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¶
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Please see the most updated VUMC and VA guidance due to frequently evolving recommendations.
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Please refer to the hospital’s current maximum oxygen requirement allowed on the floor to ensure patient is appropriately triaged.
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Basic admission workup for symptomatic, confirmed COVID-19
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Labs: CBC with diff, CMP, d-dimer, ferritin, CRP, ESR, PT/INR, PTT, procalcitonin, RPP
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Imaging: portable CXR
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Nursing: Strict I/O
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Enhanced precautions (contact, airborne, eye protection)
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Management¶
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Fluid balance goal slightly net negative to even
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Anticoagulation/DVT prophylaxis:
- Please see latest VUMC or VA guidance based on clinical status (supplemental O2 requirements, ICU vs floor, etc.)
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Pharmacologic therapies
- Note: Therapies, indications, and contraindications are frequently changing, please see latest VUMC/VA guidelines for specific indications for these medications or others
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Remdesivir
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Loading dose 200mg IV x1 then 100mg daily x 4 days
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For use in patients hospitalized for COVID within 7 days of symptom onset
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Contraindications: known hypersensitivity, ALT >/= 10x ULN, high-flow NC, PPV, intubated, or on ECMO
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Monitoring: baseline CBC, INR, q48h CMP
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Dexamethasone
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6mg PO/IV x 10 days; consideration of longer taper if no clinical improvement or persistently elevated CRP
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Contraindications: no hard contraindications, use clinical judgement if concomitant serious bacterial/fungal infection
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Antibiotics:
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The incidence of superimposed bacterial infection in the setting of COVID-19 is low
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The majority of patients do not need additional coverage for bacterial pneumonia
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You can use procalcitonin to guide decision
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Other pharmacologic therapies include baricitinib (JAK inhibitor), tocilizumab (IL-6 inhibitor) and monoclonal antibodies
Additional Information
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Complications and special considerations for COVID-19 patients
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High PE/DVT risk
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Superimposed bacterial PNA
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AKI
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GI symptoms/abnormalities (see GI section on COVID-19)
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