Presentation & Initial Investigations
- Constitutional symptoms, URI, LRI, and GI
- Some patients will have fever and cough
- Fever with variable frequency (43-98%) [absence does not exclude]
- GI symptoms in up to 10%, maybe greater frequency in some studies
- Hypoxemia without dyspnea (“happy hypoxemic”) is common.
Recommended Initial Investigations
- Most patients who are ambulatory with normal vital signs should go home with no investigations.
- Criteria for screening and diagnosis should be reviewed.
- For those that have low oxygen (SpO2) or appear unwell:
- CBC, Lytes, Creatinine, Troponin, Lactate, VBG, CRP, Blood culture
- Chest X-ray
- Nasopharyngeal swab
- IV NS lock
**Any transfers for testing require advance notification of the receiving department so they may prepare to receive the patient.**
- No pharmacological management is required for COVID-19 patients being discharged.
- Remote or home oximetry may be of value in this patient population.
- Antimicrobial therapy is not routinely recommended.
- If you believe there could be a bacterial infection, ceftriaxone 1 g IV is sufficient. No additional antibiotics are required.
- If the patient requires oxygen, they should receive Dexamethasone (6 mg orally) and they require admission.
DO NOT ROUTINELY ORDER
- CT Chest for diagnosis.
- D-dimer unless specific concern about PE (e.g. pleuritic chest pain).
- Nebulized therapy
- Ultrasound or echocardiogram unless very clear indication
- Return for radiology investigations for the morning
- Oxygen saturation below 92 on room air at rest
- SBP below 90 (hypotension) or lactate above 4
- Severe metabolic abnormality (acute renal failure, positive troponin, DKA, hyponatremia)
- Unable to self isolate in communal living
- Unable to care for self or be cared for at home*
- Decompensation of underlying chronic disease (acute kidney injury, DKA, first-time seizure)
Critical Care Consultation Criteria
- Requires greater than 50% oxygen to keep sats above 92%
- Unresolved lactate above 4 after resuscitation
- Vasopressor support
Do not intubate without consulting critical care if possible.
Do not place patients who have suspected or confirmed COVID-19 on non-invasive ventilation.
- Do not order nebulized medications
- Neonates – some careful exceptions.
- Bronchodilators do not help viral pneumonia.
- Select the inhaler route on order sets when this is an option.