COVID-19
Admission
ICU Admission
- ICU RN brings ICU bed to the floor for transfer (to avoid bed transfer in COVID precautions room and subsequent bed cleaning).
- Patient wears a surgical mask, with an extra clean gown and sheet on top.
- Providers wear standard PPE during transport.
- Security facilitates the shortest and fastest transfer route, walks 6 ft away from patient and providers, not required to wear PPE
- Diagnostic tests (e.g. CT), should be obtained prior to transfer if possible as to limit movement of the patient after admission.
Last Updated 8 months ago
Utilize Scoring Systems on MDcalc to triage who will benefit from ICU admission
- SOFA Score - Broad illness severity score; included in some scarce resource protocols.
- mSOFA - Broad illness severity; requires fewer labs than SOFA.
- Charlson Comorbidity Index - Widely used estimate of co-morbidity burden, estimates outcomes.
Admission for ICU
- Median time from symptom onset to ICU transfer is ~10 days
- Hypoxemic respiratory failure is the most common indication for ICU.
- Admit if reports of rapid progression to intubation within 12-24h
- Admit if in shock, can develop late in course
Sources:
https://jamanetwork.com/journals/jama/fullarticle/2761044
https://www.covidprotocols.org
Last Updated 8 months ago
- Create cohort ICUs for COVID-19 patients.
- Turn PACU and OR into ICU.
- Transfer out non-COVID patients.
- Keep at least one “code bed” for crashing COVID floor patient.
- Cross train all inpatient nurses
Response Category Description Conventional care The spaces, staff, and supplies used are consistent with daily practices within the institution. These spaces and practices are used during a major mass casualty incident that triggers activation of the facility emergency operations plan. Contingency care The spaces, staff, and supplies used are not consistent with daily practices but maintain or have minimal impact on usual patient care practices. These spaces or practices may be used temporarily during a major mass casualty incident or on a more sustained basis during a disaster (when the demands of the incident exceed community resources). Crisis care Adaptive spaces, staff, and supplies are not consistent with usual standards of care but provide sufficiency of care in the setting of a catastrophic disaster (ie, provide the best possible care to patients given the circumstances and resources available).
Sources:
Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. JAMA. 2020 Mar 13.
https://jamanetwork.com/journals/jama/fullarticle/2763188
Definitions from Hick et al. 8 x 8 Hick, JL, Barbera, JA, and Kelen, GD. Refining surge capacity: conventional, contingency, and crisis capacity. Disaster Med Public Health Prep. 2009; 3: S59–S67
Surge Capacity Principles Hick, John L. et al. CHEST, Volume 146, Issue 4, e1S - e16S
Last Updated 8 months ago
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- ICU RN brings ICU bed to the floor for transfer (to avoid bed transfer in COVID precautions room and subsequent bed cleaning).
- Patient wears a surgical mask, with an extra clean gown and sheet on top.
- Providers wear standard PPE during transport.
- Security facilitates the shortest and fastest transfer route, walks 6 ft away from patient and providers, not required to wear PPE
- Diagnostic tests (e.g. CT), should be obtained prior to transfer if possible as to limit movement of the patient after admission.
Utilize Scoring Systems on MDcalc to triage who will benefit from ICU admission
- SOFA Score - Broad illness severity score; included in some scarce resource protocols.
- mSOFA - Broad illness severity; requires fewer labs than SOFA.
- Charlson Comorbidity Index - Widely used estimate of co-morbidity burden, estimates outcomes.
Admission for ICU
- Median time from symptom onset to ICU transfer is ~10 days
- Hypoxemic respiratory failure is the most common indication for ICU.
- Admit if reports of rapid progression to intubation within 12-24h
- Admit if in shock, can develop late in course
Sources:
https://jamanetwork.com/journals/jama/fullarticle/2761044
https://www.covidprotocols.org
Last Updated 8 months ago
- Create cohort ICUs for COVID-19 patients.
- Turn PACU and OR into ICU.
- Transfer out non-COVID patients.
- Keep at least one “code bed” for crashing COVID floor patient.
- Cross train all inpatient nurses
| Response Category | Description |
|---|---|
| Conventional care | The spaces, staff, and supplies used are consistent with daily practices within the institution. These spaces and practices are used during a major mass casualty incident that triggers activation of the facility emergency operations plan. |
| Contingency care | The spaces, staff, and supplies used are not consistent with daily practices but maintain or have minimal impact on usual patient care practices. These spaces or practices may be used temporarily during a major mass casualty incident or on a more sustained basis during a disaster (when the demands of the incident exceed community resources). |
| Crisis care | Adaptive spaces, staff, and supplies are not consistent with usual standards of care but provide sufficiency of care in the setting of a catastrophic disaster (ie, provide the best possible care to patients given the circumstances and resources available). |
Sources:
Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response. JAMA. 2020 Mar 13.
https://jamanetwork.com/journals/jama/fullarticle/2763188
Definitions from Hick et al. 8 x 8 Hick, JL, Barbera, JA, and Kelen, GD. Refining surge capacity: conventional, contingency, and crisis capacity. Disaster Med Public Health Prep. 2009; 3: S59–S67
Surge Capacity Principles Hick, John L. et al. CHEST, Volume 146, Issue 4, e1S - e16S
Last Updated 8 months ago