The document provides information on clinical pharmacy updates regarding the COVID-19 pandemic in Ethiopia. It discusses surveillance methods, case definitions, contact tracing protocols, laboratory testing, and case management approaches. Surveillance involves rumor investigation and verification. Contact tracing identifies close and casual contacts who are actively or passively monitored. Laboratory testing uses RT-PCR and contact tracing is initiated for suspected and confirmed cases. Case management prioritizes supportive care and uses oxygen therapy, fluid management, and immune-modulators like chloroquine and azithromycin.
Corna virus detail And corona virus in pakistanEmaan Uppal
The 2019–20 coronavirus pandemic is a pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was first identified in Wuhan, Hubei, China in December 2019Avoiding close contact with sick individuals; frequently washing hands with soap and water; not touching the eyes, nose, or mouth with unwashed hands; and practicing good respiratory hygiene.
CORONA VIRUS & it’s effect on daily lifeDanao Maibam
The world is facing a challenging. An essential key to combat COVID-19 is to be educated and be familiar to the disease itself and to plan strategies that will help the world win the fight against the crisis.
Corna virus detail And corona virus in pakistanEmaan Uppal
The 2019–20 coronavirus pandemic is a pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was first identified in Wuhan, Hubei, China in December 2019Avoiding close contact with sick individuals; frequently washing hands with soap and water; not touching the eyes, nose, or mouth with unwashed hands; and practicing good respiratory hygiene.
CORONA VIRUS & it’s effect on daily lifeDanao Maibam
The world is facing a challenging. An essential key to combat COVID-19 is to be educated and be familiar to the disease itself and to plan strategies that will help the world win the fight against the crisis.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
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Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
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.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
3. Outline
• Introduction
• Background
• Surveillance
• COVID-19 Emergency Operation Center
Contact Tracing Protocol
• Laboratory testing for COVID-19
• Case Management (TRIAGE and
MANAGEMENT of SUSPECT and
CONFIRMED cases)
• Reference
3
4. Introduction
• The covid-19 pandemic is causing huge stress
on the health care system of all countries in the
world. The impact is both social and economic. It
is observed early interventions with optimal
political commitment and community
mobilization to flatten the curve averting
occurrence of many cases and deaths.
4
5. Cont’d
• Ethiopia, being one of the developing countries
trying to address the diverse needs of its people,
is currently at the verge of the epidemic. The
government is currently showing high
commitment to contain the epidemic before it
causes significant damage to the community.
Case identification, contact tracing, isolation and
quarantine are the actions being taken to
contain the spread the disease in addition to the
preventive measures put in place mainly
promoting social distancing and sanitary
measures. 5
6. Background
• Severe acute respiratory infection remain one of
the leading causes mortality around the world.
The recent pandemic caused by an RNA virus
that belongs to the of family of CORONA (Latin
Crown, from the structure of the virus under
electron microscope) virus is a challenge for
both developed and underdeveloped nations.
6
7. Cont’d
• The new CORONA identified as the cause of
acute respiratory disease in humans since the
end of December 2019(2019-nCOV), later
labeled as SARS-COV2 by World Health
Organization is a different strain of CORONA
virus from SARS and MERS CORONA viruses.
The difference is not limited to genetic make-up
only but in the clinical presentations, case fatality
and rate of spread across the globe. The
disease caused by this virus is known as
COVID-19.
7
8. Cont’d
• First seen in Wuhan, China, the disease has
been recognized as global health emergency by
World Health Organization after cases had
started to be seen outside China in less than two
month period.
• Physical contact and respiratory routes are the
two most important well established of
transmission of the virus. Poor hand hygiene
practice, overcrowding, and close physical
contacts like hand shaking contributes for the
fast spread of the virus with in short period of
time.
8
9. Cont’d
• Experience from China where the disease
is first recognized shows educating the
public about the nature of the disease and
the route of transmission, restricting
mobility of individuals with in the border
and across the borders is proven to be in
preventing transmission.
9
11. Suspected case
A. A person presenting with fever (>38c) or history of
fever and symptoms of respiratory illness e.g.
cough, difficulty in breathing AND a history of travel
or a residence in a country/area or territory local
transmission of COVID-19 disease during the 14
days prior to symptom onset. OR
B. A person with fever (>38c) or history of fever and
symptoms of respiratory tract illness e.g. cough,
difficulty in breathing AND in the last 14 days
before symptom onset, close contact with a person
who is under investigation or confirmed for COVID-
19 OR
11
12. Cont’d
C. A person with fever (>38c) or history of fever
and symptoms of respiratory illness e.g. cough,
difficulty in breathing; And requiring
hospitalization And in the absence of alternative
diagnosis that fully explains the clinical situation
12
13. Probable case
A. A suspect case for which testing for COVID-19
is inclusive OR
B. A suspect case for whom testing could not be
performed for any reason
13
14. Confirmed case
• A person with laboratory confirmation of COVID-
19 infection, irrespective clinical signs and
symptoms.
14
15. Cont’d
2. Rumor investigation and verification
• In the rumor investigation the rumor is
obtained from different ways: example from
the toll free teams/teams through 8335, health
facilities (Governmental and Non-
Governmental), screening sites (Air port and
land crossings), hotels, investment areas,
refuges and other sources
15
16. Cont’d
A. Each rumor is further investigated and verified
by a rapid response team (RRT). The
established rumor investigation team/RRT is
composed of different disciplines including:
• Epidemiologist
• Clinician
• Laboratory personnel
• Environmental (IPC) expert
• Drivers
16
17. Cont’d
B. The team always ensures the presences of the
followings PPEs and Lab equipment’s.
• Face Mask (Medical mask or N95)
• Gloves
• Eye goggles
• Gown
• Infrared thermometer
• Viral Transport Media (VTM), Biohazard Bag, cotton
etc.
17
18. Cont’d
C. After the team has deployed, the team is
expected to verify the rumor
• Expected to assess the clinical presentation and
corona virus sign and symptoms
• Expected to assess the epidemiological linkage of
the rumor
• Decision to whether to Isolate at isolation center or
home care
• If the case is not suspected reassure him/her and
link to follow up team
• If the case is a suspect, transport to isolation center,
take laboratory specimen and trace and list contacts
18
21. COVID-19 Emergency operation
center contact tracing protocol
• Background
• Once suspected case has been identified, one of
public health measures is tracking down people
who may have been exposed to the virus
through a process called contact tracing
• Health service use contact tracing to find people
who may have been exposed to an infectious
people. There are two types of contacts, close
contacts and casual contacts. The measure to
be taken for those two types of contact is
different.
21
22. Cont’d
• Contact tracing and listing should be done by
rapid response team (RRT). Once the contacts
of suspected or confirmed cases are identified
and listed, they will be linked to follow up team
and monitored by for 14 days from the last date
of contact by active or passive monitoring
depending on the type of contact.
• Objective
• To enable early detection of cases through
active monitoring of peoples exposed to possible
risks and rapidly contains the outbreak.
22
23. Cont’d
• Contact tracing approach
Contacts of suspected and confirmed cases will be
searched through the following mechanisms:
• Identifying contacts from health facility i. e. health
care workers, patients in the room or in contact with
the case, laboratory expert handling the sample,
supportive staffs in the facility etc.
• Looking for social ceremonies the case attended
starting from the date of onset of the symptom and
identifying possible contacts
23
24. Cont’d
• Exhaustively search the house hold level contacts
and visitors starting from the onset of symptom
• Searching for contacts from work places
24
25. Cont’d
Contact identification and definition
A. Close contact
Any individual who has one of the following is
considered as a close contact
• Any individual who has had greater 15 minutes face
to face (<2 meters distance) contact with a
suspected, confirmed case, in any setting.
• household contacts defined as living or sleeping in
the same home, individuals in shared
accommodation sharing kitchen or bathroom
facilities and sexual partners.
25
26. Cont’d
• Healthcare workers, including laboratory workers,
who have not worn appropriate PPE or had breach
in PPE during the following exposures to the case:
• Direct contact with the case (as defined above), their body
fluids or their laboratory specimen
• Present in the same room when an aerosol generating
procedure is undertaken on the case.
• Passengers on an aircraft sitting within two seats (in
any direction) of the COVID-19 case, travel
companions or persons providing care, and crew
members serving in the section of the aircraft where
the case was seated.
26
27. Cont’d
• For those contacts who have shared a closed
space with a confirmed case for longer than two
hours, a risk assessment should be undertaken
taking into consideration the size of the room,
ventilation and the distance from the case. This
may include office and school settings and any
sort of large conveyance.
Contact needs to have occurred during the
infectious period. The infectious period is
defined as from the day of symptom onset in the
case until the case is classified as no longer
infectious by treating team (usually 24 hours
after symptom resolution). 27
28. Cont’d
B. Casual contact
Any individual who has one of the following is
considered as a casual contact;
• Healthcare workers, not including laboratory
workers, who have taken recommended infection
control precautions, including the use of appropriate
PPE, during the following exposures to the case:
• Direct contact with the case (as defined above) or their
body fluids
• Present in the same room when aerosol generating
procedure is undertaken on the case.
28
29. Cont’d
• Any individual who has shared a closed space
with a case for less than two hours.
• Passengers on aircraft setting beyond two seats
(in any direction) of a confirmed case.
• Any individual who has shared a closed space
with a confirmed case for longer than two hours,
but following risk assessment, does not meet the
definition of a close contact.
29
30. Cont’d
Contact assessment
Contact tracing should be initiated immediately
after a confirmed case of COVID-19 or a
suspected case identified.
All persons identified as having had contact with a
confirmed case or a suspected case should be
assessed to see if they should be classified as a
close or casual contact. A contact tracing form
should be completed for each contact to collect all
relevant information.
30
31. Cont’d
• Contact management of a confirmed case
For close contacts of a confirmed case;
• Close contacts of a confirmed case should undergo active
follow up for 14 days after last possible exposure to a
confirmed COVID-19 case
• They should be advised about their risk and the symptoms
of COVID-19 and provided with PPE, including face masks
as appropriate.
• They should reminded about adhering adequate
respiratory precautions and hand hygiene practices
throughout the period of active monitoring
31
32. Cont’d
– Contact should be made them on a daily basis to ask
about relevant symptoms for 14 days after last
possible exposure to a confirmed case COVID-19
case
– Close contacts of a confirmed case should be asked
to limit their movements and interactions with others,
as far as practical.
– In particular, they should be used advised to avoid
contact with immune compromised, elderly, pregnant
or other vulnerable individuals. They should not
attend work or school.
– They should also be advised to avoid attendance at
any social gathering, crowded closed settings,
healthcare or school settings the period of active
monitoring. 32
33. Cont’d
For casual contacts of a confirmed case;
• Casual contacts should undergo passive follow up
for 14 days after the last possible exposure to a
confirmed COVID-19 case.
• They should be advised about the risk and the
symptoms of COVID-19 and provided all necessary
information
• They should advised to self-isolate if they develop
any relevant symptoms and call their local health
institution/8335
• No isolation and restriction of movement is requiring
unless they develop symptoms 33
34. Cont’d
• Contact management of a suspected case
If once the case fulfills the case definition COVID-
19 and isolated, tracing of contacts should not wait
for laboratory result.
If the suspected case test negative by RT-PCR,
release the contacts of the suspect and rather
enroll the negative suspect in to follow up and
monitor for 14 days starting from the last date of
exposure (in any) or the date of onset of the first
symptom (if exposure is unknown or no exposure).
34
35. Laboratory testing for COVID-19
• Background
• This document provides guidance to laboratories
and stake holders involved in COVID-19 virus
laboratory testing of patients as well as
radiologic imaging.
• Currently the approved and available testing
method is RT-PCR.
• Antibody tests are being introduced for
surveillance purpose for community level
circulation of the virus.
35
36. Cont’d
• Laboratory testing for corona virus disease
(COVID-19) in suspected human cases
• The decision to test should be based on clinical and
epidemiological factors and linked to an assessment
of the likelihood of infection.
• PCR testing should have to be done for all suspect
cases.
• Rapid collection and testing of appropriate specimens
from patients meeting the suspected case definition
for COVID-19 is a priority for clinical management
and outbreak control
36
37. Cont’d
• Safety procedures during specimen collection:
Ensure that adequate standard operating procedures
(SOPs) are in use and that staff are trained for
appropriate specimen collection, storage, packaging,
and transport under appropriate IPC caution.
• Specimens that can be delivered promptly to the
laboratory can be stored and transported at 2-8C.
• All specimens collected for laboratory investigations
should regarded as potentially infectious.
37
38. Cont’d
Laboratory testing for COVID-19 testing
• Laboratories undertaking testing for COVID-19
virus adhere strictly to appropriate bio-safety
practices.
• Routine information of cases of COVID-19 is
based on detection of the virus RNA by real-time
reverse-transcription polymerase chain reaction
(RRT-PCR)
38
39. Cont’d
• A number of factors could lead to false negative
result in an infected individual, including:
• Poor quality of the specimen, containing little patient
material
• The spacemen was collected late or very early in an
infection.
• The specimen was not handled and transported
appropriately
• Technical reasons inherent in the test, e.g. virus
mutation or PCR inhibition.
• If a negative result is obtained from a patient with a
high index of suspicion for COVID-19 virus infection,
the lower respiratory tact if possible, should be
collected and tested.
39
40. Cont’d
Reporting of cases and test results:
• Laboratories should follow national reporting
requirements.
• In general, all test results, positive or negative,
should be immediately reported to national
authorities
40
41. Case Management
General principle of clinical management for
COVID-19
• Identify severe cases during pre-triage and triage
screening and initiate supportive therapy as soon as
possible.
• Apply strict IPC measures when managing patients
(contact, droplet and airborne precautions should be
applied).
• Specimens for detecting COVID-19 can be obtained
from nasopharyngeal (NP) or oropharnygeal (OP)
swabs or deep expectorated sputum (if produced) or
bronchoalveolar lavage in specialized conditions.
41
42. Cont’d
• Underlying /chronic diseases should be identified as
early as possible with history of the patient, close
family members or friends.
• Drug interactions, adverse effects of drugs and drug
allergies must be considered during managing the
patient with COVID-19.
• Patient care should be with respect and dignity which
include: respect/dignity, medical support, food/water,
and information.
42
43. Cont’d
• Give supplemental oxygen therapy to patients
with low oxygen saturation:
• Oxygen therapy is effective supportive measure in
COVID-19 pts and target saturation is >90% in non-
pregnant adults and >92% in pregnant mothers and
children. For children with emergency signs (air way
obstruction, shock, severe respiratory distress,
convulsion and resuscitation) it has to be >94%
• Titrate oxygen therapy up and down to reach
appropriate targets using nasal prolongs or canulae
(maximum flow 6L/min), a simple face mask or face
mask with reservoir bag (>6L/min).
43
44. Cont’d
• Use conservative fluid management in patients
with COVID-19 patients when there is no
evidence of shock. Aggressive fluid
administration may worsen oxygenation and be
cautious unless there is justification.
44
45. Specific treatments
Immuno-modulators
• No proven anti-viral therapy or vaccine against
COVID-19 so far necessitating supportive care
for specific symptoms.
• Use Chloroquine and/or Azithromycin as
immune-modulators for patients with moderate
to severe infection and in patients with milder
symptoms if they are elderly and/or with
underlying diseases.
Dose: Chloroquine phosphate 1000mg (4tabs)
stat, then 500mg (2 tabs) after 12 hours then
500mg (2tab) bid for 5 days and Azithromycin
500mg PO daily for 3 days.
45
46. Cont’d
• Pediatrics dose: Chloroquine Total dose:
25mg/kg given over three day
Day 1: 10mg/kg, followed by 5mg/kg 6-8
hours later
Day 2: 3.5 mg/kg in a single dose
• Hydroxychloroquine: 13 mg/kg(10mg/kg as base)
(maximum: 800 mg 620 mg as base) PO followed by
6.5 mg/kg (maximum: 400 mg) PO in 6-8hours after
the initial dose on day 1; then 6.5 mg/kg (maximum
400 mg) PO as single dose on day 2 and on day 3
(maximum maintenance dose:400 mg, 310mg as
base)
46
47. Cont’d
• Durations of up to 10 days can be considered on
a case-by case basis relying on clinical
response and risk/benefit ratio for the individual
patient, though the safety of longer durations
has not been evaluated. Baseline EKG and
CBC/comprehensive metabolic panel (CMP). If
therapy is extended beyond 3 days, obtain a
CBC/CMP on day 3 and day 7.
47
48. Specific management in different
clinical categories
1. Mild illness
Clinical features
• Patients with uncomplicated upper respiratory
tract viral infection, may have non-specific
symptoms such as fever, cough, sore throat,
nasal congestion, malaise, headache, muscle
pain.
• The elderly, immunosuppressed and infants
may present with atypical symptoms.
• These patients may not have any signs of
dehydration, sepsis or shortness of breath.
48
49. Cont’d
Management
• Maintain standard Infection prevention and control
procedures
• Minimize contact with household members and ask
patient to wear a surgical mask if contact is necessary
• Close monitoring for signs of clinical deterioration
such as respiratory failure, sepsis/ septic shock has to
be done for early management of such complications.
• Advise patients to keep hydrated, but not to take too
much fluid as this can worsen oxygenation
• Monitor patients closely and look out for worsening of
their symptoms
• Provide symptomatic therapies with antipyretic/
analgesic
49
50. Cont’d
• Antipyretics / analgesics in
• Adults: Paracetamol 1gm paracetamol PO
every 6–8 hours, maximum 4g/ 24hr
Tramadol 50–100 mg PO/IV every 4–6 hours
for analgesics purpose as needed, daily
maximum 400 mg/day can be given
alternatively or combined with paracetamol.
• Pediatrics: Paracetamol 15 mg /kg PO,
Suppository every 6-8 hours: Avoid
Ibuprofen, and Aspirin use
50
51. Cont’d
2. COVID-19 patients with pneumonia (mild or
moderate)
Clinical features
• Patient with above symptom and pneumonia with
no signs of severity.
Management
• Management as in the mild illness +empiric oral
antibiotics
• Adult: Amoxicillin 500mg po TID or Amoxicillin-
clavulanate 1gm PO BID or 625 mg poTID for 5-
7days
51
52. Cont’d
• Pediatrics: Azythromycin 10mg /kg/day for day 1
and 5mg/kg/day for the rest of 4 days OR
• Amoxicillin-clavulanic acid TID dosing: 20–40
mg/kg/24 hr ÷ Q8 hr PO, BID dosing: 25–45 mg/kg/24
hr ’ Q12 hr PO,
• Extended release 600: ≥3 mo and <40 kg: 90
mg/kg/24 hr ÷ Q12 hr PO × 10 days.
52
53. Cont’d
3. COVID-19 Patients with severe Pneumonia or who
developed SARI
Clinical features
• Adult: assess severity using CURB-65 criteria. The
CURB-65 criteria (Confusion, Urea>7mmol/L or
abnormal Creatinine value, Respiratory rate >30, Blood
pressure <90/60, Age >65)
• For all patients, the CURB-65 score should be
interpreted in conjunction with clinical judgment.
Patients with a CURB-65 or CURB-65 score of >2
patient should be admitted
• Pediatrics: Pneumonia + general danger sign: inability
to breastfeed or drink, lethargy or unconsciousness, or
convulsions 53
54. Cont’d
• Management:
• Provide oxygen supplementation for an SpO2 target ≥
90% (for pregnant mother, children, patient in shock
SpO2 target >92-94%)
• Conservative IV fluid management should be instituted
except when patient is in shock
• In COVID 19 superimposed bacterial infection is
common and to treat all likely pathogens antibiotics
administration is common depending on the treating
physician judgment
• Empiric antimicrobials should be started after taking
specimen for culture and sensitivity (preferably broader
spectrum antibiotics). Don’t delay antibiotics intake if
culture service isn‘t available
54
55. Cont’d
Adults:
• In patients with who are critical, hospitalized, immune-
compromised or previous structural lung disorder:
Ceftazidime/Cefepime *2g iv Tid +or +/-Vancomycin 1
gm IV BID.
• *Ceftriaxone 1gm IV bid is alternative to
ceftazidime/Cefepime but nowadays it is not routinely
used in severe pneumonia or sepsis because of high
rate of resistance.
• If there is no response with the above antibiotics or
culture and sensitivity result suggests it Meropenem (or
other available carbapenemes) 1g IV q8hours +/-
vancomycin 1g IV q8hours +/- vancomycin 1g IV q12
hours can be used.
• When patients improve and are able to take PO
Amoxicillin-clavulanate can be given (look dose at
mild/moderate pneumonia section above).
55
56. Cont’d
Pediatrics:
• Ceftriaxone 75-100mg /kg 12 hourly +
Azythromycin 10mg /kg/day for day 1 and
5mg/kg/day for the rest of 4 days
• Vancomycin40-60 mg /kg every 6 hourly can be
added for hospital acquired infection , previous
intake of antibiotics and underlying lung
structural problem
56