The most common symptoms of a disease of a coronavirus - cough, anorexia, fever, weakness, mialgiya and diarrhea. The serious illness usually begins approximately in 1 week after emergence of symptoms. An asthma is the most common symptom of a serious illness and often is followed by an anoxemia. Feature of COVID-19 is fast progressing of respiratory insufficiency soon after emergence of an asthma and an anoxemia.
The diagnosis of existence of COVID-19 can be made on the basis of the anamnesis, clinic and at detection of SARS-CoV-2 RNA in respiratory tracts. The radiography of a thorax has to be executed, it usually shows bilateral konsolidata or turbidity as opaque glass.
Patients with a severe form of COVID-19 have to be hospitalized for careful observation. Considering high risk of intrahospital spread of an infection, it is necessary to carry out procedures of infectious control constantly. If it is possible, the patient has to wear a surgical mask to limit dispersion of infectious drops. Workers have to have the corresponding SIZ.
With a severe form of Covid-19 the essential risk of long disease and death have patients. It is necessary to watch patients carefully by means of clinical inspection and a pulsoksimetriya. Oxygen has to move with use of a nasal cannula or Venturi's mask for hemoglobin saturation maintenance by oxygen. Making decision on need of an intubation is the major aspect. Clinical physicians have to weigh risk of a premature intubation with risk of sudden infection as a result of a chaotic urgent intubation which puts personnel at higher risk. Signs of excessive effort at breath, the anoxemia refractory to oxygen and also encephalopathy foretell the approaching apnoea and dictate need of an urgent endotracheal intubation and artificial ventilation of the lungs. There is no uniform number or an algorithm defining need of an intubation. If the patient was not zaintubirovan, but remains gipoksemichny, then the high-line nasal cannula or NIVL can improve oxygenation and can prevent an intubation at certain patients. Some experts do not recommend to use high-line nasal cannulas and noninvasive ventilation of the lungs as these methods of treatment can delay a necessary intubation and subject clinical physicians to influence of infectious aerosols.
When the awake patients turn in a pron-position, inhaling high concentrations of oxygen, it improves gas exchange at patients with a severe form of COVID-19. However, not clearly, whether the pron-position can prevent an intubation. As it is difficult to provide saving ventilation of the lungs to patients who are in pron positions, this situation should be avoided at patients whose state quickly worsens.
It is recommended to take into account the patient's pron-position during artificial ventilation of the lungs with a refractory anoxemia. However reduction of the patient in a pron-position of patients demands team of not less than three experienced clinical physicians, full SIZ are necessary for each of which. Extracorporal membrane oxygenation (EKMO) is the potential strategy of rescue at patients with refractory respiratory insufficiency. However EKMO can be inefficient because of existence of tsitokinovy instability and hypercoagulation and its use will probably be limited as the pandemic limits resources.
Patients with COVID-19 often have a hypovolemia. Volume filling helps to support the blood pressure and warm emission during an intubation and ventilation under positive pressure. After the first several days of artificial ventilation of the lungs the purpose has to be in avoiding a hypervolemia. Fever and a tachypnea at patients with a severe form often increase water loss therefore it is necessary to pay close attention to a water balance.
Blood coagulation disturbances, such as thrombocytopenia and increase in the D-dimera level are widespread among patients with heavy COVID-19 and are connected with higher mortality. For reduction of risk of venous thrombosis the tromboprofilaktika has to be used.
The patients hospitalized with a severe form of COVID-19 often receive empirical treatment by antibiotics. However the bacterial infection meets seldom when patients for the first time are hospitalized. Antibiotics can be cancelled after a short course of treatment if there are no symptoms of a bacterial infection, such as leukocytosis and focal pulmonary infiltrates. The final decision concerning use of antibiotics is made depending on a concrete clinical situation.