ER TRIAGE CRITERIA AND MANAGEMENT OF COVID-19

Dr. Mohammed Azizul Quader March 10, 2020 coronaviruses, COVID-19, SARS-CoV2

Latest screening guidelines for COVID-19 (03/09/2020)

All health care providers should be prepared to identify, collect specimens, and care for patients under investigation for COVID-19. Health care providers should immediately notify infection control personnel at their health care facility if they identify a person meeting the PUI for COVID-19 criteria below.

  • 1. Any person, including health care workers1, who has had close contact2 with a laboratory- confirmed3 COVID-19 case within 14 days of symptom onset and fever4 or symptoms of lower respiratory illness (e.g., cough, shortness of breath).
  • 2. Person is part of a non-household outbreak of suspected COVID-19.
  • 3. Person hospitalized with unexplained respiratory illness or person who died from unexplained respiratory illness.
  • 4. Person traveled to or from an affected geographic area5 with widespread community transmission and has fever4 or symptoms of lower respiratory illness (e.g., cough, shortness of breath etc)
  • 5. Person had community contact (e.g., attended the same gathering or stayed on the same cruise ship) with a laboratory-confirmed COVID-19 case and fever or symptoms of lower respiratory illness (e.g., cough, shortness of breath).
  • 6. Person is age ≥ 65 years, has chronic medical conditions, or is in an immunocompromised state and has fever or symptoms of lower respiratory illness (e.g., cough, shortness of breath).
Specimen Collection for a PUI for COVID-19 for Testing at Bureau of Public Health Laboratories.

Specimens from patients meeting the first four (1-4) testing criteria above can be tested at the Bureau of Public Health Laboratories.

For initial diagnostic testing for COVID-19, CDC recommends collecting and testing upper respiratory (nasopharyngeal AND oropharyngeal swabs), and lower respiratory (sputum, if possible) for those patients with productive coughs. Induction of sputum is not recommended. Specimens should be collected as soon as possible once a PUI is identified, regardless of the time of symptom onset. Please consult your county health department for instructions on shipping to the Bureau of Public Health Laboratories.

Most of you are already well educated about COVID-19 and I am not going to discuss in details about it. Being an ER physician, I just want you to know what we do when we suspect a COVID-19 patient. We designate those patients as person under investigation (PUI). I work at Memorial Hospital Jacksonville(Duval county) and we see 90,000-100,000 patients per year in our Emergency Department. We are the first line of defense and here is our triage criteria for COVID-19 suspect:

For group one:

  • 1. Mask the patient and place in Negative pressure room.
  • 2. All stuff and providers wear PPE with following sequence: Hand wash, Gown, N95 mask, Face shield(if patient needs intubation),then Gloves.
  • 3..We contact our Infectious Disease department and Duval county health department.
  • 4. Duval county health department needs to approve COVID-19 testing.
  • 5. If approved for testing, the COVID sample will need to be collected as a NP swab using synthetic swab with viral transport medium. Then the sample is sent to Duval county for testing.
  • 6. Patient will go home with proper instructions on how to self-isolate at home and when to return.
  • 7. Duval county health department will monitor the patient.

For group two & three:

In addition to above (excluding #6 and #7):
  • 1. We order ED Respiratory Virus set (Adeno, Flu, Parainfluenza, RSV, Rhino), Bordetella, urine Legionella & Mycoplasma,
  • 2. We try to avoid high flow O2 including BIPAP, CPAP, bagging and high flow nasal O2.
  • 3. Low flow Oxygen is provided via nasal cannula and a surgical mask should be worn over face & nasal cannula.
  • 4. Bronchodilator should be provided using MDI.
  • 5. If needs intubation, we use rapid sequence intubation with Glidescope. We try to avoid direct Laryngoscope.

Treatment/ Prophylaxis:

  • No approve treatment yet.
  • No vaccine currently available.
Following medicines show promising and currently under investigation:
  • REMDESIVIR
  • LOPINAVIR/RITONAVIR,
  • CHLOROQUIN.

Prevention:

  • Frequent hand wash, Avoid touching nose and face, cover your face during coughing & sneezing, elbow shake, open door with buttock, etc
  • Avoid Adda, parties, Pohela Boishak, Picnic , Pita Utshob, travels etc.
  • Finally avoid Facebook to prevent recession and Trump's fall out!!!!!

Mohammed Quader, MD

Graduated from chittagong medical college in 1987. Did internship & Residency at The Jamaica Hospital in New York from 1993 through 1996. ER Physician at Southern Ohio medical center from 1996 through 2003. ER physician at Memorial Hospital Jacksonville from 2004 through 2030. Board certified in both Emergency Medicine & Internal Medicine.

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