Part III
Taken from a previous excerpt
Clinical Presentation
Medical Diagnosis
When to Suspect CoVID
Any individual with visible/ or not visible symptoms, ie the majority of the population which is asymptomatic and wishes to confirm diagnosis. Testing can also verify virus exposure confirmation, which may determine the presence of antibody development in the human body.
Initial testing can be conducted via the purchase of a Covid testing kit, which are currently available for the public to purchase and conduct inside their own private properties, as well as request on site in health care facilities.
Clinical applications
1: Any sepsis without clear source or any unexpected rapid deterioration in any patient especially those having code blue upon admittance to the hospital, etc. Patients who get admitted into the ER or for some other reasons may be in a career state when they present, hence any unexpected deterioration down the track should alert us.
2: High CRP with normal CBC.
Low platelet or low WCC should also suggest viral. This is due to IL-6 related effect which is one of the cytokines produced by this virus. And targeted by the treatment.
3: Any respiratory symptom (nasal, sinuses, throat, airways or lung parenchyma). Even anosmia could be the symptom.
Diagnosis
1: Hypoxia: High A-a gradient on ABG indicates interstitial issue and in setting of acute infections currently COVID comes on top.
Saturation dropping below 95% means PaO2 is below 60 mmHg. (As we need 60 mm Hg of PaO2 to for 95% Saturation).
2: X-ray or HRCT showing interstitial changes, bilateral changes, any consolidation etc. HRCT has sensitivity of 90% or above. Classic bilateral interstitial ACUTE pneumonitis changes without any reduction in lung volume, is classic for viral pneumonia. If it’s progressing to lobar pneumonia it indicates progressive disease. Additional respiratory diseases can also be taken into consideration such as bronchitis, sinusitis, pneumonitis.
Interstitial Pneumonitis
Progressive Disease with bilateral Multilobar Pneumonia:
3: Positive PCR on NPS, Throat Swab or sputum . A negative PCR has sensitivity of only 70%, so if strongly suspects repeat PCR at least thrice).
Negative PCR doesn’t exclude COVID if there is strong suspicion. If PCR is negative but clinical suspicion is high then repeat the PCR, which should be repeated thrice with an interval of 2-3 days when suspicion is high.
4: Travel history if there is one, can be helpful but no travel history is not pertinent. As wide scale world wide exposure is most likely present at the current time.
Use common sense. Above clues are important to keep in mind.
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