In 2022 we can now refer Covid-19 patients who are being discharged into the “Oximetry @home” pathway.
CHFT staff need to complete the attached referral form and email it to the LCD email address on the form. LCD will then make contact with the patient within 24 hours and onboard them (as it’s an 8am-6pm service).
Received AstraZeneca (AZ) COVID 19 vaccination within 42 days (typically 5-42 days from immunisation)
New Onset thrombocytopenia (PLTs <150×109/L) – with or without Thrombosis
5% of cases have had a “Normal” Platelet count at presentation
High index of suspicion repeat bloods next day
‘High index of suspicion’ in this context is day 5- 28 post AZ vaccine with new onset headache or abdominal pain which is atypical and severe in nature.
Initial Investigations:
FBC– specifically to confirm thrombocytopenia <150x 109/L
Coagulation screen and D Dimers
Blood film to confirm true thrombocytopenia and identify alternative causes
PROBABLE CASE: (ALL 3 criteria)
Received AZ COVID 19 vaccination within 42 days
New Onset thrombocytopenia (PLTs <150×109/L)
D Dimers > 2000 mcg/L
URGENT Scan to confirm the suspected clot.
[If patient doesn’t fit “PROBABLE CASE” proceed to usual treatment]
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
NIV/CPAP is an Aerosol Generating Proceedure (AGP)
Both COVID-19 infection and treatment with dexamethasone impair glycemic control. So its important to monitor blood sugars and consider DKA & HHS in COVID-19 patients.Latest guidance from DIABETES-UK
GLUCOSE MONITORING
Target glucose 6.0 -10.0 mmol/L (up to 12.0 mmol/L is acceptable)
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.
Oxygen – 20% reduction in mortality
Intubation – 35% reduction in mortality
No respiratory support required – No benefit found
Inclusion: Covid-19 patient requiring oxygen or intubation
Medication: (RECOVERY study protocol)
Dexamethasone administered as an oral (liquid or tablets) or intravenous preparation 6 mg once daily for 10 days.
In pregnancy or breastfeeding women, prednisolone 40 mg administered by mouth (or intravenous hydrocortisone 80 mg twice daily) should be used instead of dexamethasone.
Post Dex Glucose monitoring:
Glucose should be checked every 6hrs (ideally fasted i.e. before meal)
If Glucose ≥12, follow the chart below either guided by their normal Total Daily Dose (TDD) of insulin, or weight if insulin nave, or unknown.
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.
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.
Method:
Is this appropriate? – Could the patient walk 40 steps before they were ill?