COVID-19 Eval and Management in the Emergency Department

I have to tip my hat on this one to my wife who found this and sent it to me but also to the authors. I agree with mostly everything on here. A link to this article and everything else I've ever posted is on eddyjoemd.com, on my stories, and on my highlights under "COVID-19".

Key take-aways from the Emergency Medicine News guideline of sorts for COVID-19 patients.

With regards to the labs:

- check a CMP, with magnesium and phosphorus.

- here's why. First of all, checking LFT's is necessary for calculating SOFA scores. In the setting of rationing off ventilators (hopefully it never gets to that), SOFA scores are going to be used for this. LFT's are part of the CMP.

- There's very poor data regarding Mg levels and QT intervals but repleting this electrolyte early does not cause harm and makes us feel all warm and fuzzy inside. Phos is also very important for respiratory muscle function. These patients have potentially been sick and not eating well. They may be hypophosphatemic. No data to prove this.

- D-dimer. Hopefully this will be the clinical turning point where people stop thinking about d-dimer only as a rule in or rule out of a PE. Sigh.


Poor prognostic factors:

Listed in the website but important to keep in mind.

Imaging:

I understand that in the ED you need to obtain some baseline imaging. But for those of us taking care of patients in the ICU and wards, we really need to consider how it's going to change the management of the patient. Remember that the radiology techs are being exposed as well. We need to take care of them, too.

Fluids:

PLEASE I BEG OF YOU DO NOT GIVE THESE PATIENTS FLUIDS FOR THEIR LACTATE! I have provided a body of data on this page to support not doing this. They also support starting vasopressors earlier. I have also provided data to support this practice and I do it myself.

I also despise maintenance fluids. If you're a doc or nurse on a COVID unit and you have patients receiving 0.9% saline at 125cc/hr, you really really need to consider the fact that you may be causing harm. Especially when the thought process at this moment for the renal failure is microangiopathic. DO NOT give fluids to try to flush out the kidneys and make the numbers pretty. This does not work like that.

Intubation and O2 therapy.

They make a lot of valid points here. Please check them out for yourself.

Definitely worth reading on your own time.

-EJ

Link to Website