Apple Posted March 13, 2021 Share Posted March 13, 2021 13 minutes ago, TheTeapot said: My concern is with things like that chart you've just posted which contains some untruths. It could be useful then if you can point them out. meanwhile, this if from the. NHS site about gtretsaments for hospital admissions with Covid. There are others around the same site for different treatment eras such was primary etc. The more we know about treatments the better psychologically prepared we are and as I say that promotes better outcomes. https-::www.uhb.nhs.uk:coronavirus-staff:clinical-info-pathways:clinical-info-pathways-downloads:covid-quick-guide.pdf.webloc 1 Quote Link to comment Share on other sites More sharing options...
Apple Posted March 13, 2021 Share Posted March 13, 2021 That download didn't look right. This might be better COVID-19 – QUICK GLANCE GUIDE For management of adult non-ITU patients at UHBFT BACKGROUND • COVID-19 is a respiratory illness caused by the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) • Stay up-to-date with the latest guidance which will be posted on the Coronavirus Microsite https://www.uhb.nhs.uk/coronavirus-staff/clinical-info-pathways/key-clinical-info.htm • Travel histories should be recorded for all patients. Patients who have travelled outside the UK in the last 10 days may require isolation and should be flagged to the IPC team - Link SIGNS AND SYMPTOMS • Fever (intermittent) • Fatigue, myalgia, anorexia, anosmia, ageusia (loss of taste) • Lower respiratory symptoms – SOB, cough • “Silent hypoxia” – Sats < 94% without breathlessness esp in elderly • Other symptoms e.g. GI may be present • May present in hospitalised patients as a hospital-acquired pneumonia DIAGNOSIS – VIROLOGICAL • Test ALL patients at admission; and (if negative) further re-tests at 3 and again 5-7 days after admission or asap if patient develops possible COVID symptoms • Rapid testing is available in all admission areas (Results in ❤️ hrs) • Sensitivity is not 100%, one negative swab does NOT rule out COVID. Repeat if suspicion high RESPIRATORY SUPPORT Oxygen Maintain Sats 92 - 96% (88-92% in known COPD with CO2 retention) Nasal Cannulae 1-5 litres/min Face mask 5-10 litres/min Non rebreathe mask 10-15 litres/min Reserve Fixed performance Venturi masks (40%-60%) for those at risk of hypercapnia Respiflo humidified system 28% – 98% for sputum retention/upper airway dryness Proning Prone positioning may assist oxygenation in some patients – Link INVESTIGATIONS See PICS COVID blood panel / ICE bundle • FBC, U&Es, LFT (with LDH), CRP, Troponin, HbA1c • Coagulation profile – includes D-Dimer, PT, Ferritin and Fibrinogen • ABG – Gas exchange, Lactate • Blood cultures • Blood borne virus screen • Other microbiological specimens – as required • ECG CRP is usually high and not indicative of bacterial infection Lymphocyte and eosinophil counts are usually low IMAGING • CXR – all patients • CT Thorax – rarely required in uncomplicated COVID pneumonia • Imaging findings can be non-specific and overlap with other infections / presentations • CTPA indicated when PE suspected (recognised complication) POTENTIAL COMPLICATIONS • Respiratory Failure • Arterial and venous thromboembolism • Arrhythmias/Heart Failure/Myocarditis • Sepsis +/- Septic Shock - Link GENERAL MANAGEMENT • Admit patients to an appropriate COVID area • Empirical antibiotics for suspected bacterial pneumonia until viral pneumonia confirmed • Dexamethasone* 6mg oral (or IV) for 10 days if requiring oxygen or ventilated (cease on discharge) • Thromboprophylaxis – Link • Consider single dose Tocilizumab for patients with Oxygen requirements and raised CRP (≥75 mg/L) with consultant’s approval- Link • Remdesivir may be useful in severe disease - Link * USE OF DEXAMETHASONE • If dexamethasone is prescribed, monitor patients closely for adverse effects (e.g. psychiatric effects, hyperglycemia, secondary infections) • Consider gastro-protection (e.g. low dose PPI) if risk of GI upset (previous history, aspirin/NSAIDs) • Start QDS blood glucose monitoring - If two consecutive CBGs >12 mmol/l in 24 hours = check ketones / exclude DKA; start/Increase insulin - Link FLUID MANAGEMENT • AVOID vigorous fluid resuscitation (may lead to ARDS) but Do Not Run Patients "Dry" • Prevent avoidable AKI through effective risk recognition, investigation, management and referral - NICE guidance & Link • IV fluid to cover insensible losses (high Temp and RR) - max 2L/day Daily review of IV fluid management plan Acute Kidney Injury – Link ONGOING WARD CARE DISCHARGE • Provide clear instructions to patients on discharge • Patients should be advised to self-isolate as per National Guidelines. • Organise any follow up imaging if indicated (e.g. 3 month CXR and write to patient with results) • For more information patients (and HCPs) can consult Link • Assess individual patient risk factors for VTE (cancer, obesity, diabetes, mobility etc) and consider prescription to complete 7 days of prophylaxis • Use structured ward round templates to facilitate holistic care and comprehensive handover • Observations – Respiratory Rate (assessed for at least 30 seconds), Saturations, Temperature, BP and HR at least 4 hourly • Pay early attention to nutritional requirements – involve nutrition and dietetics team • Titrate Oxygen (both up and down) to maintain Sats in target range (see above) • Monitor Blood glucose regularly in patients with diabetes mellitus, impaired glucose tolerance and those receiving dexamethasone – manage and/or refer according to guidance Link • Blood tests should be repeated only when clinically required (change in condition) or according to AKI guidance • Start discharge planning early – home when off Oxygen 24 hours with Sats >92% and any mobility and Social Care needs are met. ESCALATION TO INTENSIVE CARE Patients with severe COVID-19 disease who are for escalation should be referred to the Critical Care COVID Assessment Consultant when their disease is severe as indicated by any one of: RR>30; SBP <90mmHg O2 required at >50% to maintain SpO2 ≥ 92% Reduced level of consciousness If intubation is required the CAC will initiate this with the COVID Intubation team The ISARIC 4C mortality score may be helpful in making escalation decisions - www.isaric4c.net/risk ADVANCED TREATMENT OPTIONS Other specific treatments / procedures must be supported by good evidence Enrolment in clinical trials is the best way to gather this evidence PALLIATION and END OF LIFE CARE (Link) • Patients with severe COVID-19 disease outside ITU may require palliation • Reassurance and emotional support are key in the dying phase and early involvement of the palliative care team is advised • Prescribe anticipatory medication via PICS structured prescribing CALLING THE ICU COVID ASSESSMENT CONSULTANT: Mobile phone via switchboard ANTIBIOTICS IN COVID-19 when clinically suspected of bacterial co-infection • Bacterial co-infection is very uncommon in patients presenting with COVID-19 infection. Do not start antibiotics unless there is clinical or microbiological evidence of bacterial infection. Refer to Antimicrobials guidelines for more information Link. • Use CURB 65 for choosing the correct antibiotics when suspecting bacterial pneumonia co-infection: • REMEMBER ANTIMICROBIAL STEWARDSHIP: Whilst antibacterials may be given in the initial stages, treatment must be reviewed once the diagnosis of viral pneumonia is confirmed. • Stopping antibiotics is appropriate if: COVID swab +ve; symptoms, blood tests and imaging consistent with COVID; bacterial cultures -ve; AND fever resolved or settling. • If antibiotics are continued, review their need regularly and give them for a total of 5 days, then stop them unless there is a clear indication to continue. Additional guidance • Delirium is a frequent complication of COVID-19, particularly in and after Intensive Care - Link • Respiratory support summary - Link • Use of Oxygen at end of life - Link Version 8; Dated 22nd February 2021 TO BE READ IN CONJUNCTION WITH SPECIALTY SPECIFIC COVID- 19 GUIDANCE Ensure early decisions are made, and documented (DNACPR/TEAL or RESPECT form) about Ceiling of Care for all patients Link Ask yourself “Would intensive care, ventilation and organ support be successful in this patient?” 1 Quote Link to comment Share on other sites More sharing options...
TheTeapot Posted March 13, 2021 Share Posted March 13, 2021 3 minutes ago, Apple said: It could be useful then if you can point them out. It recommends hydroxychloriquine for a start. 1 Quote Link to comment Share on other sites More sharing options...
CowMan Posted March 13, 2021 Share Posted March 13, 2021 Just now, TheTeapot said: It recommends hydroxychloriquine for a start. Is that the recommended extra mix for plastering a ceiling? 2 Quote Link to comment Share on other sites More sharing options...
Kopek Posted March 13, 2021 Share Posted March 13, 2021 47 minutes ago, horatiotheturd said: Its ace that I have a huge backlog of work most of which I could be doing perfectly safely. While I sympathise with your lack of current income flow, would it not be that you could use the current lockdown to allow you to do some of that UK work you profess available. When the current lock down was announced, 21 days! More realistically 28 or 35 days, could you not have taken yourself off to the UK to do a week or so's work and get back to the |Island within the lockdown legnth, doing your personal lock down as a returning resident within the national lock down? Viola, you get your work and you don't have to isolate longer that anyone else in lockdown??? You get your work done or you visit family in that first week of lockdown and then just slip into lock down re strictures on your return,which is not any different from the restructures on those who have not left the Island!!! To summarise , we announce an 21 day lock down, YOU say get over there and do those jobs in the UK, expand my Island business, I'm quids in............but if you don't, who is to blame??? 1 1 2 1 Quote Link to comment Share on other sites More sharing options...
TheTeapot Posted March 13, 2021 Share Posted March 13, 2021 (edited) 6 minutes ago, CowMan said: Is that the recommended extra mix for plastering a ceiling? May as well be for all the use it is in combating covid. There is SO MUCH BULLSHIT out there about covid, and treatments etc. Fuck the USA and their asshole people, its not Russian troll factories pumping out fake news people need to be concerned about, its them. That chart Apple posted, I dont know of its context, but mentioned on it is Baylor University. That's a private baptist university in Texas. There's your problem right there. Edited March 13, 2021 by TheTeapot 2 1 1 Quote Link to comment Share on other sites More sharing options...
CowMan Posted March 13, 2021 Share Posted March 13, 2021 1 minute ago, TheTeapot said: May as well be or ll the use it is in combating covid. There is SO MUCH BULLSHIT out there about covid, and treatments etc. Fuck the USA and their asshole people, its not Russian troll factories pumping out fake news people need to be concerned about, its them. That chart Apple posted, I dont know of its context, but mentioned on it is Baylor University. That's a private baptist university in Texas. There's your problem right there. Seems like there’s loads of self claimed highly qualified covid experts doesn’t it? I wonder how it will all end? 1 Quote Link to comment Share on other sites More sharing options...
Apple Posted March 13, 2021 Share Posted March 13, 2021 7 minutes ago, TheTeapot said: t recommends hydroxychloriquine for a start. https://www.bmj.com/content/369/bmj.m2378 This from the bmj says the jury may still be out. If there is a more relevant treatment guide then it would be useful to see it. The issue is about what pathways for treatment we are using here and who determines that. Quote Link to comment Share on other sites More sharing options...
horatiotheturd Posted March 13, 2021 Share Posted March 13, 2021 9 minutes ago, Kopek said: While I sympathise with your lack of current income flow, would it not be that you could use the current lockdown to allow you to do some of that UK work you profess available. When the current lock down was announced, 21 days! More realistically 28 or 35 days, could you not have taken yourself off to the UK to do a week or so's work and get back to the |Island within the lockdown legnth, doing your personal lock down as a returning resident within the national lock down? Viola, you get your work and you don't have to isolate longer that anyone else in lockdown??? You get your work done or you visit family in that first week of lockdown and then just slip into lock down re strictures on your return,which is not any different from the restructures on those who have not left the Island!!! To summarise , we announce an 21 day lock down, YOU say get over there and do those jobs in the UK, expand my Island business, I'm quids in............but if you don't, who is to blame??? Ah yeah. Why didn't I think of that? So simple when you say it. I am so stupid. 1 1 Quote Link to comment Share on other sites More sharing options...
Gladys Posted March 13, 2021 Share Posted March 13, 2021 1 minute ago, horatiotheturd said: Ah yeah. Why didn't I think of that? So simple when you say it. I am so stupid. Well, why don't you do it? Quote Link to comment Share on other sites More sharing options...
Utah 01 Posted March 13, 2021 Share Posted March 13, 2021 44 minutes ago, Apple said: That s why GPs often have their eyes focused on the computer when you go and see them .............and there was I thinking that's why they went to med school for 6 years when all along we could do it ourselves via google. 2 Quote Link to comment Share on other sites More sharing options...
TheTeapot Posted March 13, 2021 Share Posted March 13, 2021 4 minutes ago, Apple said: https://www.bmj.com/content/369/bmj.m2378 This from the bmj says the jury may still be out. If there is a more relevant treatment guide then it would be useful to see it. The issue is about what pathways for treatment we are using here and who determines that. That's from June last year, i'm sure it has been thoroughly dismissed as a viable treatment for covid now. I don't know what is being used here, and thinking about it, you're right, we probably should know. I know that that steroid mentioned in that nhs guidance you've shared above is being used in some cases, but other than that..? My concern is for you, don't get dragged down the path of dubiousness is all. There is currently no magic cure, and anyone selling you one is lying. Quote Link to comment Share on other sites More sharing options...
Apple Posted March 13, 2021 Share Posted March 13, 2021 11 minutes ago, CowMan said: Seems like there’s loads of self claimed highly qualified covid experts doesn’t it? I wonder how it will all end? You are right there @CowMan and what I am asking is what we do on the IOM. If people don't know then fine. The UK NHS and some of the hospitals there produce many of their own treatment guidance and also show who their medical teams are, including their clinical histories and qualifications. Sometimes they even prod local audit result. (Actually that would we could do the same). We can always refer to the UK guidance or does NICE provide any? Quote Link to comment Share on other sites More sharing options...
CowMan Posted March 13, 2021 Share Posted March 13, 2021 Just now, TheTeapot said: My concern is for you, don't get dragged down the path of dubiousness is all. There is currently no magic cure, and anyone selling you one is lying. That’s an interesting statement. So in the next 8 weeks what’s your likely source of optimism given this scientific revelation? Finding the cure for covid and managing our exit route out of this through detailed scientific analysis or doing a few ceilings to top up your MERA? Quote Link to comment Share on other sites More sharing options...
Apple Posted March 13, 2021 Share Posted March 13, 2021 2 minutes ago, TheTeapot said: I don't know what is being used here, and thinking about it, you're right, we probably should know. I appreciate that. That is the only point I am making. 3 minutes ago, TheTeapot said: There is currently no magic cure, and anyone selling you one is lying. Yes, I know, and I have met the muppets believe me. As I say, the more we can know, and the more that can be shared, the better the outcomes can be. That is certainly the lesson from the politics. Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You can post now and register later. If you have an account, sign in now to post with your account.