Running insitu SIM at CHT means we to learn and share our learning
Q: Why are Smurf’s Blue?
A: Methaemoglobin (MetHb) of course!
– MetHb is produced by oxidisation of the Iron in Haemoglobin (Hb) from Fe2+ to Fe3+
– Fe3+ prevents Hb carrying oxygen (thus produces symptoms of hypoxia)
– Often due to chemical ingestion, but may also be genetic
– Treated with Methyl Blue & supportive measures
Once the “Decision to Admit” has been made, an appropriate Covid-19 Test will need to be performed
Patients with Covid-19 symptoms should have 2 swabs taken immediately
Record result on EPR as “Covid-19 Antigen Lateral Flow – POCT”
Any patients identified by site commander as needing urgent result for flow reasons
(This also includes direct ward admissions to gastro and oncology)
Record result on EPR as “Covid-19 RNA PCR – POCT”
A swab MUST be taken and sent to the lab for PCR testing.
Patient does not wait in ED for result.
NIPPV 3 machines are used throughout the trust to deliver NIV and CPAP – and should be commenced in ED if transfer to ward/ICU is adding significant delay
This video demonstrates how to set up CPAP on the NIPPV 3
The 4C mortality score has been developed by ISARIC[BMJ], based on 35.463 UK Covid-19 patients.
If cases climb prognostication may become more important and this appears to be a good tool developed on a UK population.
*Comorbidities inc: Chronic cardiac disease; chronic respiratory disease (excluding asthma); chronic renal disease (estimated glomerular filtration rate ≤30); mild-to-severe liver disease; dementia; chronic neurological conditions; connective tissue disease; diabetes mellitus (diet, tablet or insulin-controlled); HIV/AIDS; malignancy; clinician-defined obesity.
Trust Guidance varies slightly from BNF for those patients over 100kg
|Dalteparin Cr Clearance >29ml/min||Dalteparin Cr Clearance 20-29ml/min|
|Weight (kg)||Dose||Weight (kg)||Dose|
|<45kg||7,500 units OD||<63kg||5,000 units am
2,500 units pm
|45-56kg||10,000 units OD||63-80kg||5,000 units BD|
|57-68kg||12,500 units OD||81-98kg||7,500 units am
5,000 units pm
|69-82kg||15,000 units OD||99-116kg||7,500 units BD|
|83-100kg||18,000 units OD||117-134kg||10,000 units am
7,500 units pm
|101-115kg||10,000 units BD||135-152kg||10,000 units BD|
|116-140kg||12,500 units BD|
|>140kg||15,000 units BD|
|<50kg||10,000 units OD|
|50-69kg||12,500 units OD|
|70-79kg||15,000 units OD|
|80-89kg||18,000 units OD|
|90-109kg||20,000 units OD|
|110-124kg||22,500 units OD|
|125-139kg||12,500 units BD
|140-154kg||15,000 units am
12,500 units pm
|155-169kg||15,000 units BD|
You may have seen in the news early results from the RECOVERY trial.
In Covid-19 patients requiring either Oxygen or Intubation, dexamethasone has been shown to reduce mortality.
Inclusion: Covid-19 patient requiring oxygen or intubation
Medication: (RECOVERY study protocol)
Post Dex Glucose monitoring: