AFVOA Newsletter 03 of 2020

Section 5 - Memoirs CV 2 No. 03 / 2020 Page 71 of 167 Patient having breathlessness require O2 support –ADMIT TO COVID HEALTH CARE CENTRE (CHCC) It has 3 different Isolation wards for admission. Category 1: - Patient comfortable with Nasal O2 alone, monitoring vital signs & Drug Prophylaxis Category 2: - Shortness of breath present, these Patients require intubation & Continuous oxygen and are treated in ICU for chest congestion with medication. Category 3: - Patient seriously ill with cytokine storm are managed in special units with VENTILATORS & ECHMO facilities by the specialists. MANAGEMENT PROTOCOL IN ICU – 5 “D” s- DIURETICS - COVID -19 causes wet lungs due to viral Pneumonia causing ARDS (Acute Respiratory Distress Syndrome) hence patient kept at negative fluid balance. DEXAMETHASONE-(Steroid) DEXAMETHASONE is the cornerstone in the treatment and is the life-saving drug especially if patient’s O2 saturation deteriorates. DALTAPARIN (LMWH) Heparin is the most important drug used along with steroids for all patients on O2 supplementation as they are immobile risk of DVT (Deep vein Thrombosis) & Pulmonary Embolism. DOWN POSITION -( PRONE POSITION ) helps fluid to gravitate also improves O2 supply to the lungs and helps patients to wean out from ventilator support DRUGS (ROLE OF ANTI-VIRALS) TOULUZUMAB is vital and should be started early when viral load is high before cytokine storm hits as seen by high IL6 & Lymphopenia. Serial blood tests indicating neutrophil raising & Lymphocyte falling this drug helped to reverse it. REMDESVIR & OSELTAMAVIR were used extensively with promising results. IMPORTANT FACTOR WAS RISK TO DOCTORS & NURSES – PPE kit donning & removing was an arduous task for them and risk was high with intubation & tracheostomy POST –COVID SCENERIO- Patients who have recovered are showing feature of Chronic Fatigue Syndrome & Myalgia. Insomnia or lack of sleep due to high levels of anxiety are seen. Also Severe complications like Lung Fibrosis with reduced pulmonary Function. Higher incidence of Myocardial Infarction post covid-19 attack has been reported. Statins & Aspirin are helpful for long –term prophylaxis Follow up with Cardiac Assessment is vital.