Although COVID-19 seems a benign disease in almost all children there are increasing evidence (however rare) of a “Paediatric multisystem inflammatory syndrome”. This is a RARE and newly emerging condition and there are many questions still e.g. It is currently unclear if it is directly related to the COVID-19 pandemic.
Case definition (RCPCH)
A child presenting with persistent fever, inflammation (neutrophilia, elevated CRP and lymphopaenia) and evidence of single or multi-organ dysfunction (shock, cardiac, respiratory, renal, gastrointestinal or neurological disorder). This may include children fulfilling full or partial criteria for Kawasaki disease.
Exclusion of any other microbial cause, including bacterial sepsis, staphylococcal or streptococcal shock syndromes, infections associated with myocarditis such as enterovirus (waiting for results of these investigations should not delay seeking expert advice).
SARS-CoV-2 PCR testing may be positive or negative
As you are aware during the Covid-19 pandemic our use of oxygen has increased. However, supply is limited and most hospitals can only generate 3000-5000l/min of oxygen (i.e. enough to treat 300-500 patients on 10l/min). If you exceed this capacity the oxygen valves can freeze and the whole oxygen supply can fail (e.g Watford General closing)
In an effort to optimise our use of oxygen, so as many patients as possible can be treated, trust oxygen targets have been updated.
Oxygen prescribing targets
General Adults: oxygen saturation 92-96% (adjusted from the current range of oxygen saturation 94-98%) – inc. stroke, myocardial infarction, trauma
Type 2 Resp Failure: oxygen saturation 88-92%
Covid-19 Patients: oxygen saturation 90-94%
Evidence from clinical trials: suggests that hyperoxia may be harmful and lower oxygen target ranges are safe.
Experience is showing that those with diabetic patients with COVID-19 are more likely to develop DKA/HSS. However, treating them with the traditional large amount of fluid is detrimental to their chest, if they have Covid-19
Hence the following has been developed from the Guy & Thomas’ guidance – CLICK HERE
High Clinical Suspicion of Covid-19
Clinical: Fever ≥37.8°C plus any of; cough, short of breath, myalgia, headache, sore throat
NHS England has introduced the use of a “40 step desaturation test” into discharge planning from the ED. You will have heard Covid -19 patients complaining of increasing SOB on exercise, and it’s important that we test this prior to discharge.
Is this appropriate? – Could the patient walk 40 steps before they were ill?
During the current Covid-19 pandemic relatives are not attending the hospital with patients, which means we are increasingly having to have difficult conversations over the phone. Chelsea and Westminster have published this helpful guide.
Keep your language simple
Pauses can be helpful
Talk to your colleagues (these conversations will be difficult)