Wear PPE according to local facility and
current NSW COVID-19 guidance.
Patients meeting case definition criteria should be streamed into a dedicated 'high-risk' zone, ensuring immediate isolation from other waiting patients.
When considering whether there is a
high epidemiological risk use this document in combination with your clinical assessment of the following to determine whether this is suspected COVID-19.
This table of symptoms is based on recent experience of Delta in Sydney and South Western Sydney Local Health Districts.
Undertake an ambulatory SpO2 for exertional hypoxia
If any exertional hypoxia noted discuss with your inpatient admission team
Some people are deteriorating rapidly and significantly within 6-12 hours.
These are only a guide for complexity of disease and should not replace clinical judgement.
Check if your patient has had a recent previous positive COVID-19 diagnosis and belongs to a community care team or is allocated to a virtual service.
For mild, moderate and severe:
Severe disease has been correlated with:
Aim for >/= 92% - 95%
Commence oxygen via nasal prongs and titrate to SaO2 92% - 95%
If unable to maintain SaO2>/=92% on 6L/min or if RR remains >30/min, then escalate support to HFO2, or NIV
Consult respiratory or ICU
Consider intubation as clinically necessary
PPE as per guide for aerosol generating procedures (AGPs)
Consider your fluid therapy
For those with GI symptoms
- do not withhold fluid therapy
250mL boluses up to 3 times if SBP 100mmHg
If not responsive commence on severe pathway as clinically indicated
No maintenance fluids unless specific indication
If not responsive, then commence vasopressors
Commence dexamethasone 6mg IV/PO daily for 10 days if requiring supplemental oxygen to maintain SpO2 >/=92%
For those already on steroids, increase current dose accordingly
Supportive anti-infectious therapy
Further information available at NSW TAG
Consider other pharmacological therapies in consultation with ID, respiratory or ICU specialists
For example: Remdesevir
Discharge – if no oxygen required or if weaned off oxygen and SpO2 is at, or above, 95% on room air
If exertional oxygen saturation drop is equal to, or more than 3% discuss with inpatient admissions team
For rural regions, consider presence of red flags or risk of severe disease when determining if a patient requires transfer to a facility with ICU
Admit patient and discuss with ICU
For rural facilities consider transfer to a facility with HDU/ICU onsite, unless an Advanced Care Directive is in place
Transfer of care to local COVID community care team for ongoing care
Educate patient about signs of deterioration and escalation
NSW Health guidance document
Caring for adults with COVID-19 in the community
Emergency Department COP Clinical Reference Group and ECI.
Dr Nigel Lyons, Deputy Secretary, Health System Strategy and Planning, NSW Ministry of Health.
Emergency Department COP and ECI.
This document is a quick reference guide for ED clinicians treating adults presenting to ED with symptoms consistent with suspected or confirmed COVID-19. This advice should be considered in conjunction with local guidelines.
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