Covid Notes

Covid notes :
Remdesivir :
Start remdesveer in xray involving or o2 dependant pts.
Inj remdesiveer 200 mg diluted in 200ml iv stat over 2 hrs. Then
Inj remdesiveer 100mg in 100 ml over 4 hrs*od for next 4 days.
If Ast, Alt r elevated more than 3 times:
Stop remd.
Repeat lfts every day. Then restart when trend starts getting normal .

how to write notes /dpns un every pt:

1st Send cbc rfts se, crp, ferritin, d dimers of pts whose labs r 3 days old, or repeat xray if 3
days old, in morning follow in evening.

Post admission day,

Saturation and o2 demand.
Co morbs
Tocli?
Remd day
Chest xray date,
hrct date if done,
Last pcr date,
antibiotics,
Anticoagulation,
Inflammatory markers date,
Which fluids?
Uop
Bsr.

covid pcr repeat if asyptomatic n last pcr was 8 days ago. Ideally 2 pcr needed for shifting ti
home or other ward.

Check lfts before remdesivir considetartion.

Multivitamins:
Tab cecon, surbex z, qalsan d.

If covid positive but asymptomatic :

Home isolation after discussion with family.

O2 dependant pts:
Start
Inj remdesveer
Inj clexane 40-60 mg. s/q
Inj dexa 6 mg iv od.

On discharge :
Tab azomax 500mg od for 5 days.
If pt was on iv rocephin and tlc count not yet settled : add tab cefsoan 400mg od for 5 days.
Cap risek 40 before break fast.
3 tyes of multivitamins.
Tab exept 15 mg 2 months.
Tab deltacortil 5 mg 3 plus 3 for 5 days.
If inj dexa given. Then tab deltacortil 5 mg
4+4... 5days
3+3...5 days
2+2.....5 days
1+1..... 5 days
1.....5 days.
Thn stop.
Tab myteka 10 mg at night.
Tab kestine 10mg at night.
Tocli:
Candidates : crp more than 75 plus nrb 10 litres.
8mg/ kg. Then again repeat same dose after 12 hrs.
If Alt or Ast r more than 3 times elevated then: 4mg/kg.
If Ast, Ast more than 5 times: dont give.

Contra: active t. b, zoster, increased tlc, sepsis, g. I perforate, M. S., Decrease plt count.
Side effects : super impose infection, acutely dec in bp, arrhythmias.

Dilute total dose in 200ml N/S then give in 2 hrs.

Premedicate with avil, solocortif.
Restless pt:
Discuss with S. R on call

0.2 cc serenace. IM or
Half tab serenase. Or
1mg to 1.5 mg inj serenase im.
Max 7mg per day
or
Inj dormi 2.5 mg
or
Presidex 2ml per hour continues infusion
Or
Inj valium 2.5 mg stat.

Ventilation :
if consent for vent given then
Do abgs atleast 12 hrly : if ph less than 7.2, or bicarb less than 20 or
Deasurating on max bipep or
Co2 retention
Call Anaesthesia : intubate.

Covid recovered pts vacancination: do after 3 months of recovery.

O2 settings :
We have to maintain saturation of pts equal or above 92 % in non smokers or non copd. 88-92
% in smokers, copd.
N.canula: 1 - 4 litres if not maintained then
Face mask: 5-8 litres then
NRB mask: 8-15 litres. Then
Intermittent nrb plus cpap.
Cpap: start at 8, max 12....thn shift to bipep

Contra to non- invasive ventilation : mi, arrythmia, pt in altered or severely confused state.
Increased co2: increase ipap
Decreased o2: increase epap