Covid19 treatment guidelines < Nuevas guías Nicolas Ugarte
This document provides guidelines for the treatment of COVID-19. It discusses the epidemiology, clinical presentation, diagnosis, and spectrum of disease for COVID-19. Key points include:
- COVID-19 has spread globally since early 2020, infecting over 2.4 million people. Risk factors for severe disease include age over 65 and underlying medical conditions.
- Clinical presentation ranges from asymptomatic to severe pneumonia. Common symptoms are cough, fever, and shortness of breath.
- Diagnosis is made through nasopharyngeal sampling and PCR testing. Chest imaging often shows bilateral opacities.
- Treatment guidelines are provided for various disease severities and special patient populations, focusing on supportive care and investigational therapies.
- COVID-19 is caused by SARS-CoV-2 virus and has no specific approved treatment. The document summarizes the stages of COVID-19 infection and treatment approaches based on disease severity. For mild cases, symptomatic treatment is recommended. For moderate cases, hydroxychloroquine with or without azithromycin is recommended. Severe cases may require ICU care, lopinavir/ritonavir, tocilizumab for cytokine release syndrome, and consideration of remdesivir or interferons through clinical trials.
Covid 19 advancement in treatment over timeDR.pankaj omar
This document discusses various aspects of diagnosing and treating COVID-19, including:
1. The timing of initiating antiviral, anti-inflammatory, and anticoagulant treatments is important, with antivirals recommended early in symptomatic phase and steroids in pulmonary phase.
2. Remdesivir has been shown to shorten recovery time in moderately ill hospitalized patients. Tocilizumab was not effective at preventing intubation or death.
3. Treatment protocols for mild, moderate, and severe COVID-19 cases are outlined, recommending medications, supplements, and monitoring based on disease severity and stage.
This document provides guidance on the care of patients with COVID-19. It defines COVID-19 and outlines the objectives of reviewing its history, case definition, clinical manifestations, diagnostic testing, medical management, prevention, and nursing care. It describes the virus's structure and history. Key points include its identification in China in late 2019, its declaration as a global pandemic by WHO in March 2020, and its spread to over 160 countries. Clinical features range from mild illness to pneumonia, ARDS, and septic shock. Diagnostic testing includes PCR from respiratory samples and serology. Management involves symptomatic care, oxygen therapy, treatment of coinfections, ventilation for respiratory failure, and treating septic shock.
This document discusses sepsis in the context of COVID-19. It begins by defining sepsis and the related terms systemic inflammatory response syndrome, severe sepsis, and septic shock. It then discusses how COVID-19 can sometimes lead to sepsis through a dysregulated immune response and infection. The document outlines common clinical manifestations of sepsis in COVID-19 patients and risk factors. It recommends following the Surviving Sepsis Campaign guidelines for early detection and treatment of sepsis through measuring lactate levels, administering antibiotics and fluids, and other interventions within 3-6 hours of recognition.
- The document discusses COVID-19 priorities for pediatric practice, including clinical manifestations, risk factors, transmission, investigations, treatment and management of COVID-19 in children. It notes that while children generally experience milder symptoms than adults, they can still spread the virus and some may develop severe complications requiring hospitalization. Proper isolation, supportive care, monitoring for symptoms and timely treatment are important for managing COVID-19 in the pediatric population.
The document discusses COVID-19, including what it is, its symptoms, testing procedures, treatment options, and preventive measures. It explains that COVID-19 is caused by the SARS-CoV-2 virus, that symptoms can range from mild to severe and include fever, cough and shortness of breath, and that molecular tests like PCR are used to detect the virus. It recommends measures like masks, distancing and handwashing to prevent transmission.
This was a lecture I gave for the Upstate Nurse Practitioners Association. This is a comprehensive overview. I would to thank all health care professionals for doing their jobs as well as they can.
Covid19 treatment guidelines < Nuevas guías Nicolas Ugarte
This document provides guidelines for the treatment of COVID-19. It discusses the epidemiology, clinical presentation, diagnosis, and spectrum of disease for COVID-19. Key points include:
- COVID-19 has spread globally since early 2020, infecting over 2.4 million people. Risk factors for severe disease include age over 65 and underlying medical conditions.
- Clinical presentation ranges from asymptomatic to severe pneumonia. Common symptoms are cough, fever, and shortness of breath.
- Diagnosis is made through nasopharyngeal sampling and PCR testing. Chest imaging often shows bilateral opacities.
- Treatment guidelines are provided for various disease severities and special patient populations, focusing on supportive care and investigational therapies.
- COVID-19 is caused by SARS-CoV-2 virus and has no specific approved treatment. The document summarizes the stages of COVID-19 infection and treatment approaches based on disease severity. For mild cases, symptomatic treatment is recommended. For moderate cases, hydroxychloroquine with or without azithromycin is recommended. Severe cases may require ICU care, lopinavir/ritonavir, tocilizumab for cytokine release syndrome, and consideration of remdesivir or interferons through clinical trials.
Covid 19 advancement in treatment over timeDR.pankaj omar
This document discusses various aspects of diagnosing and treating COVID-19, including:
1. The timing of initiating antiviral, anti-inflammatory, and anticoagulant treatments is important, with antivirals recommended early in symptomatic phase and steroids in pulmonary phase.
2. Remdesivir has been shown to shorten recovery time in moderately ill hospitalized patients. Tocilizumab was not effective at preventing intubation or death.
3. Treatment protocols for mild, moderate, and severe COVID-19 cases are outlined, recommending medications, supplements, and monitoring based on disease severity and stage.
This document provides guidance on the care of patients with COVID-19. It defines COVID-19 and outlines the objectives of reviewing its history, case definition, clinical manifestations, diagnostic testing, medical management, prevention, and nursing care. It describes the virus's structure and history. Key points include its identification in China in late 2019, its declaration as a global pandemic by WHO in March 2020, and its spread to over 160 countries. Clinical features range from mild illness to pneumonia, ARDS, and septic shock. Diagnostic testing includes PCR from respiratory samples and serology. Management involves symptomatic care, oxygen therapy, treatment of coinfections, ventilation for respiratory failure, and treating septic shock.
This document discusses sepsis in the context of COVID-19. It begins by defining sepsis and the related terms systemic inflammatory response syndrome, severe sepsis, and septic shock. It then discusses how COVID-19 can sometimes lead to sepsis through a dysregulated immune response and infection. The document outlines common clinical manifestations of sepsis in COVID-19 patients and risk factors. It recommends following the Surviving Sepsis Campaign guidelines for early detection and treatment of sepsis through measuring lactate levels, administering antibiotics and fluids, and other interventions within 3-6 hours of recognition.
- The document discusses COVID-19 priorities for pediatric practice, including clinical manifestations, risk factors, transmission, investigations, treatment and management of COVID-19 in children. It notes that while children generally experience milder symptoms than adults, they can still spread the virus and some may develop severe complications requiring hospitalization. Proper isolation, supportive care, monitoring for symptoms and timely treatment are important for managing COVID-19 in the pediatric population.
The document discusses COVID-19, including what it is, its symptoms, testing procedures, treatment options, and preventive measures. It explains that COVID-19 is caused by the SARS-CoV-2 virus, that symptoms can range from mild to severe and include fever, cough and shortness of breath, and that molecular tests like PCR are used to detect the virus. It recommends measures like masks, distancing and handwashing to prevent transmission.
This was a lecture I gave for the Upstate Nurse Practitioners Association. This is a comprehensive overview. I would to thank all health care professionals for doing their jobs as well as they can.
This document summarizes treatment guidelines for COVID-19 based on disease severity and stage:
- Monoclonal antibodies like Sotrovimab and Bebtelovimab can reduce hospitalization when given early for mild-moderate cases. Antiviral pills Paxlovid and Molnupiravir may also be options.
- For hospitalized patients, remdesivir, corticosteroids like dexamethasone, and IL-6 inhibitors like tocilizumab are recommended. Baricitinib may also help reduce mortality. Remdesivir works best early in hospitalization while corticosteroids are preferred later for patients with ARDS.
- Guidelines discuss optimal dosing of cort
In COVID-19 any antiviral is more effective when used early in first week of illness.
What should not be used in covid-19 is also discussed in presentation.
Rekha Dehariya (M.Sc nursing 1st year) Bhopal Nursing College, Bhopal
Covid -19 has effected broud number of people all over the world. the health education is necessary to aware people about it.
COVID 19- Basics beyond Basics by Dr. Brij Teli doc2rock
COVID-19: Basics Beyond Basics, is a concise presentation on Some Salient aspects and facts about Management of COVID-19 as per the Evidence based information on the day of Webinar.
Video of Webinar available at:
https://youtu.be/fjlgVzvwhM4
Can Join Telegram Group for Discussion: https://t.me/covindia
Target Audience being- Resident Doctors of Medicine, Pulmonary Medicine, Anesthesia, Pharmacology as well as Undergraduate Medical Students, Interns and HealthCare Workers from Various States of India as well as Outside India.
Covers aspects Like- Maskology, COVID-19 Antigen Detection Test, X-Ray & CT Findings of COVID-19, Cytokine Storm, Tocilizumab, Steroids & Recovery Trial, Covid Associated Coagulopathy(CAC), Hydroxychloroquine & the Controversies, Remdesivir, Convalescent Plasma, Awake Non-Intubated Prone Positioning, Thromboprophylaxis in COVID-19 including calculating SIC Score, Newer Trials and Publications, COVID-19 Vaccine Status, Favipiravir.
1) The document provides definitions for suspected, probable, and confirmed cases of COVID-19 according to WHO criteria based on symptoms, exposure history, and test results.
2) It describes the typical progression and severity of COVID-19 from mild to severe and critical illness, with severe cases making up 14% of cases and critical 5%. The overall fatality rate is estimated between 2.3-5%.
3) Risk factors for worse outcomes include older age, male sex, comorbidities like cardiovascular disease, and certain lab abnormalities like lymphopenia and elevated LDH, troponin, and D-Dimer levels.
This document summarizes information from Dr. Tahseen J. Siddiqui on COVID-19. It discusses the three known coronaviruses that cause SARS, MERS, and COVID-19. It emphasizes that mitigation through strict social isolation is the best current strategy to slow transmission rates and prevent healthcare systems from being overwhelmed. The risks of personal infection are low but systemic risks are high if many require critical care simultaneously. Early action through testing, contact tracing, and quarantines have helped countries like Taiwan better control the spread.
This presentation provides an overview of COVID-19 and was given by Team-D from the Department of Family Medicine at University of Uyo Teaching Hospital. It discusses the history, epidemiology, pathophysiology, clinical features, treatment, prevention and the role of family physicians in addressing the COVID-19 pandemic. Key points include that COVID-19 is caused by the SARS-CoV-2 virus, over 404 million confirmed cases worldwide as of February 2022, and prevention strategies involve vaccination, personal protective measures, and infection control in healthcare settings. The family physician plays an important role in identifying and managing potential COVID-19 cases at the primary care level.
CME Lecture on "COVID-19 Presentation and Diagnosis"
Presented at the Scientific Seminar of Philippine American Medical Association in Chicago on March 6th, 2021.
1. In late 2019, a novel coronavirus (SARS-CoV-2) emerged in Wuhan, China, causing a pneumonia outbreak of unknown origin.
2. The virus spread rapidly worldwide, and in March 2020 the WHO declared a global pandemic with over 118,000 cases across 114 countries.
3. Common symptoms of COVID-19, the disease caused by SARS-CoV-2, include fever, cough, and shortness of breath, with severe cases potentially resulting in acute respiratory distress.
The document provides recommendations for managing acute coronary syndrome (ACS) patients during the COVID-19 pandemic. It discusses challenges such as delays in care and treatment due to COVID-19 testing requirements and risks of aerosolization. Primary percutaneous coronary intervention remains the standard treatment when possible, but fibrinolytic therapy is preferred if delays occur or protective equipment is unavailable. The care of ACS patients requires special attention to safety protocols and balancing timely reperfusion with COVID-19 diagnosis and risk.
- Coronaviruses typically cause common colds but SARS-CoV and MERS-CoV can cause pneumonia, respiratory failure, and death. A novel coronavirus, SARS-CoV-2, emerged in Wuhan, China in late 2019 and caused a global pandemic.
- SARS-CoV-2 spreads mainly through respiratory droplets when people cough, sneeze or talk within 6 feet of each other. Asymptomatic and pre-symptomatic people are highly infectious.
- COVID-19 symptoms range from mild to critical illness. The elderly and those with pre-existing conditions are at higher risk for severe disease. Diagnosis involves PCR testing of respiratory samples.
Public health surveillance of covid 19NOORISLAMBAG
This document provides information on surveillance of COVID-19, including case definitions, types of contact, types of death, objectives and indicators of surveillance, and challenges. It describes the epidemiology of COVID-19 and defines suspected, probable and confirmed cases. Various types of surveillance are outlined, including routine, syndromic, sentinel, hospital-based, and digital surveillance. Challenges of surveillance in low-resource countries include doing more with less and issues with sustainability, underreporting, limited testing capacity, and lack of timeliness in reporting.
Detail explanation of COVID 19 pneumonia, with a clinical case discussion on it. moreover, SOAP format of the case presentation also available. just to improve knowledge not for clinical use.
COVID - 19(CORONAVIRUS) DIAGNOSIS AND MANAGEMENT Ayush Jain
p
Criteria Investigatio
ns
Isolation
ward/
Hospital
ised
Treatment Remarks
F Septic Shock
due to
COVID 19
Baseline
Hemogram
, ECG,
LFT, RFT,
BSL profile,
X-ray
Chest, Sr.
Amylase,
2 D Echo,
CPKMB,
PTINR
ABG
Daily SE ,
Magnesium
if QTc
prolongatio
n
ICU
Oseltamivir 150
mg BD for 10
days (Double
dose)
+
T Azithromycin
500mg OD x 10
days
+
T
Clinical Management of Covid-19 (Bangladesh)Ridwanul Hoque
This document provides information about COVID-19, including its origins in Wuhan, China, how it has spread globally and affected Bangladesh, and its clinical presentation and treatment. It defines COVID-19 as a respiratory disease caused by a novel coronavirus (SARS-CoV-2) that is primarily transmitted through respiratory droplets. Guidelines are presented for diagnosing and managing COVID-19 cases based on their severity, including general measures, pharmacological treatments, and escalation of respiratory support for critical cases.
This document provides treatment protocols for COVID-19 in 3 stages: mild or moderate cases, critically ill cases, and ICU management. It outlines symptoms, testing and isolation procedures, medications and supportive treatments. It also defines suspected cases and provides revised treatment by medical experts from various specialties and institutions.
Mass general covid 19 treatment guideline july012020Adiel Ojeda
This document provides guidance for clinicians at Massachusetts General Hospital (MGH) on the treatment of COVID-19. It summarizes recommended diagnostic testing and risk stratification for hospitalized patients. It also provides guidance on therapeutic considerations, including anti-infectives, cardiovascular medications, antithrombotics, and COVID-19 specific treatments such as remdesivir. The document is regularly updated as new data emerges on the management of COVID-19.
Paul E. Sax, MD prepared useful Practice Aids pertaining to COVID-19 for this CME/MOC/CNE/CPE activity titled "Coronavirus Disease 2019 (COVID-19): Need-to-Know Information and Practical Guidance for Healthcare Professionals on the Front Lines of Patient Care." For the full presentation, monograph, complete CME/MOC/CNE/CPE information, and to apply for credit, please visit us at https://bit.ly/3gBvfOw. CME/MOC/CNE/CPE credit will be available until July 23, 2021.
This document summarizes treatment guidelines for COVID-19 based on disease severity and stage:
- Monoclonal antibodies like Sotrovimab and Bebtelovimab can reduce hospitalization when given early for mild-moderate cases. Antiviral pills Paxlovid and Molnupiravir may also be options.
- For hospitalized patients, remdesivir, corticosteroids like dexamethasone, and IL-6 inhibitors like tocilizumab are recommended. Baricitinib may also help reduce mortality. Remdesivir works best early in hospitalization while corticosteroids are preferred later for patients with ARDS.
- Guidelines discuss optimal dosing of cort
In COVID-19 any antiviral is more effective when used early in first week of illness.
What should not be used in covid-19 is also discussed in presentation.
Rekha Dehariya (M.Sc nursing 1st year) Bhopal Nursing College, Bhopal
Covid -19 has effected broud number of people all over the world. the health education is necessary to aware people about it.
COVID 19- Basics beyond Basics by Dr. Brij Teli doc2rock
COVID-19: Basics Beyond Basics, is a concise presentation on Some Salient aspects and facts about Management of COVID-19 as per the Evidence based information on the day of Webinar.
Video of Webinar available at:
https://youtu.be/fjlgVzvwhM4
Can Join Telegram Group for Discussion: https://t.me/covindia
Target Audience being- Resident Doctors of Medicine, Pulmonary Medicine, Anesthesia, Pharmacology as well as Undergraduate Medical Students, Interns and HealthCare Workers from Various States of India as well as Outside India.
Covers aspects Like- Maskology, COVID-19 Antigen Detection Test, X-Ray & CT Findings of COVID-19, Cytokine Storm, Tocilizumab, Steroids & Recovery Trial, Covid Associated Coagulopathy(CAC), Hydroxychloroquine & the Controversies, Remdesivir, Convalescent Plasma, Awake Non-Intubated Prone Positioning, Thromboprophylaxis in COVID-19 including calculating SIC Score, Newer Trials and Publications, COVID-19 Vaccine Status, Favipiravir.
1) The document provides definitions for suspected, probable, and confirmed cases of COVID-19 according to WHO criteria based on symptoms, exposure history, and test results.
2) It describes the typical progression and severity of COVID-19 from mild to severe and critical illness, with severe cases making up 14% of cases and critical 5%. The overall fatality rate is estimated between 2.3-5%.
3) Risk factors for worse outcomes include older age, male sex, comorbidities like cardiovascular disease, and certain lab abnormalities like lymphopenia and elevated LDH, troponin, and D-Dimer levels.
This document summarizes information from Dr. Tahseen J. Siddiqui on COVID-19. It discusses the three known coronaviruses that cause SARS, MERS, and COVID-19. It emphasizes that mitigation through strict social isolation is the best current strategy to slow transmission rates and prevent healthcare systems from being overwhelmed. The risks of personal infection are low but systemic risks are high if many require critical care simultaneously. Early action through testing, contact tracing, and quarantines have helped countries like Taiwan better control the spread.
This presentation provides an overview of COVID-19 and was given by Team-D from the Department of Family Medicine at University of Uyo Teaching Hospital. It discusses the history, epidemiology, pathophysiology, clinical features, treatment, prevention and the role of family physicians in addressing the COVID-19 pandemic. Key points include that COVID-19 is caused by the SARS-CoV-2 virus, over 404 million confirmed cases worldwide as of February 2022, and prevention strategies involve vaccination, personal protective measures, and infection control in healthcare settings. The family physician plays an important role in identifying and managing potential COVID-19 cases at the primary care level.
CME Lecture on "COVID-19 Presentation and Diagnosis"
Presented at the Scientific Seminar of Philippine American Medical Association in Chicago on March 6th, 2021.
1. In late 2019, a novel coronavirus (SARS-CoV-2) emerged in Wuhan, China, causing a pneumonia outbreak of unknown origin.
2. The virus spread rapidly worldwide, and in March 2020 the WHO declared a global pandemic with over 118,000 cases across 114 countries.
3. Common symptoms of COVID-19, the disease caused by SARS-CoV-2, include fever, cough, and shortness of breath, with severe cases potentially resulting in acute respiratory distress.
The document provides recommendations for managing acute coronary syndrome (ACS) patients during the COVID-19 pandemic. It discusses challenges such as delays in care and treatment due to COVID-19 testing requirements and risks of aerosolization. Primary percutaneous coronary intervention remains the standard treatment when possible, but fibrinolytic therapy is preferred if delays occur or protective equipment is unavailable. The care of ACS patients requires special attention to safety protocols and balancing timely reperfusion with COVID-19 diagnosis and risk.
- Coronaviruses typically cause common colds but SARS-CoV and MERS-CoV can cause pneumonia, respiratory failure, and death. A novel coronavirus, SARS-CoV-2, emerged in Wuhan, China in late 2019 and caused a global pandemic.
- SARS-CoV-2 spreads mainly through respiratory droplets when people cough, sneeze or talk within 6 feet of each other. Asymptomatic and pre-symptomatic people are highly infectious.
- COVID-19 symptoms range from mild to critical illness. The elderly and those with pre-existing conditions are at higher risk for severe disease. Diagnosis involves PCR testing of respiratory samples.
Public health surveillance of covid 19NOORISLAMBAG
This document provides information on surveillance of COVID-19, including case definitions, types of contact, types of death, objectives and indicators of surveillance, and challenges. It describes the epidemiology of COVID-19 and defines suspected, probable and confirmed cases. Various types of surveillance are outlined, including routine, syndromic, sentinel, hospital-based, and digital surveillance. Challenges of surveillance in low-resource countries include doing more with less and issues with sustainability, underreporting, limited testing capacity, and lack of timeliness in reporting.
Detail explanation of COVID 19 pneumonia, with a clinical case discussion on it. moreover, SOAP format of the case presentation also available. just to improve knowledge not for clinical use.
COVID - 19(CORONAVIRUS) DIAGNOSIS AND MANAGEMENT Ayush Jain
p
Criteria Investigatio
ns
Isolation
ward/
Hospital
ised
Treatment Remarks
F Septic Shock
due to
COVID 19
Baseline
Hemogram
, ECG,
LFT, RFT,
BSL profile,
X-ray
Chest, Sr.
Amylase,
2 D Echo,
CPKMB,
PTINR
ABG
Daily SE ,
Magnesium
if QTc
prolongatio
n
ICU
Oseltamivir 150
mg BD for 10
days (Double
dose)
+
T Azithromycin
500mg OD x 10
days
+
T
Clinical Management of Covid-19 (Bangladesh)Ridwanul Hoque
This document provides information about COVID-19, including its origins in Wuhan, China, how it has spread globally and affected Bangladesh, and its clinical presentation and treatment. It defines COVID-19 as a respiratory disease caused by a novel coronavirus (SARS-CoV-2) that is primarily transmitted through respiratory droplets. Guidelines are presented for diagnosing and managing COVID-19 cases based on their severity, including general measures, pharmacological treatments, and escalation of respiratory support for critical cases.
This document provides treatment protocols for COVID-19 in 3 stages: mild or moderate cases, critically ill cases, and ICU management. It outlines symptoms, testing and isolation procedures, medications and supportive treatments. It also defines suspected cases and provides revised treatment by medical experts from various specialties and institutions.
Mass general covid 19 treatment guideline july012020Adiel Ojeda
This document provides guidance for clinicians at Massachusetts General Hospital (MGH) on the treatment of COVID-19. It summarizes recommended diagnostic testing and risk stratification for hospitalized patients. It also provides guidance on therapeutic considerations, including anti-infectives, cardiovascular medications, antithrombotics, and COVID-19 specific treatments such as remdesivir. The document is regularly updated as new data emerges on the management of COVID-19.
Paul E. Sax, MD prepared useful Practice Aids pertaining to COVID-19 for this CME/MOC/CNE/CPE activity titled "Coronavirus Disease 2019 (COVID-19): Need-to-Know Information and Practical Guidance for Healthcare Professionals on the Front Lines of Patient Care." For the full presentation, monograph, complete CME/MOC/CNE/CPE information, and to apply for credit, please visit us at https://bit.ly/3gBvfOw. CME/MOC/CNE/CPE credit will be available until July 23, 2021.
Mgh COVID-19 Treatment Guidance March 17, 2020Ken Yale
This document was developed by members of the ID division at MGH in conjunction with pharmacy, radiology, and other medicine divisions to provide guidance to frontline clinicians caring for patients with COVID-19. This document covers potential off-label and/or experimental use of medications and immunosuppression management for transplant patients as well as a suggested laboratory work up. It does NOT cover recommendations for infection control, PPE, management of hypoxemia or other complications in patients with COVID-19. This is a living document that will be updated in real time as more data emerge.
This document provides guidance from Massachusetts General Hospital on potential treatment options for COVID-19, including both approved and experimental therapies. It recommends supportive care for mild cases but considers investigational antivirals like remdesivir for moderate or severe cases. It also outlines monitoring and treatment guidance for special populations, potential side effects of therapies, and criteria for considering treatments targeting cytokine release syndrome. The guidance is intended to be updated frequently as new data emerges on COVID-19 treatment.
This document provides guidance from Massachusetts General Hospital on potential treatment options for COVID-19, including both approved and experimental therapies. It recommends supportive care for mild cases but considers investigational antivirals like remdesivir for moderate or severe cases. It also outlines monitoring and treatment guidance for special populations, potential side effects of therapies, and criteria for considering treatments targeting cytokine release syndrome. The guidance is intended to be updated frequently as new data emerges on COVID-19 treatment.
The document discusses Sars-Cov-2 and Covid-19. It provides statistics on cases globally and in India. It describes the virus, including that it is a coronavirus similar to SARS. It discusses WHO declaring Covid-19 a public health emergency. It outlines symptoms, high risk groups, diagnosis methods, clinical management including drugs like hydroxychloroquine and remdesivir, and steps to take if experiencing symptoms.
This document discusses management of multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19. MIS-C is a rare condition that can occur in children 2-6 weeks after SARS-CoV-2 infection. It involves inflammation of multiple organs and can cause symptoms like fever, rash, gastrointestinal issues, and cardiac involvement. The document outlines the epidemiology, pathophysiology, clinical manifestations, diagnostic evaluation, treatment including medications like IVIG and steroids, and follow-up care of MIS-C. Treatment is aimed at reducing inflammation and involves IVIG, steroids, aspirin, and enoxaparin in severe cases.
The document discusses clinical presentation and management of pediatric COVID-19 in India. It outlines that less than 12% of COVID cases in India are children under 20, with 3-4% under 10. Children most commonly present asymptomatically or with mild illness. Management involves home isolation and supportive care for mild cases. Moderate cases require hospital admission while severe cases should be admitted to the ICU. Complications like MIS-C (multisystem inflammatory syndrome in children) require specialized treatment and monitoring. The document provides detailed guidelines on evaluating and managing neonatal COVID-19, acute COVID-19, post-COVID conditions and MIS-C in children according to severity and symptoms.
This document provides information on various drug treatments for COVID-19, including antivirals (remdesivir, lopinavir/ritonavir, ribavirin), anticoagulants, immunomodulators (tocilizumab, interferons), and investigational drugs (bevacizumab, eculizumab, fingolimod). Dosing guidelines are presented for many of the drugs. Clinical trials are mentioned for bevacizumab and interferon-beta treatment of COVID-19. A variety of adverse effects are briefly outlined.
This document provides information on various drug treatments for COVID-19, including antivirals (remdesivir, lopinavir/ritonavir, favipiravir), anticoagulants, immunomodulators (tocilizumab, interferons), and investigational drugs (bevacizumab, eculizumab, fingolimod). It discusses dosages, administration methods, potential side effects and contraindications for these drugs. Clinical trials are evaluating some of these treatments, but more data is still needed to determine their efficacy against COVID-19. The document is a reference for healthcare providers on potential drug therapy options for managing COVID-19 patients.
This is a lecture I gave for the Upstate Nurse Practitioner's Association September 29, 2020. Parts may no longer be valid, because the topic is changing so rapidly. I did the best I could.
Origin of virus??
Transmission of virus??
First case in Wuhan?
Aerosol transmission? Fomites? Re- infection/ reactivation
Vaccine/ safety & efficacy/ antibody test/ community transmission?
Case definition?
Pathophysiology/ pathology
Cardiovascular manifestations/ risk?
ACS
Role of aspirin
Low platelet in covid-19
Anti-coagulants
ACEI/ARB/ARNI
Diuretics
Clinical features
High risk groups
Antibiotics
HCQ& Lopinavir, Ritonavir
Anti viral drugs- remdisivir/ favipiravir
Biological therapy- tocilizumab
Convalescent plasma therapy
Systemic steroids
Ivermectin
NSAIDs
Respiratory failure
Other management in covid 19- fluid/ nebulization
Chemoprophylaxis
Bronchial asthma
Anti diabetics
This document provides guidelines for the clinical management of COVID-19. It notes that while most cases are mild, approximately 14% of cases develop severe disease requiring hospitalization and oxygen support, and 5% require intensive care. Older age and comorbidities increase the risk of severe outcomes. For mild cases, isolation and symptomatic treatment is recommended, while severe cases may require oxygen therapy, fluid management, antimicrobials, and advanced support like mechanical ventilation for acute respiratory distress syndrome or vasopressors for septic shock. Testing for COVID-19 involves respiratory samples, and local protocols should be followed for patient isolation and discharge.
Management of Mild to Moderate COVID cases -VSGH ProtocolNaveen Kumar
The document discusses clinical staging and management of COVID-19 patients. It proposes a 4 stage clinical staging system: Stage I (asymptomatic to mild symptoms), Stage IIA (moderate pulmonary involvement without hypoxia), Stage IIB (moderate pulmonary involvement with hypoxia), Stage III (severe systemic hyperinflammation). Treatment protocols are outlined for each stage, including recommended investigations, medications, and criteria for transfer to higher levels of care. Comorbid conditions are also factored into the clinical staging and management guidelines.
The document summarizes research on herbs that can act as immune boosters against COVID-19. It discusses several herbs in detail, including their active components and mechanisms of action. Tinospora cordifolia, Azadirachta indica, and Zingiber officinale are highlighted as herbs with anti-viral properties that can boost immunity. For each herb, the document outlines the chemical constituents demonstrated to inhibit COVID-19 proteins and support immune function.
This document provides guidelines for the treatment of COVID-19 and its complications. It defines suspected, probable and confirmed COVID-19 cases. It describes the clinical categorization of cases and recommendations for investigations and medications like remdesivir, tocilizumab, baricitinib, monoclonal antibodies, and guidelines for multisystem inflammatory syndrome in children and adults. It also discusses COVID-associated mucormycosis and its treatment involving antifungal therapy, surgical debridement, and monitoring for response.
1) Diabetes is a major risk factor for severe illness from COVID-19, with studies showing people with diabetes are at higher risk of mortality.
2) Guidelines recommend people with diabetes who get COVID-19 closely monitor their blood glucose and follow sick day rules for diabetes. They may need adjusted diabetes medication dosages.
3) Some evidence suggests chloroquine or hydroxychloroquine may help treat COVID-19, but more research is still needed. Ibuprofen use is not recommended due to theoretical risks, and acetaminophen is preferred instead.
Essential information on covid 19 vaccinationsPathKind Labs
The document provides information on Covid-19 vaccination and vaccine development. It discusses how available genome sequence allowed for rapid diagnostic and vaccine development. Multiple vaccine platforms are highlighted, including mRNA, viral vectors, and protein-based. Operation Warp Speed is aiming to deliver hundreds of millions of doses of leading candidates by January 2021. Challenges of vaccine development include safety testing and failure is common. Long-term safety and efficacy data is still needed.
Similar to Mohp Egyptian protocol for covid19 november 2020 (20)
Rate Controlled Drug Delivery Systems, Activation Modulated Drug Delivery Systems, Mechanically activated, pH activated, Enzyme activated, Osmotic activated Drug Delivery Systems, Feedback regulated Drug Delivery Systems systems are discussed here.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - ...rightmanforbloodline
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
TEST BANK FOR Health Assessment in Nursing 7th Edition by Weber Chapters 1 - 34.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
https://cansa.org.za/who-cares-for-cancer-patients-caregivers/
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
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1. Version 1.4 / November 2020 1
Management Protocol
in Hospitals
C VID-19
Ministry of Health and Population, Egypt
Management protocol for COVID-19
Patients
Version 1.4 / November 2020
Management Protocol for
P a t i e n t s
3. Version 1.4 / November 2020 3
Table of contents
Item
Page
Number
Triage Protocol
4
Management Protocol
6
Gastrointestinal Manifestations
of COVID-19 15
Anticoagulation of COVID-19
Patients 16
High-Velocity Nasal Insufflation
17
Post-acute COVID Syndrome
18
Prevention and Control of COVID-19 Inside
Health Care Facilities 20
Antibiotics in Covid-19 25
List of Editors 26
4. Version 1.4 / November 20204
1st
Step: Triage
Case definition + severity assessment
Suspect Case Definition
A) Clinical AND epidemiological criteria: OR: B
Patient with severe acute
respiratory illness (SARI: acute
respiratory infection with history
of fever or measured fever ≥ 38°C
and a cough; onset within last 10
days; requires hospitalization)
-Acute onset of fever and cough OR
-≥ 3 of the followings: fever, cough, sore
throat, coryza, general weakness/fatigue,
headache, myalgia, dyspnea, anorexia/nausea/
vomiting, diarrhea, altered mental status
And 1 of the followings within 14 days of
symptom onset:
Residing or
working in an
area with high
risk of
transmission*
Working in
a healthcare
setting
Residing or
travel to an area
with community
transmission
*Closed residential settings, humanitarian settings such as camp and camp-like settings for displaced persons.
NB: Minimal role for the epidemiological criteria during the period of community spread
Probable Case
A patient who meets clinical criteria AND is a contact of a probable or confirmed case,
or epidemiologically linked to a cluster with at least one confirmed case.
OR
Suspect case with chest imaging showing findings suggestive of COVID-19 disease*
OR
Recent onset of loss of smell or taste in the absence of any other identified cause
OR
Unexplained death in an adult with respiratory distress who was a contact of a probable
or confirmed case or epidemiologically linked to a cluster with at least 1 confirmed case
*Hazy opacities with peripheral and lower lung distribution on chest radiography; multiple bilateral ground
glass opacities with peripheral and lower lung distribution on chest CT; or thickened pleural lines, B lines, or
consolidative patterns on lung ultrasound.
Confirmed Case
A person with laboratory confirmation* of COVID-19 infection, irrespective of clinical signs
and symptoms
*Molecular testing(PCR) with deep nasal swab is the current test of choice for the diagnosis of acute COVID-19
infection
During seasonal flu period, clinical differentiation between influenza and COVID 19 is difficult.
Swab for influenza A &B may help in early differentiation.
Triage Protocol
5. Version 1.4 / November 2020 5
Severity assessment
Suspected case
-PCR to confirm the diagnosis *
-Assess disease severity
(clinical, lab & imaging)
-Mild symptoms
-Normal imaging
Imaging: +ve
SpO2
≥ 92%
SpO2
< 92%, PaO2
/FiO2
<
300,
respiratory rate > 30
breaths/min, or
lung infiltrates > 50%
Respiratory failure,
septic shock, and/or
multiorgan
dysfunction
Admit to
Intensive care
Admit to
Intermediate Care
Hospitals admission
COVID area
Home isolation &
close follow up
If possible, < 65 years
old & no uncontrolled
comorbidity
Critical illnessSevere
Moderate
Mild Risk Factor
YesNo
In severe and critically ill patients, if-ve 1st
PCR, repeat within 48 hours, negative case is considered after 2 –ve
consecutive RT-PCR results from respiratory samples tested at least 1 day apart.
NB: Unstable patient who don’t meet the suspected criteria should receive 1st
aid therapy in non-COVID area
before referral to general hospital.+ Risk factors include, old age > 60 years, uncontrolled comorbidity as hyperten-
sion, DM, ……. or Social un applicable to home isolation.
All persons with suspected, probable or confirmed COVID-19 should be immediately
isolated to contain the virus transmission.
Triage Protocol
6. Version 1.4 / November 20206
Time is an important issueTime is an important issue in management of COVID-19. Before day 12( stage of viral
load), Antiviral drug is essential. After day 12, the role of antiviral declines with
augmentation for the role of anti-inflammatory, immune-modulators and Supportive drugs
(stage of hyper-immune state).
Potential antiviral drugs under evaluation for the treatment of COVID-19 include:Potential antiviral drugs under evaluation for the treatment of COVID-19 include:
- Hydroxy ChloroquineHydroxy Chloroquine 400mg/ 12 hours 1st
day followed by 200 mg/12 hours for 6 days,
- IvermectinIvermectin 6 mg (36 mg on day 0 -3-6),
- FavipiravirFavipiravir 1600 twice daily first day then 600 mg twice daily,
- RemdesivirRemdesivir 200 mg IV on day 1, followed by 100 mg IV daily for high risk population for 5
days that could be extended to 10 days if the response is unsatisfactory or
- Lopinavir/RitonavirLopinavir/Ritonavir 200/ 50 mg 2 tablets PO BID
- Monoclonal antibodiesMonoclonal antibodies: early testing in blocking SARS-CoV-2.
- Convalescent plasmaConvalescent plasma: for impending severely ill after counseling the scientific committee
2nd
Step: Management
Home isolation and symptomatic treatmentsymptomatic treatment (eg, antipyretics for fever, adequate nutrition,
appropriate rehydration).
Educate the patientsEducate the patients on signs/symptoms of complications that, if developed, should prompt
pursuit of urgent care.
There are insufficient data to recommend either with or against any antiviral or im-
mune-based therapy in patients with COVID-19 who have mild illness.
Mild illness
All patients with symptomatic COVID-19 and
risk factors for severe disease should be closely
monitored. The clinical course may rapidly
progress in some patients.
Antibiotics are not recommended to prevent
bacterial infection in mild patients. Administer
empiric antibiotics if bacterial
pneumonia/sepsis strongly suspected; re-evaluate
daily.
In non-hospitalized patients, do not initiate
therapeutic anticoagulants or antiplatelet
unless other indications exist.
No harmful effect for administration of vitamin
C or D or Zinc or Lactoferrin within the required
daily dose.
Check Every Patient For Risk
Factors
. Age 65 years
. SpO2 < 92%
. Heart Rate ≥110
. Respiratory Rate ≥ 25 /min.
. Neutrophil / lymphocyte ratio on
CBC ≥ 3.1
. Uncontrolled Comorbidities
. On Immunosuppressive or
chemotherapy drug
. Pregnancy
. Active Malignancy
. Obesity (BM>40)
Management Protocol
7. Version 1.4 / November 2020 7
All patients with symptomatic COVID-19 and risk factors for severe disease should
be closely monitored. In some patients, the clinical course may rapidly progress.
Flu or COVID-19
IS IT A FLU OR COVID-19?IS IT A FLU OR COVID-19?
SYMPTOM FLU COVID-19
FEVER
FATIGUE
COUGH
SORE THROAT
HEADACHES
RUNNY NOSE
SHORTNESS OF BREATH
BODY ACHES
DIARRHEA AND/OR
VOMITING
ONSET 1-4 days after infection About 5 days after infection but can range
from 2-14 days
LOSS OF TASTE AND/OR
SMELL
RED, SWOLLEN EYES
SKIN RASHES
8. Version 1.4 / November 20208
Mild Case
Symptomatic case
with lymphopenia or leucopenia
with no radiological signs for pneumonia
1. Age 65
2. Temperature > 38
3. SaO2
≤ 92%
4. Heart Rate ≥ 110
5. Respiratory Rate ≥ 25 /min.
6. Neutrophil / lymphocyte ratio
on CBC ≥ 3.1
7. Uncontrolled Comorbidities
8. Immunosuppressive Drug
9. Pregnancy
10. Active Malignancy
11. On Chemotherapy
12. Obesity (BMI>40)
Check for
Any YESAll No
Age ≥ 65
OR
Age < 65
AND
• Strict Home Isolation (Symptomatic
Treatment)
• Follow and use personal protective guide
equipment
• If any deterioration occurs, back to
hospital
NB: Paracetamol is the preferred antipyretic
If more than 3
symptoms admit
Treatment
- Hydroxychloroquine (400 mg twice in
first day then 200 mg twice for 6 days)
- Zinc 50mg daily
- Acelylcysteine 200 mg t.d.s.
- lactoferrin one sachet twice daily
- Vitamin C 1 gm daily
OR Ivermectin 6 mg (36 mg on day 0
-3-6)
OR Favipiravir 1600 TWICE daily first
day then 600 mg twice daily
+
9. Version 1.4 / November 2020 9
Anti-virals
Hydroxychloroquine +
Ivermectin or
Lopinavir/Ritonavir
or
Remdesivir for high
risk population with
SaO2 < 92
Immune-modulators
Anti-inflammatory
Anti-coagulation
Steroids
(if patient has severe
dyspnea) RR>24 or CT
scan showing rapid
deterioration
Dexamethasone 6 mg
or its oral equivalent
Prophylactic
anticoagulation if
D-Dimer between
500 -1000
Therapeutic
anti-coagulation if
D-dimer > 1000
Patient has pneumonia manifestations on radiology associated with symptoms &/Or
leucopenia or lymphopenia.
Moderate Case
Anti-virals
anticoagulation if
D-Dimer between
500 -1000
Therapeutic
anti-coagulation if
D-dimer > 1000
Or if severe
hypoxia
Anti-inflammatory
Convalescent
plasma
Steroids
(Dexamethasone 6
mg or methyl
prednisolone (1 mg /
kg /24 hours)
Tocilizumab
4-8 mg/kg/day for 2
doses 12 to 24 hours
apart after failure of
steroid therapy to
improve the case for
24 hours
Before day 12
(under clinical trial)
(after scientific
committee
approval)
RR > 30, SaO2 < 92 at room air, PaO2
/FiO2
ratio < 300, Chest radiology showing more than
50% lesion or progressive lesion within 24 to 48 hrs.
Severe cases
Remdesivir
or
Lopinavir/
Ritonavir
Anti-coagulant
Prophylactic
Admit to Intermediate Care
10. Version 1.4 / November 202010
RR > 30, Sa02 < 92 at room air, PaO2/FiO2 ratio < 300, Chest radiology showing more than
50% lesion or progressive lesion within 24 to 48 hrs. Critically ill if SaO2 <92, or RR>30, or
PaO2/FiO2 ratio < 200 despite Oxygen Therapy.
Critically ill patients
Admit to Intensive care
Anti-virals
Remdesivir
or
Lopinavir/
Ritonavir
Anti-coagulant Anti-inflammatory
Therapeutic
anti-coagulation
Steroids
(Methyl prednisolone 2mg /kg or its
equivalent)
Tocilizumab
4-8 mg/kg/day for 2 doses 12 to 24 hours
apart after failure of steroid therapy to
improve the case for 24 hours
Tocilizumab
4-8mg/kg/dose
2 doses
Early Block
the storm
if steroids
failed
Antiviral
Drugs As is In
Severe case
Steroids
Methylpred-
nisolone
1-2 mg/kg/d
Anti-
Coagulation
Enoxaparine
1 mg/kg BID
Prone
Awake or
ventilated
Avoid
Hypoxia
O2/ NIV/
HFNC/IMV
Add
Antibiotics
As per
protocol
1 mg for non
ventilated
and 2 mg for
ventilated
Consider
D-dimer level
as a guide
Improves
V/Q matching
and survival
Don’t wait
too much for
any type of
support Keep
plateau<30
High flow nasal oxygen is an important modality in the early management of critically ill patients.
11. Version 1.4 / November 2020 11
(HFNC):
Conscious patients with minimal secretions.
Hypoxia SpO2 < 90% on oxygen. Or PaCO2 >40 mmHg provided pH 7.3 and above.
NIV trial shall be short with ABG 30 minutes apart.
Any deterioration in blood gases from baseline or oxygen saturation or consciousness
level shift to IMV.
CPAP gradually increased from 5-10 cmH2O.
Pressure support from 10-15 cm H2O.
HFNC can be alternative to NIV.
Use PPE specially goggles during intubation and avoid bagging.
Indications:
Failed NIV or not available or not practical.
PaO2 < 60 mmhg despite oxygen supplementation.
Progressive Hypercapnia.
Respiratory acidosis (PH < 7.30).
Progressive or refractory septic shock.
Disturbed consciousness level (GCS ≤ 8) or deterioration in consciousness level from
baseline
Non Invasive Ventilation or High Flow Nasal Cannula
Invasive Mechanical Ventilation:
12. Version 1.4 / November 202012
COVID-19 PNEUMONIA (type L & type H)
Type L Type H
Type L
Low elastance
Low VA/Q mismatch
Low lung weight
Low recruitability High elastance
High RL shunt
High lung weight
High recruitability
Type H
Non invasive
support
Early intubation Late intubation
HFNC
CPAP
NIV
PEEP (5-10 cmH2O)
Sedation
NMBA
Higher PEEP(10-15
cmH2O)
Prone
(ECMO)
STOP STOP STOP
Lung Damage Progression
(Virus + P-SILI)
Inspiratory effort - edema
Type L and Type H patients are best identified by CT scan and are affected by different
Pathophysiological mechanisms. If CT not available, definition could be used as surrogates:
Respiratory system elastance and recruitability.
Understanding the correct pathophysiology is crucial to establishing the basis for appropriate
treatment.
13. Version 1.4 / November 2020 13
Plateau
P<30 cmH2
O
Incremental
PEEP
Shift to ARDSNet protocol if neededStep 2:
- ARDSNet protocol:
LOW TV
6-4 ml/kg Driving
P<15 cmH2
O
Initiation of Invasive Mechanical VentilationStep 1:
VCV
TV 8 ml/kg
PEEP 5 cmH2O
Plateau
Pressure
Less than 30
cmH2O
Sat >93
Keep and Watch
Less than 30
Sat<93
Increase PEEP
to 10
More than 30
ARDSnet
protocol
Inspiratory Pause for 1 second
IF PLATEAU ABOVE 30 CMH2O
14. Version 1.4 / November 202014
Assessment of respiratory support outcomeStep 3:
Improved
Weaning of
respiratory
support
Assess
ABGs, Clinical
Radiological
Stationary
Continue
respiratory
support as
needed
*Criteria for VV ECMO: Age below 55, mechanical ventilation duration
less than 7 days, no comorbidities, preserved conscious level,
PaO2/FiO2 <100 despite prone RESPscore >0.
Expert opinion is needed and depends on availability.
Deteriorating
Criteria for
ECMO*
Start with tidal volume of 6 ml/Kg to keep plateau pressure on volume controlled
ventilation (VCV) below 30 cmH2O, decrease to 4 ml/kg if the plateau remain higher
than 30 allow permissive hypercapnia so long the pH is above 7.3
compensate by increasing respiratory rate up to 30 breath/ minute. Consider heavy
sedation and paralysis. If pressures are high or any evidence of barotrauma shift to
pressure controlled ventilation and be cautious about low tidal volume alarms for
fear of unnoticed endotracheal tube obstruction. Consider ECMO
early if eligible. Increase PEEP gradually if the patient remains hypoxic
according to FIO2 level to keep driving pressure < 15cmH2O. NEVER FORGET
PRONE POSITION.
15. Version 1.4 / November 2020 15
- Gastrointestinal (GI) symptoms are seen in patients with COVID-19. The preva-
lence could be as high as 50%, but most studies show ranges from 16% to 33%
- Some patients with COVID-19 have presented with isolated GI symptoms that may
precede the development of respiratory symptoms
- It is important to note that medications used for COVID-19 may be associated with
GI symptoms as well.
- Approximately 50% of patients with coronavirus disease 2019 (COVID-19) have
detectable viral RNA in the stool
- Loss of appetite or anorexia is the most commonly reported symptom.
- Diarrhea was the second most common symptom.
- Other digestive manifestations include nausea or vomiting and abdominal pain.
- Dysgeusia has also been reported, often in conjunction with anosmia.
- Currently, management of GI symptoms in patients with COVID-19 is mainly sup-
portive.
- Treatment should be individualized according to the patient’s symptoms, underly-
ing comorbidities and COVID-19–associated complications.
- Oral or intravenous hydration
- The antidiarrheal agent loperamide can be used in an initial dose of 4 mg and with
a maximum daily dose of 16 mg in patients without fever, bloody stools, or risk fac-
tors for C. difficile infection
- Antiemetic drugs can often help relieve symptoms.
Gastrointestinal Manifestations of COVID-19
Gastrointestinal Manifestations
of COVID-19
16. Version 1.4 / November 202016
Yes No
Anticoagulation in COVID-19 Patients
the patient clinically indicated
for hospitalization
Is he/she critically ill
No Yes
Prophylactic dose
Higher than standard
dose
0.5 mg/kg/m
Therapeutic dose
Consider also therapeutic
anticoagulation for
patients with high
clinical susceptibility
of VTE and those with
Severe hypoxia not
explained by the chest CT
findings
The preferred agents
are LMWH and
Fondaparinux unless
contraindicated
In renal patients, heparin
is the preferred agent.
If the dose of LMWH
exceeds 150 twice daily
use heparin instead.
Anticoagulation in COVID-19
Patients
17. Version 1.4 / November 2020 17
High Velocity Nasal Insufflation
(Hi-VNI)
• Hi-VNI is a first-line therapy for COVID-19 patients who are struggling to
breathe.
• Hi-VNI Technology and WOB reduction: The fact that small-bore
cannulas reduce the time required to fully purge the upper airway dead space3 is
significant because as the respiratory rate of a patient in respiratory distress
increases, the time between breaths decreases. By quickly clearing the upper
airway dead space of end-expiratory gas rich in CO2, Hi-VNI Technology helps
patients breathe directly from a fresh gas reservoir and thereby reduces their
WOB.
0
70
60
50
40
30
20
10
10 20 30 40 50 60
HVNI
HFNC
Volumetric Flow (L.min-1
)
Velocity(m.sec-1
)
High-Velocity Nasal Insufflation
18. Version 1.4 / November 202018
Post- acute COVID syndrome
(long COVID)
Definition & incidence:
In the absence of agreed definition, it may be defined as “patients not
recovering for several weeks or months following the start of symptoms that
were suggestive of COVID, whether patients were tested or not.” It may
extend beyond 3 weeks from the onset of first symptoms up to 3 months,
sometimes occurring after a relatively mild acute illness. If symptoms are
extending beyond 3 months, it is termed Chronic COVID.
In short, “Despite their illness being ‘over,’ they are having a lot of
trouble returning to normal life.” It occurs in around 10% of patients.
Patients can be divided into those who may have serious sequelae (such as
thromboembolic complications) and those with a non-specific clinical pic-
ture, often dominated by fatigue and breathlessness. One last group of
covid-19 patients whose acute illness required intensive care management.
Management:
Specialist referral may be indicated based on clinical finding, for example:
Respiratory: if suspected pulmonary embolism, severe pneumonia.
Cardiology: if suspected myocardi-
al infarction, pericarditis, myocarditis or new heart failure.
Neurology: if suspected neurovascular or acute neurological event.
Pulmonary rehabilitation may be indicated if patient has persistent
breathlessness.
Post-acute COVID syndrome
19. Version 1.4 / November 2020 19
Medical management:
Symptomatic: treating fever by paracetamol & NSAIDs
Management of co-morbidities including diabetes, hypertension, kidney
diseases & ischemic heart diseases
Listening and empathy
Consider antibiotics for secondary infection
Treat specific complication as indicated
Self-management:
Daily pulse oximetry.
Attention to general health like:
Good diet
Good sleep hygiene
Quitting smoking
Limiting alcohol
limiting caffeine
Rest and relaxation.
Self-pacing and gradual increase exercise.
Set achievable targets.
Post-acute COVID syndrome
20. Version 1.4 / November 202020
Prevention and Control of Transmission
of COVID-19 inside
Health Care Facilities
21. Version 1.4 / November 2020 21
General Recommendations for
Prevention and Control of Transmission of COVID-19
inside Health Care Facilities
1-Daily screening of health care workers and patients before entering the
health care facility (HCF) based on clinical signs (fever, respiratory symp-
toms…….).
2- Any health care worker appears/reports to be diseased should be segregated
until proper examination/management.
3- All health care workers are required to wear surgical masks during work
hours (during existence in HCFs).
4- Minimal number of health care workers should be present at the same time
in patient’s units to keep social distancing
5- Restrict unneeded movements between departments.
6- Suspected or confirmed cases should take a separate route from other pa-
tients beginning from the facility entrance (Triage area), and all facility sec-
tions should follow the same separation.
7- Suspected or confirmed cases should be isolated in a well- ventilated isola-
tion room.
8- Standard precaution should be applied :
• Hand hygiene
• Cough etiquette.
• Personal protective equipment.
• Clean and disinfected Environmental surfaces.
• Sterile instrument and devices
• Sharp safety.
• Isolation transmitted precaution.
• Safe injection practices.
General Recommendations
22. Version 1.4 / November 202022
Recommendations
According To The Type Of Procedure
1) Non Aerosol Generating Procedures (AGPs)
• Standard precautions.
• Isolation precautions taken to prevent the spread of infection by spray and
contact.
• The need to adhere to washing hands before donning personal protective
equipment and immediately upon doffing.
• The necessity to adhere to donning personal protective equipment as
follows:
1- Surgical mask.
2- Protect your eyes by wearing goggles or face shield.
3- Long-sleeve medical gowns (gown) clean, non-sterile or sterile, according to
type of technique.
4- Clean or sterile gloves depending on type of technique.
5- Health care worker are not required to wear protective boots and protective
suits during routine care of cases.
6- Extended use of surgical masks, gowns, eye protectors, and face shields can
be applied while caring for COVID-19 patients in the event of a shortage of
personal 2 protective equipment for the length of the work shift (preferably
not more than six hours).
7- Always remember not to touch the eyes, mouth or nose with contaminated
hands or used gloves (wash your hands or rub using alcohol when touch any
environmental surface).
8- Always clean and disinfect surfaces .
Medical Recommendations
23. Version 1.4 / November 2020 23
2) Procedures that include (AGPs):
• Tracheal intubation .
• Non-invasive ventilation e.g. BiPAP, CPAP.
• Tracheotomy.
• Cardiopulmonary resuscitation.
• Manual ventilation before intubation or bronchoscopy.
• Sputum induction by using nebulizer hypertonic saline.
The health care workers must adhere to the following:
• Standard precautions.
• Perform procedures inside a well-ventilated room.
• Follow the isolation precautions taken to prevent the spread of infection
through air and contact.
• The need to adhere to washing hands before donning personal protective
equipment and immediately upon doffing them.
Medical Recommendations
24. Version 1.4 / November 202024
Donning personal protective equipment as follows:
- A high-performance respiratory masks such as N95 or FFP2 or equivalent,
with the need to conduct a tightness test to ensure that there is no leakage.
- Protect your eyes by wearing goggles or face shield.
- Long-sleeve medical gowns (gown) clean, non-sterile or sterile according to
the procedure.
- Clean or sterile gloves depending on type of technique.
- The extended use of a mask, medical gown, eye goggles, or face shield
(Extended use) can be applied while caring for patients with COVID-19 in the
event of a lack of personal protective equipment and for the length of the work
shift (preferably no more than six hours).
- Care must be taken not to touch the eyes, mouth or nose with contaminated
bare hands or using gloves (wash your hands or rub using alcohol when touch
any environmental surface).
- Always clean and disinfect surfaces regularly.
Personal Recommendations
25. Version 1.4 / November 2020 25
Indications:
- Rapid development of consolidation pattern.
- Development of lobar consolidation.
- Leukocytosis with absolute neutrophilia.
- Reappearance of fever after afebrile days.
- Increased CRP with improved other markers as ferritin.
- Procalcitonin is highly specific.
ANTIBIOTICS IN COVID-19
Low-risk inpatients:
- Combination therapy:
β-lactam (eg, ceftriaxone, or cefotaxime) plus either a macrolide
(eg, azithromycin or clarithromycin) or doxycycline.
- Monotherapy:
Respiratory fluoroquinolone (eg, levofloxacin or moxifloxacin)
High-risk inpatients:
- β-lactam plus a macrolide or fluoroquinolone is recommended.
ANTIBIOTICS IN COVID-19
26. Version 1.4 / November 202026
Treatment Protocol
Revised By:
NAME AFFILIATION
Hossam Hosny Masoud
Professor of Chest Diseases. Head of
Pulmonary Hypertension Unit, Faculty of
Medicine, Cairo University
Gehan Elassal
Professor of Chest Diseases, faculty of
Medicine , Ain Shams University
Dr. Mohamed Hassany
Fellow of Infectious Diseases and Endemic
Hepatogastroentrology , National Hepatology
and Tropical Medicine Research Institute
Dr. Ahmed Shawky
Professor of Chest Diseases, faculty of
Medicine , Tanta University
Dr. Mohamed Abdel Hakim
Professor of Chest Diseases, faculty of
Medicine , Cairo University
Dr. Samy Zaky
Professor of Hepatogastroentrology and
Infectious Diseases, faculty of Medicine ,
Al Azhar University
Dr. Amin Abdel Baki
Consultant and Head of Hepatology ,
Gastroentrology and Infectious Diseases
Department. National Hepatology and Tropical
Medicine Research Institute
Dr. Akram Abdelbary
Professor of Critical care Medicine , Cairo
University
Chairman elect of ELSO SWAAC chapter
Dr. Ahmed Said
Lecturer of Critical care Medicine , faculty of
Medicine, Cairo University
Dr. Khaled Taema
Assistant Professor of Critical care Medicine ,
faculty of Medicine, Cairo University
Dr. Noha Asem
Minister”s Counselor for Research and Health
Development
Chairman of Research Ethics Committee
MOHP, Lecturer of Public Health , Cairo
University
27. Version 1.4 / November 2020 27
NAME AFFILIATION
Dr. Ehab Kamal
Minister of Health Assistant for Continuous
Medical Education
General Director of Fever hospitals Directorate
Dr. Wagdy Amin Director General for Chest Diseases , MOHP
Dr. Ehab Attia General Director of IPC Department , MOHP
Dr. Hamdy Ibrahim
Infectious Diseases Consultant , National
Hepatology and Tropical Medicine Research
Institute
Dr. Alaa Eid Head of Preventive Medical Sector MOHP
Treatment Protocol
Revised By:
28. Version 1.4 / November 202028
Ministry of Health and Population
Egypt / November 2020