COVID is not the main cause, secondary injury

Question 15

COVID Effects on Liver

Answer 15

altered liver enzymes bit is more likely damage from treatment methods and hyperinflammatory than form COVID

Question 16

COVID Effects on GI tract

Answer 16

causes diarrhea, nausea, vomiting, and abdominal pain but there is very little research on the links with COVID

Question 17

COVID Effects on Cardiovascular System

Answer 17

promotes coagulation, heart disease and arrhythmias with severe to long term effects
COVID in shakey on whether or not it is the cause or if it is just an inflammatory response

Question 18

COVID Effects on CNS System

Answer 18

linked to confusion, conjunctivitis (loss of taste), agitation, headache, and paranesthesia with the effects on taste reported form 5-96% of cases
link to COVID in unknown

Question 19

COVID Effects on Immune System

Answer 19

increased production of proinflammatory cytokines, and interferons as a direct response to COVID particles
systematic hyperinflammatory response leads to cytokine storm or cytokine release syndrome, respiratory distress, disease progression, organ damage and death

Question 20

Cytokine Storm of Cytokine Release Syndrome

Answer 20

Characterized by fever and multi-organ failure where there is a systemic inflammatory state from an excess of cytokines in the body

Question 21

COVID Effects on Respiratory System

Answer 21

primary spot of infection is the upper resp track with a peak of COVID particles and site of exit in the body
lungs have more ACE-2 receptors and diffuse alveolar damage (DAD) and leads to ARDS
most common cause of death in COVID pt is respiratory failure

Question 22

DAD or Diffuse Alveolar Damage

Answer 22

structural change in alveoli where there is a fusion of alveoli from damage or disease
early stage of ARDS

Question 23

Acute Respiratory Failure or ARF

Answer 23

condition or complication of a disease of hypoxemic, no CO2 release, insufficient O2 to blood and hypercalcemia that is a major threat to the lungs
2 or more physiological mechanisms with imbalanced ventilation supply and demand

Question 24

S&S of ARF

Answer 24

air hunger
decreased O2 Sat and HTN
Tachy
SOB
hyperpigmentation of cyanosis
impaired renal function
cyanosis
metabolic acidosis
GI alteration

Question 25

Classification of Hypoxemic

Answer 25

Pa O2 < or = to 60mmHg with O2 Sat < or = to 60%

Question 26

Classification of Hypercapnic

Answer 26

ventilation failure of PaCO2 >48mmHg with a pH of >7.35, with an imbalance arising from imbalance of supply and demand

Question 27

Causes of ARF

Answer 27

``` V/Q mismatch pneumonia asthma pain atelectasis pulmonary embolism COPD COVID emphysema cystic fibrosis chronic bronchitis ```

Question 28

Effects of Hypoxemic Respiratory Failure

Answer 28

shunting (blood leaves heart without gas exchange) of anatomical (bypass lungs) or intrapulmonary (lungs no worky) diffusion limitation - decrease in gas exchange across alveolar cap membrane b/c of thickened or destroyed membrane alveolar hyperventilation

Question 29

Diagnostics of ARF

Answer 29

``` The girls who get it, get it. And the girls who don't, don't C-XR ABG ECG V/Q Mismatch and lung scan uranalysis pulmonary artery collection CBC/blood culture ```

Question 30

Tx of ARF

Answer 30

``` Stabilize increase O2 sat and levels decreased CO2 levels activity tolerance decrease symptoms effective coughing or augmentation coughing/clear secretions resp therapy of O2 therapy to be >92% and 55-60mmHg humidification airway suctioning endotracheal closed tube suctioning PPV Bi-PAP CPAP hydrate or die-drate ```

Question 31

Drugs for ARF

Answer 31

Bronchodilators to reduce bronchospasms corticosteroids to decrease airway inflammation and system inflammation increase protein and nutrition status benzothiazepines IV antibiotics for tx of infection diuretics' and nitrates to decrease pulmonary congestion meds to reduce anxiety and restlessness

Question 32

Complications of ARF

Answer 32

``` CNS disease restrictive lung disease cheat wall dysfunction neuro-muscular disease brain damage death renal damage ```

Question 33

Acute Respiratory Distress Syndrome or ARDS

Answer 33

sudden and progressive form of ARF where alveolar-capillary membrane becomes damaged and more permeable by intravascular fluid

Question 34

Causes of ARDS

Answer 34

``` COVID resp infections sepsis pneumonia direct lung injury ```

Question 35

Phases of ARDS

Answer 35

Injury or Exudative Injury - 1-7 days after injury of guckiness and impaired gas exchange that can lead to interstitial and alveolar edema and atelectasis Reparative or Proliferation - 1-2 weeks post injury with inflammation occurring that causes increased pulmonary vascular resistance and pulmonary HTN with hypoxemia worsening Fibrotic - 2-3 weeks post injury with lung remodeling that causes worsening gas exchange due to scar tissue

Question 36

S&S of ARDS

Answer 36

``` resp alkalosis SOB cough restlessness fine crackles hypoxemia cyanosis ```

Question 37

Hallmark Signs of ARDS

Answer 37

hypoxemia, PaO2/FiO2 ration <200 | C-XR showing bilateral interstitial/alveolar infiltrates

Question 38

Vaccinations

Answer 38

prophylactics treatment with either live attenuated, whole inactivated, protein subunit and virus like particle technology for mocking the virus and making the immune system recognize and make an inflammatory system response to the virus

Question 39

Pfizer and Moderna

Answer 39

we know the drill lipid nanoparticle encapsulated mRNA coding mutated form of COVID cannot get COVID from it

Question 40

AstraZeneca and J&J

Answer 40

the blood clot boi and the joke of a vax | viral vector to trigger spike protein formation for the body to identify and attack

Question 41

Noravax

Answer 41

lol not even approved in Canada it's that big of a joke recombient nanoparticle tech with very little efficacy

Question 42

Antiviral

Answer 42

prevent replication of virus in body but not ridding the body of the virus, good in theory for treating viruses

Question 43

Bamlanivimab LY-CoV5555

Answer 43

antiviral 12 and older with mild to moderate COVID to neutralize IgG1 monoclonal antibody by blocking interaction with ACE-2 receptor

Question 44

Remdesivir

Answer 44

antiviral with reverse transcription inhibitor so the RNA is unable to replicate only for 12 and older with pneumonia and O2 applied

Question 45

Immune System Enhancers

Answer 45

interferons, viral mimics, convalescent plasma from COVID pt, VIt D, and stem cell therapies to prevent severe disease but not real approval for COVID yet

Question 46

Pulmonary Supportive Agents

Answer 46

support with O2 therapy and mechanical ventilation that can be bovine lipid extract surfactant suspension and dornase alfa indicated with cystic fibrosis to decrease mucous formation, improving lung function and to decrease surface tension of alveoli

Question 47

Cardiovascular System Regulators

Answer 47

trialed for COVID potential to increase lung function but aiding in increasing circulation in lungs to clean pulmonary inflammation BB, ACE inhibitors and diuretics