Emergency Department Management of COVID-19: An Evidence-Based Approach

Nicholas M McManus, Ryan Offman, Jason D Oetman
Western Journal of Emergency Medicine 2020 September 25
The novel coronavirus, SARs-CoV-2, causes a clinical disease known as COVID-19. Since being declared a global pandemic, a significant amount of literature has been produced and guidelines are rapidly changing as more light is shed on this subject. Decisions regarding disposition must be made with attention to comorbidities. Multiple comorbidities portend a worse prognosis. Many clinical decision tools have been postulated; however, as of now, none have been validated. Laboratory testing available to the emergency physician is nonspecific but does show promise in helping prognosticate and risk stratify. Radiographic testing can also aid in the process. Escalating oxygen therapy seems to be a safe and effective therapy; delaying intubation for only the most severe cases in which respiratory muscle fatigue or mental status demands this. Despite thrombotic concerns in COVID-19, the benefit of anticoagulation in the emergency department (ED) seems to be minimal. Data regarding adjunctive therapies such as steroids and nonsteroidal anti-inflammatories are variable with no concrete recommendations, although steroids may decrease mortality in those patients developing acute respiratory distress syndrome. With current guidelines in mind, we propose a succinct flow sheet for both the escalation of oxygen therapy as well as ED management and disposition of these patients.

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Steven Ross

Admit patients with SaO2 > 93% and moderate disease? Admit to where? Our system is loaded with severe disease.


Muhammad Shaikh

I am still looking for evidence of the existence of SARS CoV 2.. I have tried to find a single study that isolated the whole virion particle from a pure sample.. and I could not.
Therefore, the best treatment is to NOT SEND THE FRAUDULENT TEST FOR A MYTHICAL DISEASE, and treat symptomatically with oxygen and sometimes with broad-spectrum antibiotics and searching for the bug with sputum or bronchoavleolar lavage cultures for pneumococcal, tuberculosis, PCP, fungal infections etc.
If you start treatment with high dose steroids, tocilizumab, remdesivir, clexane etc. The chances are the your patient will not survive with fungal superinfection due to excessive immunosuppression for a mythical disease.


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