REVISION HISTORY
Rev
No. Review Date Description of Change Date of Next Review
Reviewed by:
GERARDO S. MANZO, MD Incident Commander
Approved by: JOEL M. ABANILLA, MD Executive Director
I. STATEMENT OF THE POLICY
Interim guidelines for Healthcare Provider in the triage of patients when Coronary Virus Disease 2019 (COVID-19) infection is suspected.
II. DEFINITION OF TERMS A. Criteria for index patient
1. Confirmed Case – A person with laboratory confirmation of COVID-19 infection, regardless of clinical signs and symptoms.
2. High probability Person Under Investigation (PUI):
2.1. Patient previously / currently in the MICU (Clinically critical / unstable) for clinically
suspected COVID-19 patient with CT scan findings consistent with COVID-19 but awaiting COVID-19 test results.
2.2. Patient moderate to severe symptoms for clinically suspected COVID-19 patient with CT scan findings consistent with COVID-19 but awaiting COVID-19 test results.
3. Low probability PUI:
3.1. Patient currently admitted on home quarantine for symptoms suggestive of COVID-19 3.2. Patient exhibits mild symptoms (AURI but without fever, diarrhea with no signs of
dehydration) and has no CXR findings consistent with COVID-19 pneumonia B. Criteria for severity of symptoms:
1. Severe symptoms: with severe dyspnea or signs of severe dehydration or clinically unstable 1.1. Criteria for “severe or critically ill”
Temp ≥38°C
SpO2 < 92%
RR >30 bpm
SBP <90 mm Hg
2. Moderate symptoms: with dyspnea or fever ≥38°C and/or dehydration 3. Mild symptoms:
3.1. Predominantly AURI with no fever and no DOB 3.2. Flu-like symptoms with no fever and no DOB
3.3. Other Minor Symptoms: Anosmia or Diarrhea with no signs of severe dehydration 3.4. Criteria for “mild” disease
Cont....
SpO2 < 95%
RR <25 bpm
HR <120 bpm
Temp <38°C
Mental status normal 4. Asymptomatic
III. POLICY GUIDELINES
Triage of patients presenting at the ER:
A. Person Under Monitoring (PUM) – Asymptomatic patients with appropriate EXPOSURE history.
1. Provide instructions for quarantine for 14 days at home or Barangay isolation units.
2. Monitoring for development of symptoms is done by ER nurse.
2.1. Inform RESU 2.2. Fill out CIF
2.3. NO NEED for testing
2.3.1. Consult ER ASAP if symptoms develop.
2.3.2. Follow-up at the Infirmary Clinic (with the AP for private patients) after 14 days.
B. PUIs
1. Mild symptoms
1.1. Disposition: Provide instructions for quarantine for 14 days at home or Barangay isolation units. Monitoring for the development of symptoms is done by ER nurse.
Consult ER ASAP if symptoms develop. Follow-up at the Infirmary Clinic (with the AP for private patients) after 14 days.
1.1.1. Inform RESU 1.1.2. Fill out CIF
1.1.2.1. Diagnostics: CXR, CBC, Fecalysis (if with diarrhea) 1.1.2.2. Therapeutics: As indicated
1.1.2.3. Precaution: Personnel and patient to wear protective mask 2. Mild symptoms + Comorbid conditions* or age ≥ 60 years old
2.1. Disposition: Put patient in ER isolation room, then admit to Ward 3B**
Cont...
2.2. Diagnostics:
2.2.1. Labs: CBC, Na, K, Crea, BUN, SGPT, SGOT, TBDB, LDH CRP, Procalcitonin, D- dimer, Ferritin, Serum Albumin, Protime, ABG, 12L ECG, Blood Culture X 2 sets, ETA or Sputum GS, Fecalysis (if with diarrhea)
2.2.2. NPS / OPS
2.2.3. Imaging: CXR, Focus Echocardiogram*** in the ER isolation room; Chest CT Scan (Plain) on transport to Ward 3B
2.2.3.1. Therapeutics: As Indicated
2.2.3.2. Precautions: All personnel to wear PPEs****; Place patient in mask.
3. Moderate to severe symptoms
3.1. Disposition: Put patient in ER isolation room, then admit to Ward 3B** (for patients with moderate symptoms), or Ward 3A (for patients with severe symptoms, or High Probability PUI, or with prior COVID-19 positive result), or CCU (for critically ill patients).
3.2. Diagnostics:
3.2.1. Labs: CBC, Na, K, Crea, BUN, SGPT, SGOT, TBDB, LDH CRP, Procalcitonin, D-dimer, Ferritin, Serum Albumin, , Protime, ABG, 12L ECG, Blood Culture X 2 sets, ETA or Sputum GS, Fecalysis (if with diarrhea)
3.2.2. NPS / OPS
3.2.3. Imaging: CXR, POCUS (if with severe symptoms), Focus Echocardiogram *** in the ER isolation room; Chest CT Scan (Plain) on transport to Ward 3B
3.2.3.1. Therapeutics: As Indicated
3.2.3.2. Precautions: All personnel to wear PPEs****; Place patient in mask.
Cont...
* Comorbidities:
1. Pre-existing Pulmonary Disease 2. Chronic Kidney Disease
3. Diabetes Mellitus
4. Immunocompromised Status
5. Hypertension or Cardiovascular Disease 6. Transplant
** Ward 3B – Primarily for COVID-19 positive patients; may admit high probability PUI
*** Focus Echocardiogram – for evaluation of:
1.
Chamber enlargement2.
Wall motion abnormality3.
Left ventricular ejection fraction**** PPE:
