COVID-19 TRAINING FOR HEALTHCARE WORKERS 

Identification and Approach to the Sick Patient 

M. Strehlow, MD 
 
LEARNING OBJECTIVES - ALL 
At the end of this lecture, the learner will be able to: 
1. Recognize acutely sick patients 
2. Systematically assess undifferentiated acutely sick patients 
3. Provide immediate stabilization measures to acutely sick patients 
 
LEARNING OBJECTIVES - PHYSICIANS 
1. Learn the emergency medicine approach to undifferentiated patients – evaluate, think, act 
simultaneously 
 
KEY TEACHING POINTS - ALL 
1. Immediate assessment of patients should follow a standard approach beginning with general 
appearance, level of consciousness, ABC’s, and vital signs 
2. Learn a standard language for level of consciousness – AVPU (Alert, Verbal, Pain, 
Unresponsive) 
3. Recognize high-risk findings on initial assessment 
4. For possible COVID-19 patients pay close attention breathing 
5. Perform immediate interventions including call for help, open airway, support breathing, 
perform CPR, provide oxygen, and establish IV 
 
KEY TEACHING POINTS - PHYSICIANS 
1. Recognize the use of GCS as a standardized tool for assessing and communicating neurologic 
status 
2. Rapidly evaluate an unstable patient 
3. Develop an early differential diagnosis 
 
 
 
OUTLINE 
1. Recognize acutely sick patients 
a. General appearance 
b. Level of consciousness  
i. Alert 
ii. Verbal 
iii. Painful stimuli 
iv. Unresponsive 
c. ABC’s 
i. Airway 
1. Clear and protected 
a. Speaking clearly 
2. Obstructed or not protected 
a. Listen for 
i. Gurgling 
ii. Stridor 
iii. Snoring 
b. Look for 
i. Pooled secretions 
ii. Foreign bodies 
iii. Presence of gag reflex 
iv. Cyanosis 
ii. Breathing 
1. Normal 
a. Speak full sentences 
2. Distressed 
a. Difficulty speaking 
b. Other signs of respiratory distress  
iii. Circulation 
1. Normal 
 a. Strong radial pulse at normal rate 
2. Weak or absent radial 
a. Check central pulse if absent radial 
b. Absent central pulse consider 
i. CPR 
ii. IV Fluids 
iii. Cardiac monitor 
d. Vital signs 
i. Importance – check early, all and often 
1. Respiratory rate 
2. Heart rate 
3. Blood pressure 
4. Oxygen saturation 
5. Temperature 
ii. Use pediatric tables if less than 14 years of age 
2. Importance of systematic approach 
a. System is designed to check items in order time a patient can survive with severe 
abnormality before death 
b. System is designed to avoid forgetting key steps by doing the same thing every time 
3. Immediate interventions (specific interventions are described in other sections) 
a. Interventions should be done immediately once the abnormality on ABCs is identified 
b. If unclear or abnormal AVPU, begin with oxygen and consider IV 
4. Evaluation tips 
a. Introduce yourself 
b. Get to eye level (sit if possible) 
c. Listen for the first minute (if stable) 
d. Explain what will happen during visit 
e. Provide updates 
f. Be helpful 
5. Provider tips 
a. Importance of frequent repeat evaluations 
i. Stable patients may become unstable 
 b. Patient’s with no concerning abnormalities on Initial Assessment may still have a 
serious medical condition 
c. Practice on all patients this approach and it makes it easy during an emergency 
d. Listen to the patient’s history, it is critical 
6. Glasgow coma scale (Physicians) 
a. 15 point scale 
i. 13-15 similar 
ii. <8 very concerning that patient may not be able to protect airway 
b. Verbal – 4 points 
c. Speech – 5 points 
d. Motor – 6 points 
e. Utility of GCS versus AVPU 
7. Emergency medicine approach 
a. Evaluate, Think, Act simultaneously 
b. Evaluate 
i. Determine if obviously unstable or appears stable 
ii. Unstable patients 
1. Evaluate 
a. SAMPLE history 
b. Focused  
2. Think 
a. Differential diagnosis 
i. Common things are common 
ii. Think worst first 
iii. Re-evaluate differential diagnosis as new information 
obtained 
iv. Not getting definitive diagnosis is okay, we are still 
treating the patient 
3. Act 
a. Diagnostic testing 
b. Additional treatment 
 
REFERENCES/SUGGESTED READING: 
 1. AHA Basic Life Support 
2. AHA Helping Babies Breath 
3. AHA Pediatric Advanced Life Support 
4. What every provider should know course edX and Digital Medic 
 
INFOGRAPHICS 
● GCS 
● General Appearance/AVPU and ABCs and implement oxygen and IV