dc vamc covid 19 information repository

testing

We have four COVID tests here: the Abbott, the BDmax, the Allinity and the Cepheid tests

  • COVID-19 Allinity - This is the test you should mostly be ordering inpatient, typically with 6-12 hours of turnaround time.

  • COVID-19 Abbott - 1 hour turnover but test kits are limited

  • COVID-19 Fluvid - about 6 hour turnaround. This tests for influenza A&B, and RSV as well. Done in the ED mostly.

  • COVID-19 BDmax - being phased out of use

 

There also is a Respiratory Biofire panel that looks at 22 viruses and bacteria. This is restricted and requires ID approval. See here for what is on this panel.

ppe

PPE is in short-supply across the world and so we thank you for being conscientious in your use of supplies. That said, never let a desire to preserve PPE hinder patient care – if you need to see a patient, see the patient!

  • For COVID patients - please wear an N-95 mask, face shield, gown and gloves

  • For all other patients - please wear a surgical mask and face shield, otherwise following the directions of any other precautions they are on.

 

Eye protection is key for EVERY patient encounter.

Risk is also reduced when the patients wear their masks, so please ask the patient to don a mask when you enter the room, even if they have tested negative for COVID.

Where to get PPE?
  • N-95s can be obtained:

    • Teams 1/3: 3E Nursing Station

    • Team 2: 2D Nursing Station

    • Team 4-6: 4C Nursing Station

    • Last resort: Chiefs Office (4A-162)

  • 4pm-11pm: Vocera “SPD”

    11pm - 7:30pm: Vocera “Nursing Supervisor”

  • Remdesivir: consult Infectious Disease for consideration if patient has an oxygen requirement. Note that there is an Emergency Use Authorization for this therapy, but there is no FDA approved drug. Your attending will need to consent the patient for Remdesivir and document the consent in CPRS. The medication will then be ordered by Infectious Disease

  • Dexamethasone: based off of the RECOVERY trial, where PO or IV dexamethasone once daily for up to 10 days or hospital discharge associated with a lower incidence of death, particularly those on mechanical ventilation. Practice has been to start if patients have an oxygen requirement, with consultation with ID.

  • Hyperimmuneglobulins: the ID department is running a study on use of these and will reach out to your attending if your admitted patient is eligible

  • Convalescent plasma: available, again through Infectious Disease consultation. The order placed is for FFP with a comment written for Convalescent plasma. Also note that patient needs a blood consent for administration of plasma.

  • Anticoagulation:

    • Wards: Intermediate dose-anticoagulation based on weight and CrCl

      • >120kg or BMI >35: lovenox 0.5mg/kg SQ BID (max of 100mg SQ BID) if CrCl >30; CrCl <30 should use heparin 10,000u SQ TID

      • 60-120kg: lovenox 40mg SQ BID if CrCl >30, if <30 then heparin 7500 SW TID

      • <60kg: lovenox 30mg SQ BID if CrCl >30, if <30 then heparin 7500u SQ TID

    • MICU: empiric full dose anticoagulation with heparin gtt

therapeutics available

COVID patients will be admitted primarily to Teams 6, 5 and overflow to Team 4 if numbers go up. 

Floors: 4C can handle up to 6L of nasal cannula; PCU can handle up to 15L with cool high-flow nasal cannula. Higher than 15L will need MICU level of Care

Please utilize CXR for patients with known or suspected COVID19. Please limit all nonessential imaging (ultrasound, echo, MRI) unless it changes management.  The patient should wear a surgical mask while outside of the room and must be transported by nursing (ie transporters can not transport a PUI).