System involvement of covid-19 - Comment
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Information covered in this presentation slides: 1. Systemic involvement of Novel Corona Virus (COVID 19) Samaresh Das Consultant, Anaesthetics and Critical care Yeovil Hospital, NHS, England 2. • Covid19 outbreak has caused a pandemonium in modern world & introduced new terminologies: ‘social distancing’, ‘lock-down’, ‘stay safe’, ‘key workers’, ‘self-quarantine’, ‘work-from-home’ & so on • Started from Wuhan & has caused thousands of deaths, serious illness, & disruption of global economy never seen since the 2nd world war • New virus, limited epidemiology & mainly the Tt for symptomatic patients is supportive • However, Covid19 not only attacks the respiratory system, rather it involve other systems from the beginning or subsequent to respiratory infection Introduction 3. Respiratory System • Majority: mild, cold-like symptoms. S/s may appear 2-14 days from the initial exposure and present with cough (mostly dry but at times with copious sputum production), fever, sore throat, runny nose, SOB • Hospital admissions: pneumonia like symptoms with SOB & desaturation • ~15% develop mod. to sev. Illness, oxygen support, further 5%- ICU & organ supportive therapies including intubation and ventilation • Pneumonia: the most common complication/ARDS 4. Imaging 5. Blood gas & Imaging 6. • Prevalence of cardiovascular diseases (CVD) are substantial in general population and the probability Covid19 infection is particularly high in this subset of people • Acute cardiac injury ( ~8–12%) due to viral involvement of cardiomyocytes & SIRS • Common complications includes tachy & brady arrhythmias • Until now, no study describes ST elevation or acute MI secondary to Covid19 • Only one Chinese study reported heart failure in Covid19 patients • It is too early to assess the long- term implications of the consequences of Covid19 affection on cardiovascular system Cardiovascular System 7. • Data from Wuhan: ~79% diarrhea, decreased appetite, nausea, vomiting, abdominal pain and gastrointestinal bleeding during the onset and subsequently • Adult and young children can present only with GI symptoms • Studies from the China: Anorexia most frequent in adults (39.9%‐50.2%), Diarrhea in adults and children (2%‐49.5%) & vomiting in children • GI bleeding was found only in few ventilated patients in ICU • Recently Virus reported for the first time in stool samples in USA Gastrointestinal System 8. • long‐term hypoxemia, cell necrosis GI mucosa leads to ulceration and bleeding + IV corticosteroids, NSAIDs, physiological challenging to trace the real cause • Liver disfunction: Hepatitis, microvascular steatosis, elevated aminotransferases, high bilirubin, hypoproteinemia, and prolonged PT, activation of coagulative & fibrinolytic pathways, relatively depressed platelets, climbing neutrophils, increased neutrophil: lymphocyte, & high ferritin levels • Drug-induced liver injury is a possible contributing factor Gastrointestinal System 9. • Incidence of AKI was directly proportional to the baseline serum creatinine • The severity of AKI positively associated with older age, higher body mass index, diabetes mellitus, history of heart failure, higher peak airway pressure and higher SOFA score • The potential mechanisms of kidney involvement in these patients can be didactically divided into three aspects: cytokine damage, organ crosstalk and systemic effects Renal System 10. Central Nervous System Entry of Covid19 in the CNS 11. • Involvement may occur either during initial or late phase • Early: fever, loss of smell, taste, headache, visual impairment, dizziness, ataxia and convulsions • Neurological S/s could be a combination of hypoxia, respiratory & metabolic acidosis at advanced stage • Patients with neurological symptoms would require more specific and aggressive treatments • Recently a case report has been published Wuhan describing a patient presented with acute symmetrical ascending weakness resembling GBS Central Nervous System 12. • Generalized muscle pain and fatigue are common • Clinicians should consider the diagnosis of rhabdomyolysis when patients have focal muscle pain and fatigue • CK, myoglobin are important indexes for rhabdomyolysis & should be tested earlier to avoid ARF from rhabdomyolysis • Prolonged ventilation are prone for muscle atrophy & weakness during recovery Musculoskeletal System 13. • Microvascular thrombosis & reduced platelets count, prolongation of the PT/INR, PTT, elevation of D-dimer, and reduced fibrinogen levels • Platelets transfusion if the platelet count < 50 x 109/L, FFP- if INR > 1.8 & fibrinogen concentrate (4 grams) or cryoprecipitate (10 units) fibrinogen level < 1.5 g/L • In patients already on anticoagulation for VTE or atrial fibrillation, therapeutic doses of anticoagulant therapy should continue but may need to be withheld if platelet count is less than 50 x 109/L Hematological System 14. • Prophylactic LMWH to all hospitalized patients despite abnormal coagulation (absence of active bleeding, platelet < 25, or fibrinogen < 0.5 g/L) • Abnormal PT/INR or PTT is not a contraindication for pharmacological thromboprophylaxis • Mechanical thromboprophylaxis when pharmacological thromboprophylaxis is contraindicated Hematological System 15. • COVID patients who spend significant time in the hospital are more vulnerable to delirium; irrespective of ICU admission and regardless of the severity of illness • There are reported case of mental and social health problems even among front- line health care workers Psychological aspects 16. Systemic manifestation 17. Messages for the general population: • Be empathetic to those infected with the virus. They all deserve support, compassion & kindness • Minimize watching, reading or listening to news about COVID-19 that cause anxious or distressed; seek information only from trusted sources • Protect yourself and be supportive to others • Find opportunities to amplify positive and hopeful stories and positive images of local people who have experienced COVID-19 • Honor careers healthcare workers and supporting people Important message 18. Messages for the Health Care Workers: • Managing mental health and psychosocial well-being is as important as managing physical health • Sufficient rest during work or between shifts, healthy food, physical activity, and stay in contact with family and friends • Avoid use of tobacco, alcohol or other drugs • If possible, staying connected with your loved ones, including through digital methods (is one way to maintain contact Important message 19. Any questions? Feedback: drsamareshdas@gmail.com +447960532682 |
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| Posted by : peter88 | Post date : 2020-06-12 22:16 | ||
| Category : Health & Medicine | Views : 294 | ||
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