علاج الحلات الشديدة والمتوسطة لمرضى الكوفيد

2. Illness caused by a novel
coronavirus called severe acute
respiratory syndrome
coronavirus 2
It was first identified in Wuhan
City , China in
December 2019
It has rabidly spread

3. Fever
Cough
Dyspnea
Headache
Malagia
diarrhea

4. 1.Vaccination

5. Keep physical distance of at least
1 meter from others ,avoid crowds
and close contact
Wear a properly fitted mask when
physical distancing is not possible
and in poorly ventilated settings

6. Clean your hands frequently with
alcohol -based hand rub or soap and
water
Cover your mouth and nose with a
bent elbow or tissue when you cough
or sneeze

7. If you develop symptoms or test
positive for covid-19 , self-isolate until
you recover

8. Analysis
CBC , CRP
UR , CR
NA ,K ,CL
GLU
D-DIMER
ALT , AST

10. Severity
Mild
Symptoms
without
dyspnea
CXR{normal
}
Moderate
+SPO2
>=94 %
Severe
RR>30/MIN
SPO2<94%
PAO2/FIO2
<300
Infiltrations{
>50%}
Very severe
Respiratory
failure
Septic
shock

12. Treatment
{moderate
+severe}
Corticoster
oids
Anticoagula
tion
Antibiotic
Sprays

13. Dexamethasone
First studies :{6mg } daily 10 days
Another study: 299 patients
Receive Dexamethasone {IV}20 mg once daily for 5 days
Then 10 mg once daily for 5 days
The mean number of days alive and free from ventilation over
28 days was greater in the Dexamethasone than the standard
care alone

14. If Dexamethasone is not available
prednisone
Methylprednis
olone
hydrocortison
e
6 mg dexamethasone
equivalencies
40 mg
160 mg
32 mg

16. Anticoagulation
LMWH
Unfractionated

17. Anticoagulation
Hospitalized, Nonpregnant Adults
Who Require Low-Flow Oxygen
and Are Not Receiving Intensive
Care Unit Level of Care
Hospitalized, Nonpregnant Adults
Who Are Receiving Intensive Care
Unit Level of Care (Including
Patients Who Are Receiving High-
Flow Oxygen)

18. Anticoagulation
Hospitalized, Nonpregnant Adults
Who Require Low-Flow Oxygen
and Are Not Receiving Intensive
Care Unit Level of Care
Hospitalized, Nonpregnant Adults
Who Are Receiving Intensive Care
Unit Level of Care (Including
Patients Who Are Receiving High-
Flow Oxygen)

19. The Panel recommends using therapeutic-dose
heparin for patients who have a D-dimer above the
upper limit of normal (ULN), require low-flow
oxygen, and have no increased bleeding risk
In patients without a VTE who are started on
therapeutic-dose heparin, treatment should
continue for 14 days or until hospital discharge,
whichever comes first.

20. contraindications for therapeutic anticoagulation for
COVID-19 due to an increased bleeding risk are :
1.platelet count <50 x 109/L
2.hemoglobin <8 g/dL
3.need for dual antiplatelet therapy
4.known bleeding within the last 30 days requiring an
emergency room visit or hospitalization
5.known history of a bleeding disorder, or an inherited or
active acquired bleeding disorder

21. Anticoagulation
Hospitalized, Nonpregnant Adults
Who Require Low-Flow Oxygen
and Are Not Receiving Intensive
Care Unit Level of Care
Hospitalized, Nonpregnant Adults
Who Are Receiving Intensive Care
Unit Level of Care (Including
Patients Who Are Receiving High-
Flow Oxygen)

22. The Panel recommends against the use
of intermediate-dose (e.g., enoxaparin 1
mg/kg daily)
and therapeutic-dose anticoagulation
for VTE prophylaxis, except in a clinical
trial
.

23. Fever
CRP
PCT Flurocinolones
vancomycin

24. Tocilizumab
Pct {negative}
IL -6
ferriten

32. 1*3 {first week}
2*3 {second week}
Then 3*3 {3-6 months}

33. Vaccination

34. Vaccination
Active respiratory infection
Age < 18 YRS