8
Management Continued
Provider Health
Provider Health
Vent Settings: ARDS protective settings, use VENT Bundle
AC Volume, TV 6cc/kg of Ideal Body Weight, IFR 60-80 lpm, PEEP 5, FIO2 100%, weaning down as tolerated to SpO2 to 88-95%, RR 18
Click Here for WHO Guidelines Respiratory COVID-19.
CPR: Must wear PPE. At this time given the community spread, we recommend wearing airborne level PPE for all CPR. The Covid-19 CPR policy for BSWH actually states "Health care professionals (HCP) attempting cardiopulmonary resuscitation (CPR) and related events (rapid response and intubation) on patients under investigation (PUI) of COVID-19 or known COVID-19 infection MUST don personal protective equipment (PPE) before entering the room."
STEMI and NSTEMI: In high risk patients to have COVID19 for STEMI and NSTEMI we are trying to avoid emergent cath and exposure. We should consider thrombolysis. Click Here for BSWH Protocol.
Dosing:
Alteplase (TPA):
Dosing based on patient weight:
• 67kg: Infuse 15mg IV over 1-2min; then 50mg over 30min; then 35mg
over next 60min (i.e. 100mg over 1.5hr)
• ≤67kg: Infuse 15mg IV over 1-2min; then 0.75 mg/kg (max 50mg) over 30
min; then 0.5 mg/kg over 60min (max 35 mg)
Tenecteplase (TNKase):
• 50 mg vial in 10 mL sterile water (5 mg/mL)
• < 60 kg = 30 mg IV push over 5 seconds
• 60-69 kg = 35 mg IV push over 5 seconds
• 70-79 kg = 40 mg IV push over 5 seconds
• 80-89 kg = 45 mg IV push over 5 seconds
• 90 kg = 50 mg IV push over 5 seconds
Disposition:
• Not all persons under investigation (PUI) need admission
• Mild Symptoms may qualify for home isolation if able to comply with
health department monitoring