COVID-19: Clinical sciences

COVID-19 is a respiratory infection caused by SARS-CoV-2, a highly contagious virus that primarily spreads via respiratory droplets. Once in the respiratory tract, the virus replicates and causes symptoms similar to the common cold, while in some cases, the virus causes a robust inflammatory response that can produce life-threatening illness. Based on clinical manifestations, COVID-19 can be mild, moderate, severe, or critical.

Now, if your patient presents with chief concerns suggesting COVID-19, you should first perform an ABCDE assessment to determine if your patient is unstable. If the patient is unstable, stabilize their airway, breathing, and circulation. This might require you to intubate the patient and provide mechanical ventilation. Also, don’t forget to obtain IV access and place your patient on continuous vital sign monitoring including heart rate, blood pressure, and pulse oximetry.

Once you stabilize the patient, obtain a focused history and physical exam; but also labs, such as a SARS-CoV-2 test; an arterial blood gas, or ABG; a CMP; inflammatory markers, including CRP and ESR; as well as D-dimer, BNP, troponin, and lactate. You should also obtain a chest X-ray and ECG.

Typically, patients report respiratory symptoms, such as cough, rhinorrhea, nasal congestion, as well as shortness of breath, and difficulty breathing. They may also report new loss of taste or smell. Often, systemic symptoms like headache, fatigue, myalgia and fever, are associated. Some patients may also experience gastrointestinal symptoms like nausea, vomiting, or diarrhea. Additionally, patient history can reveal a known SARS-CoV-2 exposure.

On physical exam, you can find evidence of respiratory distress, such as hypoxemia, as well as rales or rhonchi on auscultation, and accessory muscle use and retractions. In severe cases, your patient can be hypotensive as well!