Critical Care of COVID-19 in the Emergency Department

Preface
Contents
Contributors
1: Overview of the COVID-19 Infection
Introduction
Epidemiology
Virology
Virion Structure and Host Cell Entry
Viral Replication
Viral Transmission
Viral Shedding
COVID19 Clinical Presentations
Conclusion
References
2: Management of Undifferentiated Critically Ill COVID-19 Patients
Background
Initial Management of Undifferentiated Critically Ill COVID-19 Patients
Airway
Breathing
Computed Tomography (CT) of Chest as Diagnostic and Prognostic Tools
Awake Proning to Prevent Intubation
Circulation
Shock
Coagulopathy
Pulmonary Embolism (PE) Among Patients with COVID-19
Ischemic Stroke
Other Considerations
In-Hospital Cardiac Arrest Among Critically Ill COVID-19 Patients
Quality of Cardiopulmonary Resuscitation During the Pandemic
Therapeutic Treatments for COVID-19
Remdesivir
Corticosteroids
Risk Factors and Prediction Scores
References
3: Personal Protection During Patient Care and Procedures
Introduction
Particle Dynamics
Personal Protection Equipment
Gowns
Masks
Eye Protection
Powered Air-Purifying Respirator
Side Effects and Barriers to Use
Donning and Doffing
Rooming and Isolation Procedures
Rooming Practices and Guidelines
Universal Enhanced Precautions and Testing
Entry to Healthcare Facility and Waiting Rooms
Clinical Considerations
Aerosol-Generating Procedures
Intubation
Cardiopulmonary Resuscitation
Recommendations
References
4: Evaluation and Diagnosis of COVID Illness
Introduction
Community
Healthcare Setting
Patient Presentation
Testing: Laboratory
Testing: Imaging
Testing: Diagnostic Testing of SARS-CoV-2
Testing: Summary of Strategies in the ED Setting
References
Further Reading
5: Noninvasive Respiratory Support for COVID-19
Introduction and Background
Low to Moderate Flow Devices
Heated High-Flow Nasal Cannula
Positive Pressure Noninvasive Ventilation
Aerosol Generation
Awake Prone Positioning
Therapeutic Progression
References
6: Mechanical Ventilation in the COVID-19 Patient
Introduction
When to Initiate Mechanical Ventilation
Mechanical Ventilation Principles
Compliance and Ventilator-Induced Lung Injury
Achieving Lung Protective Ventilation
Set the Tidal Volume and Respiratory Rate
Set PEEP and FiO2
Oxygenation Targets
Limit Airway Pressures
Fine-Tune PEEP and Tidal Volume
Step 1: Evaluate the stress index [50]
Step 2: Recruit what is recruitable
Limit Mechanical Power
Step 1: Reduce respiratory rate
Step 2: Reduce VQ mismatch and shunt with prone positioning
Step 3: Eliminate injurious spontaneous breathing
Alternate Ventilator Strategies
Outcomes and Complications
Mechanical Ventilation in Limited Resources
Conclusion
References
7: ECMO and Rescue Therapies for Severe Hypoxemia
Introduction
Brief History of ECMO and Use in Treatment of ARDS
Principles and Circuitry
Indications
Contraindications
Fundamental Management
Complications
Considerations
Conclusion
References
8: COVID-19: Cardiac Arrest Management
Prehospital Considerations
Intra-arrest Management
Personal Protective Equipment and Filtration Use
Airway Management
Etiologies of Cardiac Arrest
Duration of Resuscitation
Special Considerations
Post-Cardiac Arrest Management
Airway Management
Ventilator Management
Ventilation Goals
Hemodynamics
Neurologic Prognosis
COVID-19 Specific Therapeutics and Special Circumstances
References
9: COVID-19-Related Cardiac Illness
Introduction
Pathophysiology
Presentation
Early Studies
COVID-19 Specific Study Data
Arrhythmias
Myocarditis
Pre-existing Conditions
COVID-19 Workup from a Cardiac Perspective
Physical Exam
Cardiac Enzymes
Cardiac Ultrasound
ECG
Treatment
COVID-19 Drug Issues
References
10: COVID Cardiovascular Illness
Part 1 Cardiovascular: Introduction
Risk Factors
Pathophysiology
Treatment
Cardiovascular Management
Venous-Thromboembolic Disease, Anticoagulation, and Antiplatelet Therapy
Part 2 Vascular: Introduction
Pathophysiology
Treatment
References
11: COVID-19 Renal Illnesses
Epidemiology
Pathophysiology of Kidney Dysfunction
Clinical Manifestations
Treatment Approach
Anticoagulation
Remdesivir
References
12: COVID-19 Hepatic Illness
Overview/Introduction
Pathophysiology
Laboratory Findings
Preexisting Liver Disease and COVID-19
Hepatitis
Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis
Cirrhosis
Liver Transplantation
Current Management and Therapies and Their Hepatic Effects
Management of Liver Function Abnormalities
Current Therapies
Conclusion
References
13: Hematologic Emergencies in Patients with Covid-19
Introduction
Defining Hematologic Abnormalities in Covid-19
Thrombotic Events in Covid-19
VTE Diagnostic Considerations in Patients with Covid-19
Decision Tools
Laboratory Markers
Imaging
Diagnostic Strategy
Treatment of Macrothrombi
Anticoagulation in the Absence of Macrothrombi
Antiplatelet Agents
Fibrinolytic Therapy
Conclusion
References
14: COVID-19 Neurologic Illnesses
Introduction
Pathophysiology
Neurotropism
Endotheliopathy
Immunothrombosis and Coagulopathy
Clinical Syndromes
Central Nervous System
Alteration of Consciousness
Seizure
Ischemic Stroke
Intracranial Hemorrhage
Peripheral Nervous System
Conclusion
References
15: Pharmacological Agents for COVID-19 Patients
Introduction
Supportive Care
Therapeutic Review
Remdesivir
Remdesivir Literature
Monoclonal Antibodies
Development of Vaccine against SARS-CoV-2
Nucleic Acid (RNA and DNA Recombinant Vaccine Development) [31–37]
Viral Vaccines [33, 37, 40–42]
Live Virus Vector Vaccines
Johnson & Johnson’s Janssen Pharmaceutical Company [41–43]
Protein Subunit
Mucosal SARS-CoV-2 Vaccine [23, 45]
Development of Mutant SARS-CoV-2 Viruses [44, 46]
B.1.1.7 (501Y.V1) UK Variant [44, 47]
B1.351 (501Y.V2) South Africa [44, 47]
P.1 (501Y.V3) Brazil/Japan [46]
Management of Vaccine Side Effects [48]
Antibody-Dependent Enhancement (ADE) [49–51]
Conclusion
References
16: Point of Care Echocardiography in the COVID-19 Patient
Introduction
Safety Considerations
Cardiac POCUS in COVID-19
Indications [5]
Findings on Formal Transthoracic Echocardiography Studies
Basic Cardiac POCUS Protocol
Basic Technique [9]
Parasternal Long Axis (PLAX)
Parasternal Short Axis (PSAX)
Apical 4 Chamber (A4C)
Subcostal
Left Ventricular Function
Right Ventricular Function
Pulmonary POCUS in COVID-19
Indications [5]
Pulmonary Findings
References
17: Inter-Hospital Transfer of the Critically Ill COVID-19 Patient
Introduction
Regionalization
Knowing the Capabilities of Your Hospital
Local Management Versus Transfer
Futility Decisions
The Emergency Medical Treatment and Active Labor Act (EMTALA)
Timing of the Transfer Process
Transfer Procedures
Identify Patient Appropriate for Transfer
Initial Discussion with Patient/Family Regarding Intention to Seek Transfer
Identify Receiving Facility and Discuss Case with Accepting Physician
Obtain Consent for Transfer
Identify Appropriate Transfer Crew
Identify Appropriate Transfer Mode
“Package” Patient and Documentation for Transfer
Handoff to Transfer Crew
Timing of Departure
Conclusions
References
18: Surge Planning
Organizational Operations
Command
Communication and Information Management
Resource Management
Supply and Assets
Personnel
Surge Capacity
Space
Staff
Supplies
Allocation of Scarce Medical Resources
Summary
References
19: Surgical Emergencies
Introduction
Impact of COVID-19 on Patients Requiring Surgery
Patient Preparation for Surgery
Emergency Surgery in Patients with COVID-19
Strategy for Common Surgical Issues During the Pandemic
Appendicitis
Acute Cholecystitis
Abscesses and Soft Tissue Infections
Bowel Obstruction
Surgical Issues as a Sequelae of COVID-19
Emergency Surgery in Non-COVID-19 Patients During the Pandemic
Trauma
References
Index