COVID-19 Admission Approach - UCT/GSH

These guidelines have been published by University of Cape Town / Groote Schuur Hospital Departments of Medicine & Surgery.

EMGuidance confirms that it is not the owner of the information provided, nor does it intend to present it as such.

COVID-19 Admission Approach (Version 15 July 2020)

Management of laboratory confirmed or clinically diagnosed case

1. Oxygen therapy, escalating according to need

   1. Nasal cannuale (2-6 L/min)

   2. Face mask 40% (6-8L/min)

   3. Reservoir mask (flow to fill reservoir bag)

   4. High flow nasal oxygen (see UCT Medicine COVID-19 ECHO Talk)

   5. Refer to ICU for intubation and ventilation

   
   
2. Awake proning if sats < 90%
3. Dexamathasone 6mg IVI or Prednisone 40mg PO daily 
4. Enoxaparin provided no contra-indication
   1. 40mg SC daily for prophylaxis
   2. If require high intensity oxygen or D-dimer >1.5 then 1mg/kg 12 hourly (weigh patient or accurately estimate weight)
5. Lansoprazole 30mg daily or Omeprazole 20mg daily
6. Paracetamol 1g 6 hourly. Escalate analgesia if needed.
7. Appropriate management of co-morbidities (especially diabetes: SC insulin if hyperglycaemic; IVI insulin infusion and fluids if DKA)
8. No routine antibiotics
9. For some patients institution of palliative care appropriate 

Investigations

1. NP or mid-turbinate for SARS-CoV-2 (if high suspicion & swab neg then sputum)
2. Blood glucose
3. ABG (if sats < 95%)
4. CEU (Creatinine, Electrolytes, Urea)
5. FBC/diff
6. D-dimer
7. HIV
8. HbA1C
9. If ischaemic chest pain then TropT and ECG

Clinically-diagnosed cases are patients with characteristic symptoms, positive contact and/or characteristic CXR with bilateral ground glass infiltrates with prominent peripheral distribution.

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