Acute hypoxic respiratory failure secondary
secondary to COVID-19 infection

  • CC: Fever, cough, shortness of breath, hypoxia

  • PP: Fever/chills, dry cough, dyspnea, fatigue, myalgias, decreased PO intake, hypoxia

  • PN: No hemoptysis, no unilateral leg swelling, no severe chest pain

  • Pertinent SHx: Tobacco/vaping, EtOH use, drug use, sick contacts, vaccination status

  • Risk Factors: Elderly age, obesity, COPD/asthma, CHF, CAD, diabetes, CKD, immunosuppression, smoking

  • Initial DATA: CBC, CMP, CRP, ferritin, LDH, procalcitonin, COVID PCR, CXR, VBG/ABG if hypoxic, EKG, pulse ox

  • Pending DATA: Blood cultures, sputum cultures, CTA chest if PE concern

  • MEDS: Oxygen PRN, dexamethasone, remdesivir if indicated, bronchodilators PRN, antipyretics, DVT prophylaxis

Plan (2 order sets)

  • COVID 19 order set + COVID 19 treatment order set

  • Dexamethasone 6 mg daily for 10 days or until DC

  • if sx <5 days , Start with Remdesivir If patient worsens despite this (increasing O2 needs, HFNC, high CRP/inflammation) ADD Tocilizumab injection

  • Monitor respiratory status and oxygen requirement

  • COVID treatment add-on (Remdesivir) if symptom onset <5 days

  • Pulmonary hygiene/incentive spirometry

  • Monitor labs and inflammatory markers

  • DVT prophylaxis

  • Isolation precautions

  • Escalate respiratory support if worsening hypoxia