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Saturday, June 12, 2021

Explained: What to do in case of a Covid-19 emergency

Several doctors have often said that Covid patients reach hospitals very late, due to which they either die on the way, while waiting for a bed, or land straight in the ICU.

Written by Raakhi Jagga | Chandigarh |
Updated: May 18, 2021 8:09:14 am
At a Covid-19 care centre. (Express Photo: Ritesh Shukla)

Several doctors have often said that Covid patients reach hospitals very late, due to which they either die on the way, while waiting for a bed, or land straight in the ICU. The Indian Express talks to doctors about how one can avoid such a situation.

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What is a Covid emergency?

Dr Abhimanyu Sharma, Head Emergency, Fortis Hospital, Ludhiana, says: “Symptoms which can be considered as signs of Covid emergency are — falling oxygen saturation, haemodynamic instability, non-resolving high grade fever, pain in the chest, severe headache, oxygen saturation below 92, and respiratory distress. In addition to this, if a person is unable to do the 6-minute walk test, it should not be taken lightly and hence one should consider it an emergency situation.”

Which symptoms shouldn’t be taken lightly?

Feeling breathless, not being able to maintain oxygen saturation above 94 per cent or feeling restless while standing even for a few minutes. Palpitations, high pulse/heart rate above 100 per minute. High blood pressure or low BP and dehydration due to persistent loose stools/vomiting, blood in sputum or cough are few of the symptoms which should not be taken lightly at all, says Dr Surendra Gupta, a general physician practising in Ludhiana.

How can it be prevented?

Follow instructions of doctors. Practice deep breathing, monitor oxygen/pulse rate on a regular basis and also stay hydrated. Sleepiness can lead to hypoxia and one may not be able to take timely measures. Accumulation of carbon dioxide in the blood can cause dizziness and deep-breathing helps in maintaining a fair balance of gases in the blood. Easily digestible nutritious food, fluids should be taken.

Sipping a bit of water after regular intervals can supply oxygen too, said Dr Ankur Shah, an oncologist from Intas Pharmaceuticals.

What should one do in case of a Covid emergency?

The patient should contact his/her treating doctor for further management and an appointment with a superspecialist should be arranged or visit a hospital. Depending on the condition of the patient, an oxygen bed may be arranged using local Covid bed availability app.

Apart from RT-PCR, what other tests should be conducted starting from day 1 of onset of symptoms?

Apart from RT-PCR, which is a Covid test, complete blood counts (CBC), random blood-glucose, Quantitative-CRP (C-reactive-protein), SGOT, D-dimer, LDH, Ferretin, IL-6, kidney/liver function tests and HRCT chest should be done for overall assessment, based on doctor’s advice.

These tests determine whether major organs of the body are functioning properly and whether there is any inflammation in the body or not so as to start medication accordingly, said Dr Kulwant Singh, a cardiologist and former IMA president, Ludhiana district.

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What if the RT-PCR test is negative but CRP is positive and HRCT indicates Covid pneumonia?

One should start treatment as per Covid-19 protocol because CT gives a clear picture of lung involvement. RT-PCR has sensitivity of 70 per cent only and there have been cases of false negatives. Treatment should be started soon, said Dr Abhimanyu.

What line of treatment can be followed at home in the mean time?

The patient should practice deep-breathing. He/she should do a 6-minute walk test every 8 hours and after that record oxygen concentration and pulse. Prone position will help increase Spo2. One should follow home isolation under the guidance of a physician for better monitoring. Above all, patients or their family members should not panic.

The patient should do short breathing exercises, walk a little within their home etc. This can help increase oxygen saturation in case the patient is elderly or diabetic.

Here, shallow breathing efforts can be followed, said doctors, while those showing fall in oxygen-saturation and sharp increase in heart rate need to be given oxygenation improving therapy so as to treat chest-tightness i.e. lung pneumonia.

What sort of medication should be given to avoid Covid emergency?

Oral and inhaled steroids along with bronchodilators have to be given, antibiotic, vitamin C, Zinc supplements and steam inhalation should be part of medication to avoid emergencies. Alcohol and smoking should be avoided one should strictly follow Covid protocols, doctors said.

How can patients with co-morbidities avoid Covid emergency?

People with co-morbidities like diabetes/heart or kidney diseases or stroke need to continue their medications and ensure a good control over their diseases.

They should regularly practice deep-breathing, keep calm but motivated and stress-free. They need to stay physically active, even in their home environment. They should check their blood-glucose, blood pressure apart from oxygen saturation on a regular basis. They should contact their treating doctors on the phone in case of any abnormal feeling or findings, Dr Gupta said.

How frequently should a patient undergo tests?

Doctors feel that ideally, patients should avoid going out more than once. So it’s better if RT-PCR/lab investigations and HRCT of chest are done in a one go, but tests can be repeated as per physicians’ directives. However, utmost protection needs to be ensured.

What are the dos and don’ts?

A Covid patient’s mandatory 14 days’ isolation has to be respected by patient and all family members. Patients should be kept in a separate room, with windows and a bathroom. Family members should not panic and start running for vaccination, as it can be counterproductive.

One should avoid self-medication. Only family physicians or a super specialist’s prescribed medications should be taken alongwith other lifestyle modifications as advised, said doctors.

In addition to this, Dr Gupta added that in isolation, patients should continue their online business activities, talk to family via video-conference etc. Lab personnel shouldn’t be invited again and again for sample collection, as they too are a potential risk.

Freshly prepared diet should be given to patients at regular intervals. If the patient is stable, he/she should mop their room/bathroom with detergent or sodium hypochlorite solution or the caregiver should do it following all precautions.

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