Laboratory and Radiographic Findings
NP swab may be negative, especially early in the course.
Any and all respiratory symptoms can be COVID.
If pretest likelihood is high, a negative swab does not rule out COVID
Lymphopenia is common; if prolonged and severe predictive of poor outcome.
Mild thrombocytopenia common, lower = poor prognostic sign.
Elevated transaminases (AST/ALT)
CT pulmonary angiogram (CTPA) should not be routinely ordered in COVID-19 patients who do not have clinical signs of pulmonary embolism beyond hypoxia alone.
If there is pleuritic chest pain or hypoxia out of keeping with radiographic findings it may be appropriate to order CTPA. An elevated D-dimer is an expected finding in COVID-19.
Common to see + troponin. Strong prognostic indicator for mortality.
Mild acute kidney injury common and is often pre-renal.
A word about CRP
Young and Ruan both found low CRP levels in people not requiring oxygen.
Ruan found CRP tracked with mortality (those that died often had >100, survivors 10-60).
CXR – Repeat if significant deterioration
Bilateral or unilateral opacities, often peripheral
Can look similar to pulmonary edema
Pleural effusions are uncommon
Follow oxygen levels not CXR or CT.
If suspect bacterial super-infection (not typically before 9-11 days), CXR and Abx.
CT Thorax – DO NOT ORDER OUTSIDE OF A CLINICAL PROTOCOL
CT scan can show signs before PCR (NPS) positivity.
Do not do this test because curious.
This should only be part of an organized, systematic institutional protocol.
Link: Specialized Treatments
Use of prone positioning in patients not on mechanical ventilation
There is equipoise over the impact of this practice however we have developed a discussion document as well as several resources for staff to use if this therapy is considered.
When to call ICU
Avoid uncontrolled intubation.
CCRT / Rapid Response calling criteria are a good guide.
Tachypnea and hypoxia will be the reason most people will need ICU.
Patients on 50% oxygen or higher who are candidates for admission to the ICU can benefit from critical care co-management.
BiPAP in patients with suspected or confirmed COVID-19 infection carries high risk of viral dispersion. Do not use it.