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

West J Emerg Med. 2020 Sep 25;21(6):32-44. doi: 10.5811/westjem.2020.8.48288.

Abstract

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.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Anticoagulants / therapeutic use
  • Antipyretics / therapeutic use
  • Biomarkers / blood
  • Bronchodilator Agents / therapeutic use
  • COVID-19 / diagnosis
  • COVID-19 / therapy*
  • Emergency Service, Hospital*
  • Glucocorticoids / therapeutic use
  • Humans
  • Infection Control
  • Lung / diagnostic imaging
  • Nitric Oxide / therapeutic use
  • Oxygen Inhalation Therapy
  • Respiration, Artificial
  • Respiratory Distress Syndrome / therapy
  • Respiratory Distress Syndrome / virology
  • SARS-CoV-2
  • Severity of Illness Index
  • Thromboembolism / diagnosis
  • Thromboembolism / prevention & control
  • Thromboembolism / virology
  • Vasoconstrictor Agents / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Anti-Inflammatory Agents, Non-Steroidal
  • Anticoagulants
  • Antipyretics
  • Biomarkers
  • Bronchodilator Agents
  • Glucocorticoids
  • Vasoconstrictor Agents
  • Nitric Oxide