this is the best practice to manage the critically ill Covid19 patient

1. COVID19
DR.MAGDY KH.
CRITICAL CARE MEDICINE
SARS-COV2 SYNDROME
BEST PRACTICE

2. OBJECTIVES
Understanding the SARS-COV2
Pathogenesis
01
Define the clinical presentations of
SARS-COV2
02
.
Understanding the possible lines of
treatment
03

3. Insert the Sub Title o Your Presentation

4. SARS-COV2 Syndrome
Pulmonary Affection
ARDS phenotype H
ARDS-Like phenotype L
Cardiovascular
Affection
Vasculitis
Endothelial injury
Myocarditis
Vascular dysfunction
Coagulopathy
Antiphospholipid Ab
syndrome.
DIC-Like
Hypercoagulability

5. Clinical presentation of SARS-COV2
Droplet
infection
ARDS
Fever 88%
Dry cough 68%
Fatigue 38%
Mucus 33%
Sore throat 15%
Shortness of breath
+/-Chest pain
+/-Cough
Fever
Pneumonia 5%
Distress
Desaturation
Fatigue
Disturbed consciousness
URTI 95%

6. Best Practice
Initial
evaluation HFNC/BIPAP
Invasive
MV
Hospital
care
Need
ICU
5% Need
Admission
Increased
O2 Needs
Initial O2
therapy
Progression of hospitalized Covid19
Cases
Patient O2SAT Persistently low with
Initial O2 therapy
RR > 30
Upgrade O2 Therapy or proceed to
IMV
NC 1-5L/min
Face mask up to 5L/min
Nonrebreather Face mask up to
15L/min .
Initial O2 Therapy
.
95% of cases is mild or
asymptomatic

7. BEST PRACTICE EVIDENCE
BASED
.
1-Early Intubation
2-Early Prone
3-Proper MV settings
4-Early steroids
5-Early anticoagulation
6-Professional one to one Nursing Care
CONTENTS:

8. EARLY INTUBATION
Persistent Hypoxia P/F <150
Persistent RR >30
HD instability
Exhaustion and CO2 retension
INDICATIONS
Good option of initial
therapy and can decrease
the need of intubation in
some COVID19 Patients
BUT need reevaluation
every 2hrs
If persistent hypoxia/RR>30
go for intubation
HFNC/BIPAP
*Prevent PILI
*Prevent patient exhaustion
*Better for applying prone
position as some patient
can’t tolerate awake prone
Why Early Intubation is
better?
Don’t leave your Patient
suffering the hypoxia and
distress for long time give him
a chance for improvement by
HFNC/BIPAP but for only
few hours if not improve go
straight to intubation
Final Advice

9. EARLY INTUBATION EVIDENCE BASED

11. The decision-making process for nonoperating room intubation used in Wuhan

14. EARLY PRONE

15. PROPER MV SETTING
The majority of COVID19 cases don’t need very high PEEP, Most cases well managed by PEEP between (10-15 H2O)
COVID19 cases need usually normal to low Tidal volume between (6-8ml/kg/breath)
Driving pressure =Plateau pressure–PEEP) ∆P<15cmH2O

16. EARLY STEROIDS
No doubt that steroids is a game changer medication in COVID19 Pandemic as evidenced by RECOVERY-Trial
Start early once the Patient needs O2 supplements

17. EARLY TOCILIZUMAB
Start early Tocilizumab doses guided by increasing inflammatory markers and S.IL6 level
Also evidenced to reduce mortality by RECOVERY-Trial

19. CS Score

20. EARLY ANTICOAGULATIONS
It’s evidenced that the Covid19 severe cases suffering from hypercoagulability state and micro thrombus inside the lungs, so the
role of anticoagulation is very important in the management of critically ill patients.
All hospitalized adults with COVID-19 should receive pharmacologic thromboprophylaxis with LMWH over unfractionated
heparin to reduce contact with healthcare providers, unless the risk of bleeding outweighs the risk of thrombosis

21. Professional one to one Nursing Care
No doubt that the nursing care is the main game changer in COVID19 pandemic, we all appreciating the role of nursing staff in the
pandemic they can stay caring for the patients for more than 12 hours wearing the very tough PPE
The more overwhelmed ICUs with cases the more the mortality because of lack of proper care

22. THANK YOU