COVID-19 Assessment & Management 1) Select the appropriate options below (hold Ctrl button and click to make multiple selections).Assess whether increased risk of severe illness- No high risk (clinically extremely vulnerable) conditions- Is at high risk (clinically extremely vulnerable) due to:High risk conditions- organ transplant- current chemotherapy or immunotherapy- lung cancer on radiotherapy- blood or bone marrow cancer- bone marrow/stem cell transplant in the last 6 months- severe lung disease (severe Asthma/COPD/CF)- sickle cell anaemia or SCID- high dose steroids or other immunosuppressants- pregnancy with a serious heart condition- splenectomy- Down's syndrome (adult)- CKD5 or on dialysis- a clinical judgementModerate risk conditions- No moderate risk (clinically vulnerable) conditions- Is at moderate risk (clinically vulnerable) due to:Moderate risk conditionsage ≥ 70chronic lung disease (Asthma, COPD, emphysema or bronchitis)chronic heart diseaseDiabetesCKDchronic liver diseasechronic neurological condition (Parkinson's disease, MND, MS, Cerebral palsy)a condition that means they have a high risk of getting infectionlow dose steroidsBMI ≥ 40pregnancyDocument pertinent negative risk factorsNot in the at-risk age groupNo chronic lung diseaseNo chronic heart diseaseNot diabeticNo CKDNo chronic liver diseaseNo neurological diseaseNo other chronic conditionsNo splenectomyNo immunosuppressionNo steroidsBMI not in the at-risk rangeNot pregnantNot from BAME originOther risk factorsClinical impression →Mild symptoms + low risk signsModerate symptoms + medium risk signsModerate symptoms + high risk signsSevere symptomsMild - low risk textModerate - medium risk textModerate - High risk textSevere - High risk textMild symptoms + low risk signs No moderate or severe symptoms Sats ≥ 95% HR ≤ 90 RR ≤ 20 NEWS-2 score = 0-2 ▼ Moderate symptoms New breathlessness on walking Dizzy/faint on walking Severe headache Not passing urine Moderate tight chest/wheezy MEDIUM RISK SIGNS No Desaturation with exertion on desaturation test or ≤ 2% from resting values Sats = 93-94 (or individualise for patients with chronic hypoxia) HR = 91-130 RR = 21-24 NEWS-2 score = 3-4 Speaking in full sentences Deteriorating symptoms ▼ Moderate symptoms New breathlessness on walking Dizzy/faint on walking Severe headache Not passing urine Moderate tight chest/wheezy HIGH RISK SIGNS Desaturation with exertion on desaturation test of ≥ 3% from resting values Sats ≤ 92% (or individualise for patients with chronic hypoxia) HR ≥ 131 RR ≥ 25 NEWS-2 score ≥ 5 Unable to speak full sentences Signs of sepsis Other emergency signs ▼ Severe symptoms Drowsy/Unconscious or new onset confusion Cannot stand due to dizziness/faintness Cannot complete sentence due to SOB Cardiac chest pain Not passed urine in last 24 hours HIGH RISK SIGNS Sats ≤ 92% (or individualise for patients with chronic hypoxia) HR ≥ 131 RR ≥ 25 NEWS-2 score ≥ 5 Unable to speak full sentences Signs of sepsis Other emergency signs ▼Management →Select multiple options then edit text boxes belowExplanation, advice, and discussionSign-posted to NHS PILSelf-isolateArrange COVID testSADMAN drug advice givenSymptomatic treatment advice givenAgreed on a trial of home-based treatmentOximetry @Home referralOxygen saturation monitoringFollow-up and referral adviceSafety netting**Moderate symptoms + medium risk signs- Normal advice and symptomatic treatment- Signposted to www.nhs.uk for written information and self-management advice- To have investigations done and call the surgery for results and review **Moderate symptoms + high risk signs- Discussed medication- Prescription issued- No contra-indication to medication- Discussed mechanism of action, time to benefit, side-effects and risks- Call surgery or pharmacist is any problems **Severe symptoms- Advised to seek further review if not improved as expected in [time-frame]- To call the surgery/111 if worse, new symptoms or not improving- Safety netting advice regarding the development of red flags or significant deterioration that need an immediate review at the surgery or OOH or A+E- Aware to seek immediate medical review if any concerns Add to practice list of known/suspected Covid 19 patients (and notify public health) Self management advice Antigen testing, Stay at home advice & safety netting [Source] Currently medium risk Add to practice list of known/suspected Covid 19 patients (and notify public health) Consider trial of treatment at home Consider treatment to prevent secondary bacterial pneumonia (Doxycycline 200mg day 1 then 100mg for 4 days OR Amoxicillin 500mg tds for 5 days) Treat an exacerbation of asthma or COPD IF known steroid responsive Consider high dose bronchodilators (4-8 puffs salbutamol via large volume spacer (or nebuliser) Antigen testing, Stay at home advice & safety netting Arrange daily follow up call via hot site or GP to assess breathlessness at rest/with usual activity and daily pulse oximetry Follow up until 48 hours of improvement in symptoms and O2 Saturations refer to seondary care if deteriorating saturations Patient to call 999 if deteriorating [Source] 999 Hospital Admission unless: Advance Care Plan/plan on CMC. Refer to local primary and palliative care teams Assess comorbidities and underlying health conditions in conjunction with Clinical Frailty Score [Source] 999 Hospital Admission unless: Advance Care Plan/plan on CMC. Refer to local primary and palliative care teams Assess comorbidities and underlying health conditions in conjunction with Clinical Frailty Score [Source] Useful links NHS - self isolation and treatment COVID isolating at home PIL + Safety netting advice NHS volunteer responder support service Remote oximetry monitoring Sick day rules - SADMAN Diabetic Sick day rules Management 2) Edit the text boxes to reflect the management recommendations you have made for the present clinical case. Newline ----- Explanation, advice and discussionNewline ----- Sign-posted to NHS PILNewline ----- Please arrange a COVID-19 testNewline ----- Self isolate for 10 days (household for 10 days) or until your test is confirmed negativeNewline ----- SADMAN drug advice givenDocument meds here if needed and use links to advise regarding sick day rules especially for DiabeticsNewline ----- SADMAN drug advice given 2- Explained illnesses like COVID-19 can cause dehydration which in combination with (SADMAN) medication can lead to more serious illness. - Advised to temporarily STOP (SADMAN) medication. Can restart when well (after 24-48hrs of eating and drinking normally). Can seek further advice if in any doubt.Newline ----- Symptomatic treatmentNewline ----- Symptomatic treatment advice 2- Stay at home, rest (not advisable to push yourself), and drink 6-8 glasses of water a day - Antipyretics as needed (seek advice if fever persists > 39 despite Rx) - Monitor breathing - advised may help breathing to lie on the front or lie on the side if unable to lie on the front, rotate position every 2 hours front/side/sitting up - Ask someone to check on you regularlyNewline ----- Trial of home based treatmentNewline ----- Oximetry @Home referralNewline ----- Oximetery- Record your oxygen level 3 times a day and take extra measurements if you feel there has been a change in your health - follow the instructions in the PIL - link given - https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/06/C0445-Remote-monitoring-in-primary-care-Annex-2-diary.pdfNewline ----- Prescription 3Newline ----- Safety nettingSafety netting advice given about when and where to seek further medical advice: Contact NHS 111 as soon as possible by the phone (111), online (111.nhs.uk) or via the practice if you experience any of the following: - Feeling breathless or difficulty breathing, especially when standing up or moving - Severe muscle aches or tiredness - Shakes or shivers - If you use a pulse oximeter, your blood oxygen level is 94% or 93% or continues to be lower than your usual reading where your normal oxygen saturation is below 95% (re-take a reading within an hour first) - Sense that something is wrong (general weakness, severe tiredness, loss of appetite, peeing much less than normal, unable to care for yourself – simple tasks like washing and dressing ormaking food). You should attend A&E as quickly as possible or call 999 immediately if you experience the following: - Your blood oxygen levels are 92% or less (retake your reading immediately first) - You are unable to complete short sentences when at rest due to breathlessness - Your breathing gets worse suddenly. OR if you develop these more general signs of serious illness: - Chest pain or Cough up blood - Feel cold and sweaty with pale or blotchy skin - Collapse or faint - Develop a rash that doesn’t fade when you roll a glass over it - Become agitated, confused or very drowsy - Stopped passing urine or are passing urine much less than usual.COVID isolating at home PIL (pdf - contains O2 sats monitoring advice)Prescription 4Prescription 5Newline ----- Safety netting 1Newline ----- Safety netting 2Newline ----- Safety netting 3Newline ----- Safety netting 4Newline ----- 3) Click the button to review your clinical note. 4) Edit, select (Ctrl A), copy (Ctrl C) and paste (Ctrl V) the text below into the consultation template or directly into the clinical notes. {HighRisk:57:value} {MyField:54:value} {ModRisk:58:value} {MyField:55:value} {NegRisk:59:value} {Text:56:value} {ClinicalImpression:63:value} {MyField:64:value} {MyField:65:value} {MyField:66:value} {Newline:7:value} {Text:8:value} {Newline:9:value} {Text:10:value} {Newline:11:value} {Text:14:value} {Newline:15:value} {Text:12:value} {Newline:13:value} {Text:16:value} {Newline:17:value} {Text:67:value} {Newline:19:value} {Text:18:value} {Newline:21:value} {Text:68:value} {Newline:23:value} {Text:20:value} {Newline:25:value} {Text:22:value} {Newline:27:value} {Text:69:value} {Newline:29:value} {Text:28:value} {Newline:31:value} {Text:62:value}
