COVID-19 MANAGEMENT IN EMERGENCY MEDİCİNE

Öz

Abstract: Although Covid-19 is usually transmitted by droplets, it also passes from person to person after contact with the infected object, as a result of the interaction of the contact area with the mouth, nose and eyes. Emergency services with closed and restricted areas pose a high risk for Covid-19 infection. The absolute continuity of the emergency service operation has led to the need for other critical patient management and infected patient processes to be carried out simultaneously. At the same time, the high variation in clinical presentations of Covid-19 patients is one of the factors that increase the risk for both working and non-infected patients. Considering the limited facilities of emergency services, it is necessary to make some arrangements in order to meet various needs, to separate triage, observation, resuscitation and, if possible, imaging areas for infected patients, and to arrange rapid hospitalization algorithms for patients with Covid-19. In this article, we aimed to discuss Covid-19 management in the emergency room.

Anahtar Kelimeler

• Covid-19
• emergency department
• patient manegement

ACİL SERVİSTE COVİD-19 YÖNETİMİ

Öz

Özet: Covid-19, genellikle damlacık yoluyla bulaş gösterse de enfekte obje teması sonrasında, temas edilen bölgenin ağız, burun ve göz ile etkileşimi sonucunda da insandan insana geçmektedir. Kapalı ve kısıtlı alanlara sahip acil servisler, Covid-19 enfeksiyonu için oldukça risk barındırmaktadır. Acil servis işleyişinin mutlak suretle devam ediyor olması, diğer kritik hasta yönetimleriyle enfekte hasta süreçlerinin eş zamanlı yürütülmesi gerekliliğini doğurmuştur. Aynı zamanda Covid-19 hastalarının klinik başvuru çeşitliliğinin fazlaca varyasyon göstermesi hem çalışan, hem de enfekte olmayan hastalar adına riski artıran faktörlerdendir. Acil servislerin imkanları da göz önüne alınarak, çeşitli ihtiyaçların karşılanabilmesi adına bazı düzenlemelerin yapılması, enfekte hastalar için triaj, müşahede, resüsitasyon ve mümkünse görüntüleme alanlarının ayrılması, Covid-19’lu hastalar için hızlı yatış algoritmalarının düzenlenmesi gereklidir. Bu makalemizde acil servis içerisinde Covid-19 yönetimini tartışmayı amaçladık.

Anahtar Kelimeler

• Covid-19
• Acil Servis
• Hasta Yönetimi

Kaynakça

1. 1. Park SE. Epidemiology, virology, and clinical features of severe acute respiratory syndrome -coronavirus-2 (SARS-CoV-2; Coronavirus Disease-19). Clin Exp Pediatr, 2020;63(4):119-124.
2. 2. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia. N Eng J Med, 2020; 382(13): 1199-1207.
3. 3. Annweiler C, Sacco G, Salles N, Aquino JP, Gautier J, Berrut G, et al. National French Survey of Coronavirus Disease (COVID-19) Symptoms in People Aged 70 and Over. Clin Infect Dis, 2021;72(3): 490-494.
4. 4. Recalcati S. Cutaneous manifestations in COVID-19: a first perspective. J Eur Acad Dermatol Venereol, 2020; 34(5): e212-e213.
5. 5. Galván Casas C, Català A, Carretero Hernández G, Rodríguez-Jiménez P, Fernández-Nieto D, Rodríguez-Villa Lario A, et al. Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. Br J Dermatol, 2020; 183(1):71-77.
6. 6. Colavita F, Lapa D, Carletti F, Lalle E, Bordi L, Marsella P, et al. SARS-CoV-2 Isolation From Ocular Secretions of a Patient With COVID-19 in Italy With Prolonged Viral RNA Detection. Ann Intern Med, 2020;173(3):242-243.
7. 7. Ma N, Li P, Wang X, Yu Y, Tan X, Chen P, et al. Ocular Manifestations and Clinical Characteristics of Children With Laboratory-Confirmed COVID-19 in Wuhan, China. JAMA Ophthalmol, 2020; 138(10):1079-1086.
8. 8. Manalo IF, Smith MK, Cheeley J, Jacobs R. A dermatologic manifestation of COVID-19: Transient livedo reticularis. J Am Acad Dermatol, 2020; 83(2): 700.

9. 9. Karcioğlu O. Sağlık Profesyonelleri İçin Covid-19 Tanı ve Tedavisi. 1st ed. Istanbul: EMA Tıp Kitabevi; 2020.
10. 10. Chan JF, Yuan S, Kok K, To KK, Chu H, Yanget J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet, 2020; 395(10223):514-523.
11. 11. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med, 2020;382(18):1708-1720.
12. 12. Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med, 2020;172(9):577-582.
13. 13. People with Certain Medical Conditions. National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases 2021 [cited 04 April 2021]. Available from: https://www.cdc.gov/ncird/dvd.html
14. 14. Center for Disease Control and Prevention. [cited 04 April 2021]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/index.html.
15. 15. Patel A, Jernigan DB, 2019-nCoV CDC Response Team. Initial Public Health Response and Interim Clinical Guidance for the 2019 Novel Coronavirus Outbreak - United States, December 31, 2019-February 4, 2020. MMWR Morb Mortal Wkly Rep, 2020; 69(5): 140-146.
16. 16. Hanson KE, Caliendo AM, Arias CA, Hayden MK, Englund JA, Lee MJ, et al. Infectious Diseases Society of America Guidelines on the Diagnosis of COVID-19: Molecular Diagnostic Testing. [cited 04 April 2021]. Available from: https://www.idsociety.org/practice-guideline/covid-19-guideline-diagnostics/
17. 17. Centers for Disease Control and Prevention. Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons Under Investigation (PUIs) for Coronavirus Disease 2019 (COVID-19). [cited 04 April 2021]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimens.html
18. 18. Giwa AL, Desai A, Duca A. Novel 2019 coronavirus SARS-CoV-2 (COVID-19): An updated overview for emergency clinicians. Emerg Med Pract, 2020; 22(5): 1-28.
19. 19. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020;395(10223):497-506.
20. 20. Chavez S, Long B, Koyfman A, Liang SY. Coronavirus Disease (COVID-19): A primer for emergency physicians. Am J Emerg Med, 2020;S0735-6757(20)30178-9.
21. 21. Garcia-Castrillo L, Petrino R, Leach R, Dodt C, Behringer W, Khoury A, Sabbe M. European Society For Emergency Medicine position paper on emergency medical systems' response to COVID-19. Eur J Emerg Med, 2020;27(3):174-177.
22. 22. Lu Z, Kou W, Du B, Wu Y, Zhao S, Brusco OA, et al. Effect of Xuezhikang, an extract from red yeast Chinese rice, on coronary events in a Chinese population with previous myocardial infarction. Am J Cardiol, 2008; 101(12):1689-93.
23. 23. COVID-19 (SARS-COV-2 Enfeksiyonu) Rehberi Bilim Kurulu Çalışması, TC Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü, 2020 [cited 04 April 2021]. Available from: https://covid19bilgi.saglik.gov.tr/depo/rehberler/COVID-19_Rehberi.pdf?type=file.
24. 24. Oğuz AB, Polat O. COVID-19 Salgınında Acil Servis Organizasyonu ve Triaj. In: Memikoğlu O, Genç V. Covid-19 (e kitap), Ankara Üniversitesi Basımevi, 2020: 161-164. Available from: http://www.medicine.ankara.edu.tr/wp-content/uploads/sites/121/2020/05/COVID-19-Kitap.pdf
25. 25. Stokes EK, Zambrano LD, Anderson KN, Marder EP, Raz KM, Felix SEB, et al. Coronavirus Disease 2019 Case Surveillance - United States, January 22-May 30, 2020. MMWR Morb Mortal Wkly Rep, 2020; 69(24):759-765.
26. 26. COVID-19 Nursing Home Data ( cited 4 April 2021). Available from: https://data.cms.gov/stories/s/COVID-19-Nursing-Home-Data/bkwz-xpvg.
27. 27. Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, et al. SARS-CoV-2 Infection in Children. N Engl J Med, 2020;382(17):1663-1665.
28. 28. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, Tong S. Epidemiology of COVID-19 Among Children in China. Pediatrics, 2020;145(6): e20200702.
29. 29. CDC COVID-19 Response Team. Coronavirus Disease 2019 in Children - United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep, 2020; 69(14):422-426.
30. 30. Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet, 2020; 395(10237):1607-1608.
31. 31. Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19). (cited 04 April 2021). Available from: https://emergency.cdc.gov/han/2020/han00432.asp.
32. 32. Paediatric inflammatory multisystem syndrome and SARS-CoV-2 infection in children. ( cited 4 April 2021): Available from: https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-risk-assessment-paediatric-inflammatory-multisystem-syndrome-15-May-2020.pdf
33. 33. Multisystem inflammatory syndrome in children and adolescents temporally related to COVID-19. (cited 04.April 2021). Available from: https://www.who.int/news-room/commentaries/detail/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19.
34. 34. Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet, 2020;395(10239):1771-1778.
35. 35. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med, 2020;8(5):475-481.
36. 36. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA, 2020; 323(11):1061-1069.
37. 37. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet, 2020;395(10229):1054-1062.
38. 38. Greenhalgh T, Koh GCH, Car J. Covid-19: a remote assessment in primary care. BMJ, 2020;368: m1182.
39. 39. Khan M, Pretty CG, Amies AC, Elliott R, Chiew YS, Shaw GM, Chase JG. Analysing the effects of cold, normal, and warm digits on transmittance pulse oximetry. Biomedical Signal Processing and Control, 2016;26:34-41.
40. 40. Pulse Oximeter Accuracy and Limitations: FDA Safety Communication. (cited 04 April 2021). Availanle from: https://www.fda.gov/medical-devices/safety-communications/pulse-oximeter-accuracy-and-limitations-fda-safety-communication