COVID-19 Response Community management of mild COVID-19 illness in rural Queensland v1.0
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
COVID-19 Response Community management of mild COVID-19 illness in rural Queensland v1.0
• • • • • • •
• • • • For the purpose of this document virtual care includes telehealth, telephone calls and other ICT enabled communication.
• • •
• • • • • • • • • • •
• • • • • • • •
• • • • • • • • •
• • • • • • • • • •
• • •
• • • • • • • • • • • • •
• • • • •
–
• • • •
•
•
•
•
•
•
•
•
o
o
o
•
•
•• • • • • • • • • • • •
• •
• • •
• • • •
•
o
o
o
•
•
o
o
o
o
o
o
o
o• •
• • •
• • • • • • • • • • • • • •
MANAGEMENT
OF MILD COVID-19
VERSION 4.1
PUBLISHED
4 JUNE 2020
MANAGING RISK OF INFECTION
Definition of disease severity
Follow national advice for use of PPE in non-inpatient heathcare settings Mild illness
during the COVID-19 outbreak. PP [Taskforce/AHPPC] Person not presenting any clinical features suggesting a complicated
course of illness.
Characteristics:
• no symptoms
MANAGEMENT IN THE COMMUNITY
• or mild upper respiratory tract symptoms
• or cough, new myalgia or asthenia without new shortness of breath
• Patients with mild COVID-19 can be managed in the community or a reduction in oxygen saturation
with advice on self management of symptoms and self isolation.
PP [BMJ]
• Any person clinically assessed as being a likely case of COVID-19
should be managed as if they are a confirmed case until they receive
a negative test for SARS-CoV-2. PP [Taskforce]
General
• Ensure that patients living alone have identified someone to check on
them regularly, even if they are currently well. PP [BMJ]
• Assess whether or not the patient and carer(s) have the ability to
manage infection control to a high standard. PP [Taskforce]
BASELINE ASSESSMENT
Check for signs of moderate/severe disease (refer to Assessment for
suspected COVID-19 Clinical Flow Chart)
Check status of oro/nasopharyngeal swab results.
No baseline investigations are required for mild COVID-19.
Perform CXR and/or blood tests if clinically indicated.
Chest CT scan is not indicated for COVID-19, but should be performed
if clinically indicated for other reasons.
PP [Taskforce]
COVID-19 THERAPIES THERAPIES FOR PRE-EXISTING CONDITIONS
SUPPORTIVE CARE GENERAL
Manage mild COVID-19 in a similar way to seasonal flu and advise Ensure that people with suspected COVID-19 continue to receive their
patients to rest and drink fluids. PP [BMJ] usual care for pre-existing conditions. PP [Taskforce]
An antipyretic is generally not required, but paracetamol can be People advised to take NSAIDs routinely may continue with treatment.
considered for symptomatic relief. PP [ACSQHC] PP [ACSQHC]
ANTIVIRALS AND OTHER DISEASE-MODIFYING TREATMENTS ASTHMA AND COPD
Hydroxychloroquine TF7.1 Use inhaled or oral steroids for the management of people with
TF5.1 For people with COVID-19, only administer hydroxychloroquine in co-existing asthma or COPD and COVID-19 as you normally would for
the context of randomised trials with appropriate ethical approval. viral exacerbation of asthma or COPD. Do not use a nebuliser.
EBR [Taskforce] CBR [Taskforce]
Treatment
Lopinavir/ritonavir
TF5.2 For people with COVID-19, only administer lopinavir/ritonavir in DIABETES AND CARDIOVASCULAR DISEASE
the context of randomised trials with appropriate ethical approval.
EBR [Taskforce]
TF9.1 In patients with COVID-19 who are receiving ACE-I/ARB,
these medications should be continued, unless contraindicated
Remdesivir (e.g. hypotension). CBR [Taskforce]
TF5.3 Whenever possible remdesivir should be administered in the
context of a randomised trial with appropriate ethical approval. Use of
remdesivir for adults with moderate, severe or critical COVID-19 outside Do not cease or change the dose of other treatments such as insulin,
of a trial setting may be considered. EBR [Taskforce] other diabetes medications, or statins. PP [Taskforce]
Other disease-modifying treatments
TF5.4 For people with COVID-19, only administer disease-modifying CONDITIONS MANAGED WITH IMMUNOSUPPRESSANTS
treatments in the context of randomised trials with appropriate ethical
approval. CBR [Taskforce]
Only cease or change the dose of long term immunosuppressants such as
high-dose corticosteroids, chemotherapy, biologics, or disease-modifying
44.7 Do not initiate corticosteroids. PP [Taskforce] anti-rheumatic drugs (DMARDs) on the advice of the treating specialist.
PP [Taskforce]
ANTIBIOTICS
44.7 Do not prescribe antibiotics unless indicated for other reasons,
such as suspected CAP. PP [Taskforce]
THINGS TO WATCH FOR
Advise the person and their carer or family members to look out for
Monitoring
the development of new or worsening symptoms, especially breathing
difficulties which may indicate the development of pneumonia or
hypoxaemia.
Reassure the person that 4 out of 5 people with COVID-19 will have a
mild illness and will usually recover 2 to 3 weeks after the initial onset of
symptoms.
If symptoms do worsen, this is most likely to occur in the 2nd or 3rd week
of illness.
PP [Taskforce]
ESCALATION OF CARE TRANSFER TO HOSPITAL
Transfer to hospital is recommended if the person develops symptoms
or signs suggestive of moderate or severe COVID-19, such as: Check the person’s wishes regarding transfer, and whether they
have an Advanced Care Directive for proceeding with hospital
• symptoms or signs of pneumonia management.
• severe shortness of breath or difficulty breathing If the person wishes to stay in their place of residence, discuss care
• blue lips or face arrangements with the patient, their carer(s) and family. Involve
• pain or pressure in the chest their GP, and local palliative care services if available. Be aware that
Next steps in care
out-of-hospital care will be dependent on the capacity of carer(s)
• cold, clammy or pale and mottled skin
and family to manage infection risk at home.
• new confusion or fainting
If the person wishes to be admitted to hospital, advise the carer or
• becoming difficult to rouse family member to call an ambulance and to notify the paramedics
• little or no urine output that the person has suspected or confirmed COVID-19.
• coughing up blood PP [Taskforce]
PP [BMJ]
RELEASE FROM ISOLATION
• Refer to relevant State public health advice for the conditions that
must be met prior to release of a person from isolation.
• Review patient Care at Home advice and provide to patient if
appropriate.
PP [Taskforce]
LEGEND
Sources EBR: Evidence-Based Recommendation
ACSQHC – Australian Commission on Safety and Quality in Health Care. COVID-19 Position CBR: Consensus-Based Recommendation
Statement - Managing fever associated with COVID-19. Revised 29 April 2020
PP: Practice Point
AHPPC – Australian Health Protection Principal Committee (AHPPC). Guidance on use of personal
protective equipment (PPE) in non-inpatient healthcare settings, during the COVID-19 outbreak.
11 May 2020. Living Prioritised Not prioritised
BMJ – Covid-19: a remote assessment in primary care. BMJ 2020;368:m1182 doi: Guidance for review for review
10.1136/bmj.m1182 (25 March 2020)
Taskforce – Current guidance from the National COVID-19 Clinical Evidence Taskforce• • • • • • • • • • • •
• • • • • • • •
• •
☐ ☐ ☐
☐ ☐
☐ ☐
☐ ☐
☐ ☐
☐ ☐
☐ ☐
☐ ☐
☐ ☐
☐ ☐
☐ ☐ ☐ ☐
☐ ☐
☐ ☐
☐ ☐
☐ ☐
☐ ☐
☐ ☐
☐ ☐☐ ☐ ☐
coronavirus (covid-19) Version 1 correct
Telehealth and consultations in GP respiratory clinics as at 8 April 2020
This graphic, intended for use in a primary care setting, is based on data available in March 2020, much of
which is from hospital settings in China. It will be revised as more relevant data emerges
Clinical
Telehealth only characteristics
1. Set up Review patient Video is useful for Scan medical record for risk factors such as:
69% Cough
Prepare yourself Care at Home
Anxious patients Diabetes Pregnancy Smoking
and decide how advice. Provide
to connect to patient if Comorbidities Chronic kidney or liver disease COPD Temperature
22% 37.5-38°C
appropriate.
Hard of hearing Steroids or other immunosuppressants
Temperature
Cardiovascular disease Asthma 22% >38°C
38% Fatigue
2. Connect Check video Confirm the Check where the Note patient’s phone number in
Make video and audio patient’s identity patient is and who case connection fails
34% Sputum
link if possible, else is present
otherwise call on Can you Name
the phone hear/see If possible ensure the patient has Shortness of
me? Date of Birth privacy 19% breath
Muscles
15% aches
3. Get started Covid-19: remote consultations
Rapid assessment Establish what the patient
Version 1.3wants out of the
Visual summary
Quickly assess A quickor
guide to very
assessing consultation, such 25as:Mar 2020
If they sound look sickpatients
such by video or voice call 14% Sore throat
whether sick or
This graphic, intended for useas in atoo breathless
primary toistalk,
care setting, basedconsider
on Clinical assessment Certificate
lessavailable
sick in March 2020, much of which is from hospital Clinical Referral
data calling an ambulance and inform characteristics
them
settings in China. It will be revised of COVID
as more relevantrisk.
data emerges. Reassurance BasedAdvice on self isolation Headache
on 1099 14%
hospitalised patients
1 Set up Have current ‘stay Video is useful for Scan medical record for risk factors such as: in Wuhan, China
at home’ covid-19 Severe illness Diabetes Pregnancy Smoking
Telehealth
Prepare yourself and
decide how to
and GPonRespiratory
guidance hand Clinics Chronic kidney or liver disease
Anxious patients COPD 69% Cough 12% Chills
connect UK government advice: Comorbidities Steroids or other immunosuppressants
4. History Exposure risk
http://bit.ly/ukgovisol Hard of hearing Cardiovascular disease Asthma History
22%
Temperature
of
37.5-38°C Most common Nasal
Adapt questions current presentation 5% congestion
Close contact with a known COVID-19 case Temperature
to patient’s own illness>38°C
22%
2 Connect CheckHealth
video Confirm
care the
worker Check where Note patient’s phone number Fatigue Nausea or
medical history and audio patient’s patient is in case connection fails Day of first
38% Fatigue 5%
Make video link if
identity Short of breath vomiting
possible, otherwise Travel
Can you overseas or on a cruise
Where ship symptoms
call on the phone hear/see Name are you
If possible, ensure the 34% Sputum
Area of local
me? Datetransmission
of birth
right now? Cough Fever
patient has privacy Diarrhoea
Shortness 4%
19%
of breath
Living in a ‘closed community’ Cough is dry but Up to 50% of patients
3 Get started Rapid assessment Establish what the patient wants sputum is aches
15% Muscle not do not have fever Any
Residential
If they sound or lookcare
very sick, Boarding school
out of the consultation, such as: 24% comorbidity
Quickly assess
such as too breathless to talk,
uncommon presentation
Clinical assessment Referral Certificate
whether sick goCorrection facilities
direct to key clinical questions Detention centres
Reassurance Advice on self isolation
14% Sore throat
or less sick
Rural and remote communities Military barracks 14% Headache
! Red flags
4 History Contacts Most common presentation 12% Chills
Adapt questions to Close contact with Cough Fatigue Fever Short of breath
5
known covid-19 case
. Examination
patient’s own medical Nasal COVID-19:
history During
Immediate the consultation
family History of ask patient
Cough isor carerUp
totodescribe:
50% of 5% During
congestion the consultation look for:
Assess physical member unwell current illness usually dry but patients do not
Nausea
Severe shortness
State of breathing
Date of first sputum is not have fever at 5% General demeanour of breath at rest
and mental Occupational
symptoms uncommon presentation or vomiting
risk group
function as best What does your breathlessness prevent you doing? Skin colour
4% Diarrhoea Difficulty breathing
as you can
Colour of face and lips (text a photo if possible) Work of breathing
5 Examination Over phone, ask carer Over video, Check respiratory function - inability to talk 24% Any Pain or pressure in
comorbidity
or patient to describe:
Assess physical and look for: in full sentences is common in severe illness chest
State of breathing
mental function as General How Is it worse What does
best as you can Colour of face demeanour is your today than your breathlessness Red flags Cold, clammy or
6 pale and mottled
breathing? yesterday? prevent you doing?
. Consider comorbidities that Skin
and lips place
colour Diabetes Immunocompromised Respiratory conditions
patient at risk of more severe disease Covid-19: skin
and need closerPatient
monitoring
may be able to take TemperatureCardiac
Pulse conditions (including
Interpret self monitoring hypertension)
results Severe shortness Other chronic diseases
their own measurements if Peak flow Blood pressure
of breath at rest
with caution and in the context New confusion
they have instruments at home of your wider assessment Difficulty breathing
Oxygen saturation
Pain or pressure Becoming
in the chest difficult to rouse
Unlikely COVID-19 Likely COVID-19, Likely COVID-19, Consider sending to
76. Decision
Decision and action
but well Relevant
Unwell
Cold, clammy,
and needsunwellmottled skin hospital if:
Likely covid-19 but Likely covid-19, or pale and Blue lips or face
and and
Advise action
arrange follow-up, well, with mild unwell, deteriorating comorbidities
admission
symptoms
taking account of local capacity
• Self management, • Test and follow up New confusion
• Respiratory Rate Little or no
• Test and arrange
paracetamol for Arrangeresults
Becoming difficult
>20 breaths per minute urine output
Which pneumonia patients Self management:
follow up by Proactive, follow up
Ambulance to rouse
to send to hospital? symptomatic video. Monitor closely if
• Self management,
whole protocol
depending on
Blue lips or face • Heart rate
fluids, paracetamol
you suspect pneumonia patient care (999) Coughing up blood
Clinical concern, such as: relief paracetamol, clinical picture
Little or no >100 with new confusion
• Temperature > 38°C
encourage fluids urine output
• Self management, • Oxygen saturation Other conditions
• Respiratory rate > 20* Coughing up blood
• Heart rate > 100† Reduce spread of Safety netting paracetamol, by oximeterYou can also read
