covid community hubs induction course · safety, triage, assessment, treatment induction training -...
TRANSCRIPT
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COVID Community Hubs
Induction Course
UCD Centre for Emergency Medical Science
Welcome to the most people
you’ve probably seen
for a month!
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COVID Community HubsSafety, Triage, assessment, Treatment
Induction training - our aims
i. To competently manage safety procedures / PPE use.
ii. To familiarize staff with operational model and roles
iii. To provide core clinical content
iv. To establish team ethos
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9.00 Introduction – COVID-19
9.30 PPE video
NAS demonstration
10.00 Coffee
10.15 Donning PPE
Skills 1 – assessment / iNEWS
Skills 2 – COVID+ / ‘big sick’
Skills 3 – COVID+ / other illness
Doffing PPE
12.15 Community Hubs – operational model
12.30 Q&A, feedback
12.45 Finish
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SARS-CoV2
• Novel RNA virus
• Targets ACE2 receptors in lower respiratory tract
• R0 – 2.5 (?reported by HPSC as 4.5)
• Median incubation period 6/7, infective 1-2/7 pre-
symptoms
• RT-PCR +ve when symptomatic
• No antibody test in general use
• No useful response to antivirals5
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But…symptoms alone don’t distinguish between mild and
moderate or severe cases and clinical judgement should
always be used. Consider atypical presentations.
COVID Community Acquired Pneumonia
Clinical signs indicating deterioration
• Respiratory rate ≥20 per min
• Temperature ≥38 °C
• Pulse rate > per 100 min
• Hypoxia <92%, (<88% in COPD)
• Crackles +ve (But…auscultation may represent a significant risk
and may not add to the diagnostic accuracy of your assessment.)
Irish National Early Warning Score
(iNEWS)
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iNEWS
• Validated in Acute Care (hospital settings), pre-Covid-19
• Current community studies in UK
• Only valid if all parameters used
• Mixed evidence regarding its ability to predict adverse
events mortality or ICU admission based on 2019 SR with
21 studies and >225,000 patients)
• Regard it as a way of documenting observations
• Be aware of false reassurance
• Use your clinical judgement
Care plan
General principles
• ED, self-isolation at home, community isolation units
• Paracetamol po for pyrexia, O2 if hypoxic
• Specific therapies for problems in low acuity patients
• Ambulance service to ED for any hypoxic patient
• Follow-up with own GP – records in development
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Aerosol Generating Procedures
Bioaerosols can be dispersed widely
and persist for long periods
Therefore:
Resuscitation – use full PPE
Nebulisers – use spacer / MDI instead
CPAP – avoid
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Key clinical messages
• Context: Consider age and co-morbidities
• Clinical judgement plus red flags:
pO2 93 or less
Raised RR (>20)
Confusion
Pyrexia (>38)
Tachycardia (>100)
Hypotension (<110/100)
COVID Community Hubs
Purpose
Safety, Triage, Assessment, Treatment
i. Ensure safety of all involved in consultation
ii. Assess acuity
iii. Is this patient ‘big sick’? Is it due to COVID? Do they
need to be in hospital?
iv. Agree appropriate care plan: ED, home, isolation unit,
follow-up
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?
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Thanks to:
Prof. Susan Smith
Prof Colin Bradley
Prof Andrew Murphy
Dr. Nuala O’Connor
Dr. Diarmuid Quinlan
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Links
https://academic.oup.com/cid/article/52/3/325/305087
Centre for Evidence Based Medicine, Oxford
https://www.cebm.net/covid-19/rapid-diagnosis-of-community-acquired-pneumonia-for-clinicians/
https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/guidance/vulnerablegroupsguidance/COVID-19%20Guidance%20for%20extremely%20medically%20vulnerable%20V1.pdf
CEBM Symptom tracker
https://www.cebm.net/covid-19/covid-19-signs-and-symptoms-tracker/
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