BWH QUICK-REFERENCE GUIDE

COVID-19 Inpatient Management Version 092020.1

See also: Respiratory Failure and Drugs & Treatment COVI D-19 Testing and Flags  Start with PCR from ED
guides at https://covidprotocols.org/quick-guides
If POSITIVE: flag SarsCoV2
PPE / I nfection Control If NEGATIVE + SYMPTOMS
• Outside patient rooms: surgical masks • flag CoV-Risk and second PCR at 12 h; if second test...
• Inside patient rooms: N95 or PAPR, face shield, gown, ‫ ظ‬POSITIVE: flag SarsCoV2
bouffant/cap, gloves ‫ ظ‬NEGATIVE: flag CoV-Presumed and consider:
• Aerosol-generating procedure (AGP) precautions: serology, alternate etiologies, ID consult
‫ ظ‬PPE and negative pressure room if possible If NEGATIVE + NO SYMPTOMS
‫ ظ‬treat NG tubes and oropharyngeal procedures as AGP • Low risk: no flag
• Minimize contact, place infusion pumps and monitors • High risk: flag CoV-Risk (does not need SPICU)
outside room and use video/phone to talk with patients and second PCR at 12 h; if second test...
‫ ظ‬POSITIVE: flag SarsCoV2
Code Blue
‫ ظ‬NEGATIVE: no flag
• Before entering room: don full PPE
• Before compressions: bedsheet over face until intubated COVI D-19 Clearance
• Minimize personnel: 2 compressors, code leader, Currently hospitalized patients may be cleared by either:
code RN, anesthesiologist, RT
Testing Time
• Consider reversibility: > 90% COVID codes PEA/asystole
10 days since first positive 30 days since first positive
Floor Labs + 1 day after symptom + 1 day after symptom
resolution resolution
On admission CBC w Diff, BMP, Mag, LFTs, Trop, CPK, + at least 2 neg PCR swabs
NT-proBNP, LDH, CRP, D-dimer, Procal,
PTT/INR, Ferritin, Fibrinogen, EKG
Documentation / Notes
Daily (or if stable, CBC w Diff, BMP, Mag
every other day • GOC documented (ACP module in Epic) and healthcare
proxy form signed on admission
Every other day LFTs, Trop, CPK, NT-proBNP, LDH, CRP, • Dot phrases in Epic:
D-dimer, Ferritin, PTT/ΙNR, Fibrinogen
‫ ظ‬Admission: SPUADMITNOTE
Twice weekly sIL-2R ‫ ظ‬Progress: PACEPROGRESSNOTE
‫ ظ‬Discharge counseling: SPUCOUNSELING
• Expect: lymphopenia, mild thrombocytopenia, mildly ‫ ظ‬Discharge note: SPUDISCHARGECOVIDPOSITIVE or
elevated AST/ALT (if severe, consult hematology or GΙ)
SPUDISCHARGECOVIDNEGATIV
• Consider cytokine storm and consult Rheumatology if
clinical deterioration and elevated markers: Suppor t Teams
‫ ظ‬CRP > 50 plus any two of…
D-Dimer >1000; Ferritin > 500; LDH > 300 • Airway: p11668 (if STAT, p26555)
• ECMO: p35010
I maging • ICU triage: p39999
• Infection Control: p11482
• CXR on admission or PRN for clinical change:
• Medicine Bedside Procedure Service: p38552
‫ ظ‬expect: bilateral, basilar and peripheral GGOs,
• Palliative team: p42200
but can be unilateral or consolidated
• COVID clinical questions: ID team following, or p39634
• Do not order routine CT Chest; obtain only for alternate
• COVID flag management: p39635
concerns (eg, abscess, empyema, PE)
• COVID Nurse Administrator: p39284

FOR URGENT QUESTIONS: consult ICU Triage p39999. See https://covidprotocols.org/ for current full manual.