Management of LABORATORY CONFIRMED COVID 19 PATIENT

Published by Department of Health & Family Welfare, Govt of West Bengal (modified on 04.01.22) LABORATORY CONFIRMED COVID 19 PATIENT

  1. All asymptomatic patients.
  2. Comorbid patients with no symptoms (prioritise to control the comorbid state)
  3. Mild symptoms (low fever, dry cough, anosmia, ageusia, nasal block, sore throat, weakness, diarrhea, myalgia etc) with
     Fever
     No signs of respiratory distress
     SpO2 ≥ 94%
     Normal mental status,
     systolic BP > 100 mmHg
     Respiratory rate < 24/min HOME ISOLATION/ SAFE HOME  Supportive Management  Mask, Hand Hygiene, Physical distancing, droplet precaution  PARACETAMOL (if fever/bodyache)  Anti histaminic (if needed)  Laxative (if required)  Inhalational BUDESONIDE 800 mcg twice daily for 5 days if distressing cough more than 5 days  Systemic Steroids should NOT be used routinely in mild cases Warning Signs  Difficulty in breathing  Persistent Fever/ High grade fever more than 7 days  Recurrence of Fever  Palpitations  Chest pain/ Chest tightness  Severe Cough  Any new onset symptoms  SpO2 Oxygen requirement 10 L/min
    COVID WARD HDU/ ICU
    ANTIPYRETICS:
    Paracetamol for fever
    OXYGEN SUPPORT
     Target SpO2 ≥ 94% (≥88% in pts. with COPD)
     appropriate Oxygen delivery device (cannula / Face mask/ non-re-breathing face mask)
     Conscious proning should be encouraged
    STEROID
     Dexamethasone 0.1 to 0.2 mg/kg (Maximum 8 mg / day) for 5-10 days
    ANTICOAGULATION
     Prophylactic dose of UFH or LMWH
    ANTIVIRAL
     REMDESIVIR: to be decided on
    case to case basis. Not to start
    after 10th days of symptom onset /Test date
    ANTIBIOTICS
     (Antibiotics should be used judiciously as per Antibiotic protocol)
    MONITORING
     CBC, CRP, D-Dimer: 48-72 hourly
     LFT, KFT: 48-72 hourly
     CBG monitoring
     Trop T, ECG, Coagulation Profile
     Imaging if worsening of
    symptoms
     Look for increase in oxygen
    requirement, Work of breathing, Hemodynamic instability
    RESPIRATORY SUPPORT
     O2 through NRBM upto 15 litre/ min
     If NRBM is inadequate HFNC or NIV
     Worsening condition, rise in PCO2 and clinician’s judgment
    intubation and mechanical ventilation
     Lung protective ventilation strategy by
    o ARDSnetprotocol
    o ProneventilationinrefractoryHypoxemia
    STEROID
     Dexamethasone 0.2 to 0.4 mg/kg (Maximum 16 mg/day) for 5-10 days
    ANTICOAGULATION
     Therapeutic UFH/ LMWH (consider UFH if CrCl<30)
    ANTIVIRAL
     Antiviral agents are less likely to be beneficial at this stage; use of Remdesivir to be decided on case to case
    basis, Not to start after 10th days of symptom onset/Test date
    TOCILIZUMAB
     may be considered on a case to case basis after shared decision making
    ANTIBIOTICS
     should be used judiciously as per Antibiotic protocol
    INVESTIGATIONS
    Essential investigations along with
     Cultures (Blood / Urine/ ET aspirate)
     CBG monitoring
     CBC
     CRP
     Ferritin
     D-Dimer
     Trop-T/ Quantitative Troponins
     Procalcitonin
     Coagulation Profile
     HRCT Thorax
    SUPPORTIVE MEASURES
    • Maintain euvolemia
    • Sepsis/septic shock: manage as per protocol and
    antibiotic policy
    • Sedation and Nutrition therapy along with as per existing
    guidelines (FAST HUG)

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