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Bonus Short - COVID-19 Lessons From NYC

Frank Illuzzi, MD, Mike Weinstock, MD, and Matthieu DeClerck, MD
00:00
22:44

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Patients with COVID-19 present in a variety of ways, and urgent care clinicians need to have a low index of suspicion for diagnosis. Management involves emergency referral for patients with a low oxygen saturation. Every patient should be treated as if they could have COVID-19.

REFERENCES:

  • SARS-CoV-1. N Engl J Med. 2020 Mar 17. PMID: 32182409.
  • Guan, W.-jie, & Yu Hu, W. (2019). Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine.
  • Shi, H., Han, X., Jiang, N., Cao, Y., Alwalid, O., Gu, J., … Zheng, C. (2020). Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. The Lancet Infectious Diseases, 20(4), 425–434. doi: 10.1016/s1473-3099(20)30086-4
  • Wong, H. Y. F., Lam, H. Y. S., Fong, A. H.-T., Leung, S. T., Chin, T. W.-Y., Lo, C. S. Y., … Ng, M.-Y. (2019). Frequency and Distribution of Chest Radiographic Findings in COVID-19 Positive Patients. Radiology, 201160. doi: 10.1148/radiol.2020201160

Greg J. -

This was super helpful Thank you for doing all of these podcast on the primary care, urgent care, and Emergency care plateforms. I am listening to all of them and they are helping me stay up to date. I do have some questions for you or Dr. Illuzzi. I do work in a small urgent care.
1. Do your urgent cares have negative pressure rooms?
2. If you don’t have negative pressure rooms, are you concerned about contaminating your heating or air conditioning or duct work?
3. The following questions are assuming your urgent cares are not negative pressure facilities and have “typical” primary care or urgent care facilities
a. Do you have all patients wear masks?
i. What if you run out
b. Do you have to do any special cleaning activities to your rooms with suspected or confirmed covid patiets?
c. What PPE do you wear when
i. Just seeing the patient ie doing HPI, ROS, physical exam?
ii. Doing a strep test?
iii. Doing an influenza test?
Thanks again for all you do.
Greg

Mike W., MD -

Hi Greg and thanks for the support - to answer some of your questions, I do not believe most UCs are negative pressure rooms, but even if so, would still be vigilant w PPE. Yes, I have all my patients wear masks - no harm here if they are available. I wear a N95 mask, but these may or may not be available to all. I wear mine for the whole day and only take it off for lunch. I stay 6 feet away from all my patients except for my brief exam. Consider observing the patient do a self swab - if inadequate can be repeated, but if adequate then minimizes health care worker risk!
M

Ian L., Dr -

Great exposition .
The front line health workers are regarded as great people world wide
Regarding asthmatics corticosteroids can be given and the hospitals would give uncontrolled asthmatics oral corticosteroids . -The evidence around corticosteroids is mixed there may be prolongation of the virus but excess inflammation may be muted . -There is a discussion of this in a paper by Beth Russel et al in ecancer 2020 -1023 Titled :COVID 19 and treatment with NSAIDSs and corticosteroids :should we be limiting their use in the clinical setting ? -Also advocated elsewhere is IM adrenalin or subcutaneous Terbutaline if spacer is not helping . -Some Patients with a severe exacerbation of COPD and asthma unable to breathe in - will have be jet nebulised - if possible outside the clinic in their car with window open or even on the footpath or tent outside the Urgent Care .

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