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Inpatient COVID-19 Management

Kathryn Snyder

Background

  • COVID-19 is the novel coronavirus responsible for the ongoing pandemic that started in late 2019. The virus has ongoing mutations resulting in new dominant strains.

Evaluation

  • Please see the most updated VUMC and VA guidance due to frequently evolving recommendations.

  • Please refer to the hospital’s current maximum oxygen requirement allowed on the floor to ensure patient is appropriately triaged.

  • Basic admission workup for symptomatic, confirmed COVID-19

    • Labs: CBC with diff, CMP, d-dimer, ferritin, CRP, ESR, PT/INR, PTT, procalcitonin, RPP

    • Imaging: portable CXR

    • Nursing: Strict I/O

    • Enhanced precautions (contact, airborne, eye protection)

Management

  • Fluid balance goal slightly net negative to even

  • Anticoagulation/DVT prophylaxis:

    • Please see latest VUMC or VA guidance based on clinical status (supplemental O2 requirements, ICU vs floor, etc.)

  • Pharmacologic therapies

    • Note: Therapies, indications, and contraindications are frequently changing, please see latest VUMC/VA guidelines for specific indications for these medications or others

  • Remdesivir

    • Loading dose 200mg IV x1 then 100mg daily x 4 days

    • For use in patients hospitalized for COVID within 7 days of symptom onset

    • Contraindications: known hypersensitivity, ALT >/= 10x ULN, high-flow NC, PPV, intubated, or on ECMO

    • Monitoring: baseline CBC, INR, q48h CMP

  • Dexamethasone

    • 6mg PO/IV x 10 days; consideration of longer taper if no clinical improvement or persistently elevated CRP

    • Contraindications: no hard contraindications, use clinical judgement if concomitant serious bacterial/fungal infection

  • Antibiotics:

    • The incidence of superimposed bacterial infection in the setting of COVID-19 is low

    • The majority of patients do not need additional coverage for bacterial pneumonia

    • You can use procalcitonin to guide decision

  • Other pharmacologic therapies include baricitinib (JAK inhibitor), tocilizumab (IL-6 inhibitor) and monoclonal antibodies

Additional Information

  • Complications and special considerations for COVID-19 patients

    • High PE/DVT risk

    • Superimposed bacterial PNA

    • AKI

    • GI symptoms/abnormalities (see GI section on COVID-19)

Last update: 2022-06-21 22:06:46