COVID-19
Interactive Case Files
In collaboration with faculty members of the Johns Hopkins Department of Emergency Medicine, Lecturio has developed interactive clinical cases to teach you the fundamentals of caring for patients with COVID-19. To safely and effectively care for these patients, it is important to be familiar with modifications to standard protocols. These cases will teach you what you need to know!
Updated March 28, 2023
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Early Management of Hypoxia
Hypoxia, inadequate oxygen levels in the tissues of the body, must be identified and treated promptly to prevent respiratory failure. As treatment of hypoxia is dependent on several factors including presentation and cause, an understanding of different oxygen delivery methods is essential to providing care for these complex client situations. In this case, you will learn how to care for the hypoxic client. The learning objectives for this case are:
Identify the signs and symptoms of hypoxia
Describe the priority actions for individuals experiencing hypoxia
List oxygen delivery methods and identify the indications for each
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Assessment and Triage of Suspected COVID-19 Patients
Evaluation of medical instability in a patient with COVID-19 rests in the helpful mnemonic ABCD, referring to airway patency, breathing, circulation, and disability. It is of paramount importance to assess these clinical indicators of severe disease before moving on in the evaluation of the patient. In this case, you will also become familiar with the use of the ACEP COVID-19 management tool and the PRIEST score, validated tools to stratify risk in COVID-19 patients. The learning objectives for this case are to:
Quickly assess your COVID-19 patient for ABCD stability
Categorize your patient’s COVID-19 severity using the ACEP COVID-19 management tool
Estimate your COVID-19 patient’s risk of death or need for ICU care using the PRIEST score
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Hypoxia Management in Ventilated Patients
Patients with severe COVID-19 pneumonia may suffer from acute respiratory distress syndrome (ARDS), an inflammatory reaction resulting in diffuse lung injury. ARDS results in hypoxemic respiratory failure leading to worsening dyspnea and an increased oxygen requirement. These patients often require intubation and mechanical ventilation. In this case, you’ll learn ventilator management strategies for adult patients with ARDS due to COVID-19. The learning objectives for this case are:
- List the differential diagnosis for hypoxia among ventilated patients with COVID-19.
- Describe an approach to the diagnostic evaluation of hypoxic ventilated patients with COVID-19.
- Describe an approach to ventilator management to treat hypoxia among ventilated patients with COVID-19.
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Early Symptomatic Management
Worsening dyspnea in patients with suspected or confirmed COVID-19 infection is concerning for progressing pulmonary disease. These patients warrant further inpatient evaluation and management. In this case, you’ll gain an overview of supportive care measures for symptomatic patients and infection control interventions necessary to reduce COVID-19 transmission. The learning objectives for this case are:
- Choose correct PPE for providers caring for COVID-19-positive patients.
- Apply initial management steps for symptomatic COVID-19-positive patients that minimize aerosolization.
- Describe why non-invasive ventilation (NIV) is avoided in COVID-19-positive patients.
- Recall goal oxygenation targets for symptomatic/hypoxic COVID-19-positive patients.
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Airway Considerations
Patients with COVID-19 infection can experience increasing oxygen requirements despite receiving noninvasive ventilation. Early intubation should be considered in these patients showing signs of impending respiratory failure. There is an increased risk for disease transmission during intubation due to aerosolization of the virus; therefore, healthcare workers should be aware of important precautions prior to engaging in airway management procedures. In this case, you’ll learn the most effective approach to securing the airway rapidly while minimizing the aerosolization of respiratory secretions. The learning objectives for this case are:
- Describe features/findings in COVID-19-positive patients that warrant consideration for early intubation.
- Describe pre-oxygenation strategies for COVID-19-positive patients.
- Choose the correct strategy to confirm ETT placement in a COVID-19-positive patient.
- Prepare/choose intubation strategies that minimize aerosolization.
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Managing Sepsis
Critically ill patients with COVID-19 infection can develop sepsis, a clinical syndrome characterized by a dysregulated systemic inflammatory response to infection. Septic shock, distinguished by reduced mean arterial pressure and elevated lactate, can result in life-threatening organ dysfunction. In this case, you’ll establish an approach to diagnosing and managing septic shock in patients with COVD-19 infection. The learning objectives for this case are:
- Describe the differential diagnosis for COVID-19-positive patients arriving in shock.
- Construct a diagnostic pathway and plan to address hypotension in the COVID-19-positive patient.
- Apply sepsis management knowledge to a COVID-19-positive patient.
- Identify and describe pressor choice in a COVID-19-positive patient in septic shock.
- Describe the components of the RUSH ultrasound exam for patients with undifferentiated shock.
- Interpret ultrasound data obtained during the evaluation of a COVID-19-positive hypotensive patient.
- Apply the best evidence from ARDS patients to determine fluid resuscitation strategies for COVID-19-positive patients.
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Cardiac Arrest Management
Advanced cardiac life support (ACLS) comprises the clinical algorithms used to treat life-threatening cardiovascular emergencies. The treatment of cardiac arrest in patients with COVID-19 presents unique challenges. Resuscitative interventions should be prompt without compromising precautions that are necessary to minimize disease transmission. In this case, you’ll learn ACLS guidelines specifically for patients with suspected or confirmed COVID-19 infection. The learning objectives for this case are:
- Specify the proper personal protective equipment needed for COVID-19 critical care.
- Recognize the room composition needed in COVID-19 critical care.
- Describe how to triage patients suspected of having COVID-19.
- Describe the ACLS algorithm for use with COVID-19 patients.
- Recognize safe methods for pre-oxygenation before intubation in COVID-19 patients.
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