By vgreene, 27 March, 2020 Direct ICU admission for major severity criteria e g septic shock needing pressors or resp failure requiring mechanical ventilation or if 3 of RR 30 PaO2 FiO2 250 multilobe infiltrates AMS BUN 20 WBC
By vgreene, 27 March, 2020 Mask isolate pt upon 1st contact w health care setting 1 2 Repeatedly assess for droplet contact airborne precautions 1 Use PPE 2 if possible use disposable dedicated stethoscope BP cuff pulse ox thermometer etc or disinfect between each pt 1
By vgreene, 27 March, 2020 In the setting of COVID 19 screen and isolate pts at 1st point of contact 1 use PPE 2 Use severity criteria for ICU decision Start empiric antibacterials even if flu test in CAP 3 give steroids in severe COVID 19
By vgreene, 27 March, 2020 Use outpt supportive care, eg, antipyretics5 (NSAIDs not contraindicated, per FDA6). Avoid steroids1,5 unless required for other indications (eg, COPD exac);3 weigh benefit/harm of antenatal steroids if pregnant @ risk for preterm labor
By vgreene, 27 March, 2020 Follow most recent guidance for postexposure ppx or tx see epocrates resource Consensus Guidelines for COVID 19 Drug Therapies in Adults
By vgreene, 27 March, 2020 Home isolation suitable educate about when to seek care pts who are older have underlying conditions or are immunocompromised are at higher risk so they should contact physician early even for mild sx 3 and warrant closer monitoring 3 5
By vgreene, 27 March, 2020 Routine f u CXR for CAP not recommended if sx resolved in 5 7 days 1 per ATS IDSA
By vgreene, 27 March, 2020 If influenza suspected or test Start antiviral w in 48h of sx onset per ACCP 2 ATS IDSA suggests flu tx for CAP pts w flu test regardless of sx duration 1
By vgreene, 27 March, 2020 If high risk comorbidity chronic heart lung liver or renal dz DM alcoholism malignancy asplenia 1 combo tx w 1 of these amoxicillin clavulanate cefpodoxime cefuroxime PLUS 1 of these azithromycin clarithromycin doxycycline Or use mono tx w levofloxacin mo
By vgreene, 27 March, 2020 If no high risk comorbidity1 MRSA Pseudomonas infection risk 1 amoxicillin doxycycline macrolides OK if local resistance