We have learned a lot about this virus since it was first discovered a few months ago. However, because it is so new, clinical guidelines are not easy to come by. Much of the information I’ve been able to find are anecdotal accounts from individual practitioners. This isn’t how medicine is supposed to work.
I found myself thinking that I was unsure of what to look for and which patients to be worried about. Sure, it would be nice to be able to immediately identify every COVID-positive patient, but that’s not realistic. At first, testing was taking multiple days, and even now, we are still having to wait almost 24 hours for results. This might be helpful for inpatient nurses, but as an ER nurse, this isn’t good enough.
So, as a frontline nurse, how am I supposed to know which patients to consider a PUI (the term we’ve been using to mean “a potentially-positive person,” short for “Person Under Investigation”)? After Googling a lot of information and consulting the CDC’s website, I compiled a PDF of some straight-forward information that I thought was useful. Obviously, I’m not a physician and this information should be used only as a guide only–not to mention that the data could change at any moment. Regardless, I wanted to share what I found so that it may help you.
Here’s a link to the printable PDF: https://bit.ly/2VzM3LQ.
Below is a web-friendly version:
Symptoms
- Fever, cough, fatigue, and anorexia are the most common findings.
- Shortness of breath, sputum production, and muscle aches can also be found.
Laboratory Findings
Most Common
- Decreased lymphocytes (lymphopenia) are found in 83% of patients.
Associated with Greater Illness Severity
- Elevated neutrophils (neutrophilia)
- Elevated ALT and AST
- Elevated lactic acid
- Elevated CRP
- Elevated ferritin levels
- Procalcitonin may be initially normal and then increase.
- WBC may not be elevated, but may increase with a secondary infection, like pneumonia. The presence of another infection does not mean COVID-19 is not present also.
Associated with Mortality
- Elevated D-dimer
- Decreased lymphocytes
- Elevated plasma levels of inflammatory markers, like CRP, ESR, and LDH (could show immune dysregulation).
Radiology
- Early in the disease, CTs and XRs may be normal.
- Bilateral consolidations or bilateral ground glass opacities
- Caution: CT alone is not recommended for the diagnosis of COVID-19. 56% of patients who were COVID-19 + showed normal CTs within 2 days.
I hope this information is useful. If you have comments or information to add, you can message me on Twitter (@David_Mancini) and I would be happy to add your comments here.
