1.
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3. First show the blank slides (eg. Aetiology ) > Ask
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today's topic. > Then show next slide which enumerates
aetiologies.
4. At the end rerun the show – show blank> ask questions >
show next slide.
5. This will be an ACTIVE LEARNING SESSION x
three revisions.
6. Good for self study also.
7. See notes for bibliography.

2.
Self Protection.

3.
Self Protection.
• May start Tab. Chloroquine Phosphate 500mg./
Hydroxychloroquine 400mg.every week.
• Dont’t apply foundation, sunscreen, liipstick with N95.
• Don’t wear any jewellery, Bangles Watch, money, Belt,
wallet, purse etc.
• Shave beard.
• Don’t carry mobile while on PPE.
• San itize mobile frequently.
• Don PPE before
1. Entering the room of a covid19 +ve .
2. Going within 3feet of a suspect.
3. Ask a suspect to don surgical mask himself.
4. Ask Covid19 +ve to put on N95 before you enter his

4.
Self Protection.
• Avoid touching eyes, nose and mouth.
• Keep social distancing .
• Frequent hand hygiene.

5.
Self Protection.
• Avoid/ be extremely careful aerosol
generating procedures-
1. CPR – consider DNR
2. Endotracheal intubation
3. Non invasive ventilation-
1. Bi Pap
2. C Pap
3. Bag mask ventilation
4. High flow Oxygen.
5. Suctioning.

6.
Self Protection.
• Doff PPE very carefully
– Outer surface is contaminated don’t touch it
with bare hands.
– Roll gown and gloves inside out.
– Perform hand hygiene after doffing.
– Doff inside isolation ward.
– Don’t doff in corridor.
– Use checklist’.
• Discard in proper bin/ disinfection bin.

7.
Self Protection.
•

8.
Doffing Checklist.

9.
Doffing Checklist.
1. Waterproof apron.
2. Shoe covers.
3. Gown and gloves peeled off as one unit., roll
inside out.
4. Gum boots
5. Hand hygeine.
6. Head cover from behind.
7. Face sheild/ goggles.
8. Mask from behind lower string first outside
doffng area.
9. Hand hygeine.

10.
Donning & Doffing

11.
Self Protection.

12.
Self Protection.
Cleaning Staff
• Don’t use broom (झाड
ू ) only mopping
• Use PPE
– Splash proof gown
– Goggles
– Mask
– Gum boots
– Nitril gloves

13.
Self Protection CPR.
• Don’t rush.
• Consider DNR beforehand.
• Put on PPE +N95mask.
• Minimize number of healthcare workers
involved.
• Avoid Chest compressions.
• Avoid Bag and mask ventillation.
• Avoid Syction.
• Intubate >connect to mechanical ventillator.

14.
Self Protection CPR.
• Don’t ever give mouth to mouth/ mouth to
tube respiration.
• Don’t auscultate.
• Use Intubation + defibrillation.

15.
Definitions.

16.
Definitions.
• Isolation : Isolating a symptomatic patient.
• Quarantine: Isolating a asymptomatic
persons.
• Suspected Case
1. Symptoms Fever, cough +Travel history.
2. Severe Symptoms Fever, cough requiring
hospitalization.
3. Symptoms Fever, cough + Contact with
COVID19 +ve patients.

17.
Definitions.
• Confirmed case
– A person with laboratory confirmation of
COVID-19 infection, irrespective of clinical
signs and symptoms

18.
TESTING STRATEGY

19.
TESTING STRATEGY
• Symptomatic individuals who have undertaken
international / hotspots travel in the last 2months
• Symptomatic contacts of laboratory confirmed
cases.
• Symptomatic health care workers even non covid
areas
• All hospitalized patients with Severe Acute
Respiratory Illness
• Asymptomatic direct and high-risk contacts of a
confirmed case should be tested once between day
5 and day 14 of coming in his/her contact .

20.
TESTING STRATEGY
• All symtomatic ILI Influenza Like Illness).
– ILI – Fever, cough,
• All patients undergoing emergency
operations.
• All patients undergoing endoscopy.
• All Negative Rapid antigen test patients.
• All indoor patients in non covid hospital

21.
Direct and high-risk contact

22.
Direct and high-risk contact
Without adequate protection with a
Lab.confirmed case done any of following-
1. Who live in the same household.
2. Healthcare workers who examined.
3. Touched body flluids
4. Being coughed on touched used tissue.
5. Touched or cleaned linen clothes or dishes.
6. In close proximity (<1meter)
7. Co passenger >6 hours.

23.
SCREENING

24.
SCREENING
1. At the Gate no.3 by guards.
2. wardboy-
3. Give mask record Name, age, sex, address,
mobile no. Handover to doctor .
4. Doctor will ask according to questionnaire

25.
Questionnaire

26.
Questionnaire
Criteria A: - EXPOSURE
• Is there a history of travel to a foreign
country in the last 4 weeks .
• Is there a history of travel to hotspot after
10th march.
• Is there a contact with a suspected or
confirmed case of Covid-19 (CASE
CONTACT)?
• Is there a close contact with a person who
has travelled to a foreign country in the last
4 weeks (TRAVELLER CONTACT)?

27.
Questionnaire.. Cont
Criteria B: - SYMPTOMS
• History of fever or respiratory symptoms
(SYMPTOMS)?
– Fever, cough, breathlessness, others.
– Temperature screening using non-contact IR
thermometer.

28.
Questionnaire..cont
• If all negative send back home/Quarantine.
• Put seal of quarantine on hand.
• Coming from other district – Send to zone
wise quarantine ie. Coming from red zone
> send to Red zone quarantine.
• If any positive – send in.

29.
INITIAL ASSESSMENT FOR
SUSPECTED PATIENT

30.
INITIAL ASSESSMENT FOR
SUSPECTED PATIENT
• Patient sent inside to sister.
• Don’t Handover the the paper to patient .
• Sister will check saturation.
• Doctor will confirm the history and visual
assessment.
• Councilling

31.
Counciling

32.
Counciling
• Alone
• Don’t roam
• Food
• Sanitize hands
• Call
• Stay till report comes.

33.
INITIAL ASSESSMENT FOR
SUSPECTED PATIENT

34.
INITIAL ASSESSMENT FOR
SUSPECTED PATIENT
• Do not touch or examine the patient.
• The patient should be wearing a 3 ply mask
• The patient should be seated at least 3 feet away
from the resident.
• If examination is required, it should be done only
after wearing PPE.
• Any equipment used should be disposed or placed
in a designated container for decontamination.
• The examination area should also be
decontaminated.

35.
Screening 3-Ground floor

36.
Screening 3-Ground floor
• Send to ward according to symptoms-
1. Asymptomatic ward.
2. Mild to moderate symptomatic –
Symptomatic ward.
3. Severe symptomatic –SARI ward
Take swab from all.

37.
HANDOVER OF SUSPECTED PATIENT
TO WARD

38.
HANDOVER OF SUSPECTED PATIENT
TO WARD
• After the suspect is assessed and deemed to
require admission, the admission slip will
be given.
• The admission slip/case sheet will not be
handled by the patient .
• If the patient is ambulatory, he will be asked
to enter the allotted ward.
• If the patient is not ambulatory, he will be
shifted by wheelchair.

39.
HANDOVER OF SUSPECTED PATIENT
TO WARD
• Ward boy who shifts the patient will wear
PPE.
• The Staff Nurse will enter the ward only if
indicated, and only after performing hand
hygiene and wearing PPE.
• After a visit to the patient, the staff will
doff the PPE in the doffing room before
exiting the isolation ward. This should not
be done in the corridor.
• Exit the isolation ward and then perform
hand hygiene again.

40.
Lab. Results

41.
Lab. Results
• If +VE – Shift to 3rd Floor
• If –ve send -
1. Severe symptoms -stabilise and send to
general hospital..
2. Mild Symptoms -Tab. PCM + cough syrup+
Home quarantine 14 days.
3. Asymptomatic- Home quarantine 14 days.

42.
Counseling

43.
Counseling
• Accompany to 3rd floor.
• Explain about stay till you are negative.
• Food.
• Call us for symptoms.

44.
DISCHARGE OF COVID NEGATIVE
PATIENTS

45.
DISCHARGE OF COVID NEGATIVE
PATIENTS
• The written report should be verified before
disclosing the report to the patient. This
should be done by at least two persons and
this should be documented (two residents
OR one resident and one nurse).
• The decision should never be based on mere
verbal communication.
• The Senior Resident In-Charge will
communicate the test result to the nursing
officer in the Ward.

46.
DISCHARGE OF COVID NEGATIVE
PATIENTS
• The discharge summary will be given by the
duty JR/SR to the nursing officer and then
handed over to the patient
• A detailed and thorough counselling will be
given to the patient to maintain home self-
isolation till they recover completely. They
should remain in home isolation for at least
14 days from exposure.

47.
3rd Floor

48.
3rd Floor
According to severity-
1. Asymptomatic - +ve ward.
2. Mild to moderate symptomatic –
Symptomatic +ve ward.
3. Severe symptomatic – ICU.

49.
Indications
•

50.
Management Protocol for Suspected
COVID-19 Patients Admitted to Ward

51.
Management Protocol for Suspected
COVID-19 Patients Admitted to Ward
1. Rule out other microbial etiology for pneumonia.
• Investigations to be sent:
– i. CBC,ii. ESR, iii. CRP, iv. Blood glucose, v. LFT
– vi. Blood urea, serum creatinine, vii. Electrolytes
– viii. ABG,ix. Blood culture x 2
• x. Sputum Gram stain and c/s
• xi. N-P swab RT-PCR for COVID-19
• xii. Chest x-ray (portable).

52.
Management Protocol for Suspected
COVID-19 Patients Admitted to Ward
Medications
1. Paracetamol for fever; avoid NSAIDs
2. Tab. Chloroquine
3. Nasal oxygen to maintain SpO2 >94%
4. Initial empiric antimicrobials
5. Concomitant medications for pre-existing medical
problems to be continued
6. For ACE-I and ARBs
1. Stop if HTN mild and well controlled;
2. Continue for severe uncontrolled hypertension, heart
failure
6.AVOID ALL NEBULISED DRUGS
Use salbutamol infusion (5 to 20 ƒÊg/minute) instead

53.
Management Protocol for Suspected
COVID-19 Patients Admitted to Ward
Transfer out if COVID-19 negative
Discharge: afebrile for 48 hours; normal vital signs
(pulse, respiration and BP

54.
Pediatric Covid 19
suspect/confirm patient

55.
Pediatric Covid 19
suspect/confirm patient
• For fever- Syp PCM dose @ 15 mg/kg/dose
Look for concentration of PCM in 5 ml
1. 125 mg/ 5ml
2. 250mg/5ml
Weigh band dose
1. < 8 kg- 3 ml
2. 8-10 kg- 5 ml 125mg/5ml, sos or QID
3. 10-15 kg- 7 ml
4. 15- 20 kg- 8 to 10 ml
5. 20- 30 kg- tab PCM ½ tab

56.
• For cough- use salbutamol or
levosalbutamol containing syp
– 1. < 8 kg – 3 ml Bid or TID
– 2. 8 to 13kg – 5 ml BID or QID

57.
Indications for intubation

58.
Indications for intubation
1. Gasping with pulse
2. Severely hypoxic SPO2<50% ON O2
3. Combative patient

59.
Before intubation

60.
Before intubation
1. Doctor and Staff Nurse wears PPE
2. PPE-Cover-all, N95, Goggles, Double
gloves.
3. Use Video Laryngoscope.
4. Avoid the use of high-flow nasal
oxygenation and mask CPAP or BiPAP If
possible bag-valve mask, nebulizers, non-
invasive positive pressure ventilation

61.
Modified Rapid Sequence Induction (RSI)
for COVID-19

62.
Modified Rapid Sequence Induction (RSI)
for COVID-19
• Pre-oxygenate with a non-rebreather mask
(NRBM) with reservoir
• Avoid bag and mask ventilation {if needed,
use Bag-Valve Mask (BVM) with filter}
• Avoid suctioning as far as possible
• Elevate bed to 40 degree with head-end
elevation position for increasing first pass
success rate
• Do rapid sequence induction with etomidate
and succinylcholine (High dose paralytic)

63.
Modified Rapid Sequence Induction (RSI)
for COVID-19
• Intubate with Bougie always to increase first pass
success rate.
• Nurse to give ETT with attached cuff inflation
syringe for rapid cuff inflation to minimize aerosol
generation.
• Visualize the black line and tube position by
centimeter check; avoid auscultation to check for
tube position
• Attach HME filter to ETT and attach to Bains
circuit/ Mechanical Ventilator.
• Staff Nurse to dispose and decontaminate the
equipment in the resuscitation area

64.
Waste management for COVID-19

65.
Waste management for COVID-19
• Keep colour coded bins .
• Double bags.
• Label Bins, Bags, containers, trolleys “COVID19
waste”.
• Transport “COVID19 waste” seperately from
other waste.
• BMW staff to wear PPEs Splash proof gowns,
Goggles, Masks, Nitrile gloves, Gum boots.
• Disinfect Bins, Bags, containers, trolleys 1%
hypochlorite solution.
• Make seperate Pit for burial.

66.
Colour coding of Hospital Waste
Transfer out if COVID-19 negative
Discharge: afebrile for 48 hours; normal vital signs
(pulse, respiration and BP

67.
Sanitization

68.
Sanitization
• No brooms.
• No Vaccum Cleaners
• Only mopping with 1% hypochlorite 3 times a
day.
• Unidirectional Mopping away from you.
• The door knobs, handles, railings, lift switches,
nursing platforms etc. should be frequently
disinfected with 1% hypochlorite.

69.
After death

70.
After death
• Don PPE
• All tubes, drains,Catheters removed and disposed.
• All punctures, holes, wounds resulting from
rempoval of tubes, drains,Catheters cleaned with
1% hypochlorite and dressed with impermeable
material.
• Plug oral, Nasal orifices .
• If family wish to see the dead body allow with
PPE.
• Place the body in leakproof plastic bodybag.
Cont....

71.
After death
• ...Cont
• Exterior of bodybag be cleaned with 1%
hypochlorite
• This be covered / wrapped with sheet provided by
relatives.

72.
Robot Nurse
•

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