Ep 137 COVID-19 Part 1 – Screening, Diagnosis and Management

In this early release first podcast in a series of main episodes on COVID-19, Infectious Diseases specialist at Mount Sinai Health Systems and University Health Network and Professor at the University of Toronto Andrew Morris joins Anton on the latest on emergency screening, diagnosis and management of COVID-19, with some tips on managing yourself and your team by Howard Ovens... Podcast production, sound design & editing by Anton Helman Written Summary and blog post by Anton Helman March 20th, 2020 Cite this podcast as: Helman, A. Morris, A. Ep 137 COVID-19 - Screening, Diagnosis and Management. Emergency Medicine Cases. March, 2020. https://emergencymedicinecases.com/covid-19-screening-management-surge-capacity-airway-epidemiology. Accessed [date] This podcast was recorded on March 19th, 2020 and the information within is accurate up to this date only, as the COVID pandemic evolves and new data emerges. The blog post will be updated regularly and we are working on a weekly update via the EM Cases Newsletter which will be replicated on the EM Cases website under 'COVID-19' in the navigation bar. This podcast and blog post are based on Level C evidence - consensus and expert opinion. Examples of protocols, checklists and algorithms are for educational purposes only and require modification for your particular needs as well as approval by your hospital before use in clinical practice. Quick tips on managing yourself and your team during the COVID -19 outbreak with Howard Ovens * Communication amongst your ED group is crucial which can be augmented using available apps such as WhatsApp, Slack etc. * Decide on reliable sources of information personally and amongst your group as there is an overwhelming amount of both reliable and unreliable information being disseminated * Risk to health care workers may be overstated, and in many cases of "superspreader" events there were violations of personal protection guidelines, highlighting the importance of complying with guidelines * Pace yourself - plan for rest, regular exercise, healthy food, sleep and maintain meditation if you are skilled * Contributing in a constructive way to your ED group and your community may help alleviate anxiety around COVID-19 Clinical Presentation and natural history of COVID-19 There is much overlap in the presentation of COVID-19 with influenza, the common cold and bacterial pneumonia. The typical triad includes dry/nonproductive cough, fever and shortness of breath, and most patients will have either fever, cough or both. However up to 20% of patients may have sore throat, nasal congestion or headache, and they may develop sputum production and others may experience antecedent gastrointestinal symptoms such as nausea/vomiting and diarrhea in 3-10% of cases. Fever is present in only 44% of patients at the time of admission. Most patients present within the first week, with a median incubation period of 4-5 days following exposure, with some cases having an incubation period of 14 days, or rarely longer. Older patients and those with chronic medical conditions may be at higher risk for severe illness, however most cases are in people 30-69 years of age. A small minority of patients develop septic shock and/or ARDS, which often occurs precipitously around 1 week after symptom onset. Therefore, patients who are discharged from the ED should be instructed to return for worsening shortness of breath or lethargy. Possible risk factors for progressing to severe illness may include older age and co-morbidities (lung disease, cancer, heart failure, cerebrovascular disease, renal disease, liver disease, diabetes, immunocompromising conditions). From PulmCrit The only sign or symptom that seems to have any predictive value for severe disease is shortness ...