COVID Community Hubs Induction Course · Safety, Triage, assessment, Treatment Induction training -...

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COVID Community Hubs

Induction Course

UCD Centre for Emergency Medical Science

Welcome to the most people

you’ve probably seen

for a month!

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COVID Community HubsSafety, Triage, assessment, Treatment

Induction training - our aims

i. To competently manage safety procedures / PPE use.

ii. To familiarize staff with operational model and roles

iii. To provide core clinical content

iv. To establish team ethos

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9.00 Introduction – COVID-19

9.30 PPE video

NAS demonstration

10.00 Coffee

10.15 Donning PPE

Skills 1 – assessment / iNEWS

Skills 2 – COVID+ / ‘big sick’

Skills 3 – COVID+ / other illness

Doffing PPE

12.15 Community Hubs – operational model

12.30 Q&A, feedback

12.45 Finish

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SARS-CoV2

• Novel RNA virus

• Targets ACE2 receptors in lower respiratory tract

• R0 – 2.5 (?reported by HPSC as 4.5)

• Median incubation period 6/7, infective 1-2/7 pre-

symptoms

• RT-PCR +ve when symptomatic

• No antibody test in general use

• No useful response to antivirals5

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But…symptoms alone don’t distinguish between mild and

moderate or severe cases and clinical judgement should

always be used. Consider atypical presentations.

COVID Community Acquired Pneumonia

Clinical signs indicating deterioration

• Respiratory rate ≥20 per min

• Temperature ≥38 °C

• Pulse rate > per 100 min

• Hypoxia <92%, (<88% in COPD)

• Crackles +ve (But…auscultation may represent a significant risk

and may not add to the diagnostic accuracy of your assessment.)

Irish National Early Warning Score

(iNEWS)

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iNEWS

• Validated in Acute Care (hospital settings), pre-Covid-19

• Current community studies in UK

• Only valid if all parameters used

• Mixed evidence regarding its ability to predict adverse

events mortality or ICU admission based on 2019 SR with

21 studies and >225,000 patients)

• Regard it as a way of documenting observations

• Be aware of false reassurance

• Use your clinical judgement

Care plan

General principles

• ED, self-isolation at home, community isolation units

• Paracetamol po for pyrexia, O2 if hypoxic

• Specific therapies for problems in low acuity patients

• Ambulance service to ED for any hypoxic patient

• Follow-up with own GP – records in development

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Aerosol Generating Procedures

Bioaerosols can be dispersed widely

and persist for long periods

Therefore:

Resuscitation – use full PPE

Nebulisers – use spacer / MDI instead

CPAP – avoid

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Key clinical messages

• Context: Consider age and co-morbidities

• Clinical judgement plus red flags:

pO2 93 or less

Raised RR (>20)

Confusion

Pyrexia (>38)

Tachycardia (>100)

Hypotension (<110/100)

COVID Community Hubs

Purpose

Safety, Triage, Assessment, Treatment

i. Ensure safety of all involved in consultation

ii. Assess acuity

iii. Is this patient ‘big sick’? Is it due to COVID? Do they

need to be in hospital?

iv. Agree appropriate care plan: ED, home, isolation unit,

follow-up

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?

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Thanks to:

Prof. Susan Smith

Prof Colin Bradley

Prof Andrew Murphy

Dr. Nuala O’Connor

Dr. Diarmuid Quinlan

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Links

https://academic.oup.com/cid/article/52/3/325/305087

Centre for Evidence Based Medicine, Oxford

https://www.cebm.net/covid-19/rapid-diagnosis-of-community-acquired-pneumonia-for-clinicians/

https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/guidance/vulnerablegroupsguidance/COVID-19%20Guidance%20for%20extremely%20medically%20vulnerable%20V1.pdf

CEBM Symptom tracker

https://www.cebm.net/covid-19/covid-19-signs-and-symptoms-tracker/

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