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All we need to know about COVID-19 10
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What are the differences between the first wave and second wave in India?Lecture1.1
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How to assess risk Factors for Severe DiseaseLecture1.2
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How to manage on Day 1 of symptoms with COVID-19?Lecture1.3
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How to Interpret the Lab Findings in Mild/Moderate/Severe cases:Lecture1.4
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How to manage patients with information from the lab tests?Lecture1.5
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When to access need for critical care intervention?Lecture1.6
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What Investigations may be needed for inpatients?Lecture1.7
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HRCT in Covid – Indications and importance of HRCT Thorax:Lecture1.8
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Summary Points in COVID-19 Management.Lecture1.9
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Do’s and Don’ts in Covid 19:Lecture1.10
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CONCLUSION: 0
The COVID-19 infection has two phases, the first is the viraemic phase and the second one is the immunologic phase. These two have to be promptly identified and managed appropriately as mentioned above. The critical treatments are oxygen therapy when hypoxic and steroids during severe immunologic phase of the disease. Non Invasive Ventilation and other supportive care including appropriate anticoagulation when needed are crucial and may help to avoid ventilation as prognosis by then can be grim with almost 30-50% mortality.
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How to manage patients with information from the lab tests?
- CRP: CRP can be a guide for steroid dose. Higher the CRP, use a higher dose of steroid. However, beware of co existing bacterial infection as a possibility in which case antibiotic cover may be more appropriate than escalation of steroid dose.
- INTERLEUKIN-6: IL 6 results are very unreliable due to non standardized lab methods. The same sample can give different readings in different labs. There can be transport delays of the collected blood sample; temperature exposure alters IL 6 values. Hence it is advisable to use the same lab/assay throughout the follow-up for a patient.
- D- DIMER: D DIMER is an important marker; all hospitalized patients should receive LMWH (e.g., Enoxaparin 40 mg daily and 1mg/kg/day for severe disease. If D-dimer >1mcg/ml, suspect DVT/PE.Start therapeutic anticoagulation (Enoxaparin 60 mg BD) for proven or strongly suspected DVT or PE till excluded on venous doppler/CTPA. Monitor d-dimer every 2-3 days. At discharge, consider starting oral anticoagulant (e.g., Rivaroxaban 10 mg OD for 4 weeks high-risk patients).
- LDH – Any increase in LDH is a sign of cell death and LDH is an enzyme implicated in the conversion of lactate to pyruvate in the cells of most body tissues. A significant increase in LDH is a potentially useful follow-up parameter in COVID-19 pneumonia for risk stratification and early intervention.
- Procalcitonin: Procalcitonin is a mediator of inflammation which is the pro-peptide of calcitonin devoid of hormonal Under normal circumstances, it is produced in the C-cells of the thyroid gland and in healthy humans, PCT levels are undetectable (< 0.1 ng/mL).PCT is also a mediator of inflammation produced mostly by extra-thyroid tissue and are within reference ranges in patients with non-complicated SARS-CoV-2 infection; any substantial increase reflects bacterial co-infection and the development of a severe form of the disease and a more complicated clinical picture. PCT in the initial days is to rule out a secondary co-infection and not to assess the severity of covid19 disease.