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101. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version)

, the nurse should analyze the cause comprehensively andbe vigilantto notify thedoctor. 8.2.2 Nursing of medication Mild patients generally use antiviral drugs, antibacterial drugs (when bacterial infection exists), and symptomatic treatment. The doctor’s advice should be followed accur- ately and timely. The adverse reactions of oseltamivir mainly include nausea, vomiting, diarrhea, abdominal pain and bronchitis, cough, etc. The adverse reactions of inter- feron are mainly flu-like symptoms such as fever

2020 Covid-19 Ad hoc guidelines

102. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19)

with Staphylococcus aureus is common with in?uenza pneumonia and can be especially virulent [154]. Recent clinical practice guidelines recommend initiating empiric antibacterial therapy in adults with community-acquired pneumonia who test positive for in?uenza [154]. Data from critically ill patients demonstrate secondary infection in about 11% of cases, although the numbers are small. Isolated organisms included gram-negative Intensive Care Medicine GUIDELINES Un-edited accepted proof* © European Society (...) of Intensive Care Medicine and the Society of Critical Care Medicine 2020 31 organisms such as K. pneumoniae, P. aeruganosa, and S. marcescens. On the basis of these limited data it is difficult to determine patterns of superinfection, including the risk of S. aureus infection, commonly seen in influenza. In patients with COVID-19 and hypoxic respiratory failure requiring mechanical ventilation, the panel suggest empiric antimicrobial treatment, on the basis that superinfection is reasonably common

2020 Covid-19 Ad hoc guidelines

104. Covid-19: National supporting guidance for Scottish General Practice

be considered for review by the practice: ? Routine bloods ? Routine BPs ? Other routine work ? Medication Reviews ? Long term condition/ Chronic Disease Reviews ? Review of Enhanced Services eg Minor Surgery, Diabetes etc ? Review all Private Work – routine medical reports, ESA, PIP forms, Insurance medical forms, HGV medicals etc ? Review all Subject Access Requests ? Lower threshold to issue acute medicines on request rather than make contact with patient ? Lower threshold for antibiotic prescribing (...) /watching TV, less concerning than lying in bed not wanting to do anything at all). FEVER/COUGH/SHORTNESS of BREATH/UNWELL: • Use the NHS24 COVID-19 Assessment Tool (see below) COVID 19 GP Assessment Tool V1.0.pdf COVID 19 Self Care V0.6.pdf • Remember, some patients have BP machines and pulse oximeters at home - ask. What is normal for them? • Assess whether they need hospitalisation. If symptoms of pneumonia (green/yellow sputum) prescribe antibiotics. If not send them the COVID-19 Self Care document

2020 Covid-19 Ad hoc guidelines

105. Critical Care Preparation and Management in the COVID-19 Pandemic

dose (MAC 0.2-0.5) inhalational anaesthesia may be used to maintain sedation with a volatile agent in a low-flow (circle) system. Ventilation Ensure use of an antimicrobial filter within the circuit or placed on the expiratory limb or ventilator exhaust. Note that filters represent an airflow obstruction risk when saturated and routine exchange is advised. Use in-line suction catheters where possible. Avoid inadvertent ventilator circuit disconnections by ensuring all connections are 'tight (...) .' Manual ventilation, or 'hand-bagging' is not advised. Ensure the endotracheal tube is clamped during any planned circuit disconnection, eg switching between ventilators, replacing the antimicrobial filter, or inserting a bronchoscope into the tube. Management of Acute respiratory distress syndrome (ARDS) Follow including: lung protective ventilation conservative fluid management strategy neuromuscular blockade lung recruiting manoeuvres and ventilator modes (eg APRV). Further information from

2020 ICM Anaesthesia COVID-19

106. Covid-19: Guidance on adaptations to standard UK critical care medication prescribing and administration practices during pandemic emergency pressures

sparing agents. However, beware that these are less titratable. Antibiotics ? Consider not commencing antibiotics empirically at presentation. ? Continue to follow local antimicrobial policies unless specific shortages occur. ? Continue to practice good antimicrobial stewardship with regular review to stop, de- escalate or switch to oral/ enteral route. Stress ulcer prophylaxis ? If standard practice is intravenous ranitidine consider switching to PPI if unavailable or stopping once enteral feed (...) . ? Consider the local implementation of teams to administer IV medicines (e.g. roles for doctors who are re-deployed from other clinical areas). ? Consider bolus dosing / administration of medicines where possible (e.g. magnesium, certain antibiotics). ? Administration (i.e. if a person in PPE already, doctor or nurse, to check which other professional group role needs to be done in any given timeline). 2 Alternative techniques First line drugs / priority clinical indications Alternative drugs Sedation

2020 ICM Anaesthesia COVID-19

107. Management of patients with severe to critical COVID-19

antibacterial agents, over no antibacterials. If the treating team initiates empiric antibacterials, they should assess for de-escalation daily, and re-evaluate the duration of therapy and spectrum of coverage based on the microbiology results and the patient’s clinical status. [Adapted from SSC] 33.36 For mechanically ventilated adults with COVID-19 and moderate to severe ARDS: We suggest using, as needed, intermittent boluses of neuromuscular blocking agents (NMBA), over continuous NMBA infusion

2020 National COVID-19 Clinical Evidence Taskforce

108. Assessing the infection prevention and control measures for the prevention and management of COVID-19 in healthcare settings

. 7. Lai CC, Shih TP, Ko WC, et al. Severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. International Journal of Antimicrobial Agents 2020; (no pagination). Review. 8. Jin YH, Cai L, Cheng ZS, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Military Medical Research 2020; 7 (1) (no pagination). Review. 9. Wax RS

2020 Covid-19 Ad hoc guidelines

110. Clinical guide for the management of respiratory patients during the coronavirus pandemic

physicians have support and training in helping deliver some routine respiratory care. This could be facilitated by deploying hospital-based nurses to support colleagues. Ambulatory care and management of pleural disease • Maximise ambulatory care options to allow safe discharge from A&E/MAU of appropriate cases • Use home intravenous antibiotic services where available • Move to a day case, ambulatory care model for pleural disease • Agree local pathways for pleural disease that can be used for urgent (...) admission avoidance • There should be a clean day case area for patients to attend for pleural procedures, administration of biologics for asthma, insertion of lines and test dose of antibiotics for CF 3 | Clinical guide for the management of respiratory patients during the coronavirus pandemic Outpatient clinics GIRFT has produced a virtual working guide as part of this series of Specialty guides: www.england.nhs.uk/coronavirus/secondary-care/other-resources/specialty-guides/ • The majority

2020 Covid-19 Ad hoc guidelines

111. Information for adult patients with immune thrombocytopenia in the setting of COVID-19 pandemic

Cyclosporine Vincristine Rituximab (given in the past 12 months) Splenectomy (patients are advised to be diligent with their antibiotic prophylaxis and be up- to-date with their vaccination schedule) Neither Romiplostim (N-Plate) nor Eltrombopag (Revolade) will affect the immune system and risk will depend on other treatments being received at the same time or in the recent past. Any change in ITP medication should be discussed with your ITP centre and should NOT be discontinued unless advised. If you

2020 Covid-19 Ad hoc guidelines

112. Haemoglobinopathy HCCs response to Covid-19

. If they present out of hours the patient or the admitting medical/haematology teams should be encouraged to contact the haemoglobinopathy teams. If self-isolating they should be given additional antibiotics, phone follow up should be arranged and they should be asked to present if they have worsening symptoms. Red flag symptoms: Patients should be encouraged to attend the Emergency Department (A+E) or call 999 if any of the following occur: ? Uncontrolled pain >7/10 despite usual home analgesia ? Respiratory

2020 Covid-19 Ad hoc guidelines

113. Care of patients with liver disease during the COVID-19 pandemic: EASL-ESCMID position paper

injury with jaundice seem to be rare 39 Patients with decompensated cirrhosis should not be treated Consider risk of HBV reactivation 40 Methylprednisolone (steroids) Corticosteroids bind nuclear receptors to dampen proin?ammatory cytokines Mostly used in patients with septic shock Currently NOT recommended by WHO 41 The risk of other infections (e.g. SBP) and viral shedding may increase in patents with decompensated liver cirrhosis Consider antimicrobial prophylaxis Consider risk of HBV

2020 European Association for the Study of the Liver

114. Clinical care of severe acute respiratory infections – Tool kit

transportation 64 5.8 Guideline for specimen transportation 65 5.9 Guide for blood culture collection 66 6. OXYGEN THERAPY 67 Summary 68 References and resources 69 6.1 Algorithm to deliver increasing oxygen in adults 70 6.2 Algorithm to deliver increasing oxygen in children 71 6.3 Checklist to troubleshoot warning signs during oxygen delivery 73 6.4 Algorithm to escalate supportive respiratory therapy 74 7. ANTIMICROBIAL THERAPY 75 Summary 76 References and resources 77 7.1 Anti-COVID-19 therapeutics 79 7.2 (...) Pneumonia severity and empiric antimicrobial therapy 80 7.3 Oseltamivir notice 82 8. SEPSIS AND SEPTIC SHOCK 85 Summary 86 References and resources 87 8.1 Sepsis definitions 89 8.2 Targeted resuscitation in adults in an ICU setting 90 8.3 Initial resuscitation, fluid and vasoactive-inotrope management algorithm for children with septic shock 91 8.4 Guide to the use of vasopressors in septic shock for adults and children 93 8.5 Passive leg raise 94 Clinical Care for Severe Acute Respiratory Infection

2020 WHO Coronavirus disease (COVID-19) Pandemic

115. Water, sanitation, hygiene and waste management for COVID-19

solution, mixing detergent with water can be used j . The ratio of detergent to water will depend on types and strengths of locally available product. 39 Soap does not need to be antibacterial and evidence indicates that normal soap is effective in inactivating enveloped viruses, such as coronaviruses. 40,41 Alcohol-based hand rub should contain at least 60% alcohol. Such products should be certified and, where supplies are limited or prohibitively expensive, can be produced locally according to WHO (...) , Yeasmin D, Akhter S, et al. Nonrandomized Trial of Feasibility and Acceptability of Strategies for Promotion of Soapy Water as a Handwashing Agent in Rural Bangladesh. The American journal of tropical medicine and hygiene. 2017;96(2):421-9. doi: 10.4269/ajtmh.16-0304. 40. Montville R, Schaffner DW. A meta-analysis of the published literature on the effectiveness of antimicrobial soaps. J Food Prot. 2011;74(11):1875-82. doi: 10.4315/0362-028X.JFP-11-122. 41. Sickbert-Bennett EE, Weber DJ, Gergen-Teague

2020 WHO Coronavirus disease (COVID-19) Pandemic

116. Laboratory testing for coronavirus disease (COVID-19) in suspected human cases: interim guidance

* For transport of samples for viral detection, use viral transport medium (VTM) containing antifungal and antibiotic supplements. Avoid repeated freezing and thawing of specimens. If VTM is not available sterile saline may be used instead (in which case, duration of sample storage at 2-8 °C may be different from what is indicated above). Aside from specific collection materials indicated in the table also assure other materials and equipment are available: e.g. transport containers and specimen collection

2020 WHO Coronavirus disease (COVID-19) Pandemic

117. Current epidemiology and guidance for COVID-19 caused by SARS-CoV-2 virus, in children: March 2020

-be-used-in-children-when-covid-19-is-suspected March 2020. Korean Society of Infectious Diseases; Korean Society of Pediatric Infectious Diseases; Korean Society of Epidemiology; Korean Society for Antimicrobial Therapy; Korean Society for Healthcare-associated Infection Control and Prevention; Korea Centers for Disease Control and Prevention. Report on the epidemiological features of coronavirus disease 2019 (COVID-19) outbreak in the Republic of Korea from January 19 to March 2, 2020. J Korean Med

2020 Canadian Paediatric Society

118. Sepsis and the Emergency Department

of rapid antibiotic treatment, and benefit of care bundles [3,4], however these are the mainstay of management 6. Ensuring audit of these processes, and sepsis care. 7. Ensuring compliance with minimisation of inappropriate antibiotic use* 8. Ensuring staff compliance with Infection Control (including hand hygiene and procedural) policies, and regular audit of this 9. Ensure compliance with Public Health requirements for epidemic and imported disease Those patients being discharged home (e.g. with oral (...) antibiotics, or with a diagnosis of a viral infection (where antibiotics will not help)) should receive clear advice with regards what to do if their condition deteriorates and what specific signs to look out for. *Whilst time to antibiotic for patients with Sepsis is an important measure; for those patients who do not have Sepsis it is important that merely having an abnormal early warning score is not used as an indication to give IV antibiotics ‘just in case’ or for a poorly chosen antibiotic

2020 Royal College of Emergency Medicine

119. Covid-19: Management of emergency department patients

presentations not requiring admission: (taken from same day emergency care (SDEC) guidelines, documents and expert advice from national clinical directors) Expect not to admit overnight the following: Clinical specialty Emergencies that do not require admission Respiratory Pneumonia/COPD without oxygen /NIV requirement. May need initial antibiotics and assessment of response (yet may not require an overnight stay). Asthmatic with PEFR > 75% best or predicted PE without physiological compromise CNS Stroke (...) with clinical decision for oral antibiotic or SDEC i.v. Toxicology Overdose patients with non -toxic levels or asymptomatic 6-12 hrs after ingestion (guided by ToxBase) Other Patients on an end of life pathway or for whom ceiling of care does not require hospitalisation All patients in the above groups who are not admitted must receive appropriate follow up, wherever possible by telephone/video call etc. Advice for patients with flu like symptoms who are not being admitted PHE has published clear guidelines

2020 Covid-19 Ad hoc guidelines

120. Covid-19: Management of palliative care in hospital during the coronavirus pandemic

not already exist. NHS England and NHS Improvement Goals of care The treatment of patients suffering from coronavirus may be orientated towards: • • • Supportive measures – for example, provision of fluids and/or oxygen. Targeted treatment – for example, provision of antibiotics to treat pneumonia. Organ support – for example, ventilator support, renal replacement therapy, etc. These are aimed at preserving and prolonging life. It is important to remember that most people with coronavirus will survive (...) supportive treatments and management of their comorbidities has been optimised. The good practice approach to symptom management is as follows: • Correct the correctable, for example, give the patient antibiotics for a bacterial infection. • Non-drug approaches, especially in mild to moderate disease – see Appendix 1. 3 | Clinical guide for the management of palliative care in secondary care during the coronavirus pandemic, Version 1 • Drug approaches – see Appendix 1. The most common symptoms

2020 Covid-19 Ad hoc guidelines

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