Emergency Department Management of COVID-19: An Evidence-based Approach

An Evidence-Based Approach

Nicholas M. McManus, DO; Ryan Offman, DO; Jason D. Oetman, DO

Disclosures

Western J Emerg Med. 2020;21(6):32-44. 

In This Article

Abstract and Introduction

Abstract

The novel coronavirus, SARs-CoV-2, causes a clinical disease known as COVID-19. Since being declared a global pandemic, a significant amount of literature has been produced and guidelines are rapidly changing as more light is shed on this subject. Decisions regarding disposition must be made with attention to comorbidities. Multiple comorbidities portend a worse prognosis. Many clinical decision tools have been postulated; however, as of now, none have been validated. Laboratory testing available to the emergency physician is nonspecific but does show promise in helping prognosticate and risk stratify. Radiographic testing can also aid in the process. Escalating oxygen therapy seems to be a safe and effective therapy; delaying intubation for only the most severe cases in which respiratory muscle fatigue or mental status demands this. Despite thrombotic concerns in COVID-19, the benefit of anticoagulation in the emergency department (ED) seems to be minimal. Data regarding adjunctive therapies such as steroids and nonsteroidal anti-inflammatories are variable with no concrete recommendations, although steroids may decrease mortality in those patients developing acute respiratory distress syndrome. With current guidelines in mind, we propose a succinct flow sheet for both the escalation of oxygen therapy as well as ED management and disposition of these patients.

Introduction

It took just over two months for the novel coronavirus, SARs-CoV-2 to be declared a global pandemic by the World Health Organization (WHO). In the immediate week following this announcement, more than 400 papers were published pertaining to COVID-19. Just two months later, this number had increased to over 2000 releases per week in the literature.[1] Keeping up with ever-changing information can be quite difficult. The purpose of this clinical review is to provide the emergency physician (EP) with a summary of current literature and supporting societal guidelines relevant to the management of the COVID-19 patient in the emergency department (ED). Finally, we propose an ED-based algorithm for the work-up and initial management of patients with suspected COVID-19 infections.

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