Covid Management and my experience

COVID  MANAGEMENT

Management 

Be calm, anticipate future and take actions. 

1) sample diet plan for covid patients 

2) Checks of tests and treatment of covid patients 

a) For detected Covid Patients, Initial tests if required.

• Chest XRAY - must. 
• CBC, D-Dimer (checks the blood clots in blood), Ferratin, ESR, 
• CT Thorax if needed.

b) BP and Sugar checks if needed. HBA1C for diabetic if needed.  

c) Tablets for mild patients to prevent virus expansion - HCQs or FabiFlu ( Favifiravir )

d) Critical patients ( Oxygen patients ) - Remedisvir given or not 

    Tests to be done to give Remedisvir -> CBC, RFT, LFT, sr ferritin, D-Dimer, CRP 

Remedisvir has its own side effects. 

e) Observe what steroids are being given and for how long. 

3) Make sure oxygen saturation is maintained in 94 to 100 with oxygen.

> If it is not maintained, make sure patient is shifted to high flow oxygen or ventilator if needed. 

> If patient removes oxygen and goes for toilet and bathroom, oxygen saturation may drop drastically to 60 to 70 too. But once patient puts oxygen, if he maintains oxygen saturation again above 94, no need to be panic. 

Tip - If patient is very tired, make sure catheter / diaper is used to patients. 

> Do not remove the oxygen for more time. If someone is slow eater, remove it and eat and put it while chewing. 

Tip - If oxygen level being given in less than 5 liters per minute, One can prefer Nasal Cannula instead of Oxygen mask.

Nasal Cannula - https://amzn.to/357iHcG

Oxygen mask - https://amzn.to/37ks4IT

4) Get yourself ready with contacts of available hospitals in city and near by cities when the patient is in Oxygen ward, so that you can contact them if patient required ventilator or high flow oxygen support and current hospital does not have the vacancy. 

> Remember, many lives are lost when patient is transferred from one hospital to other, may be because of low oxygen in Ambulance, Phycology / panic of patient, roads and traffic, process and bed availability at the hospitals. So, your first preference should be in current hospital, where there is no way or hope, make sure everything mentioned above is taken care 

5) Doctors, PGs, Sisters, brothers and other workers working @ hospital may be rash. Do not loose your patience, be calm and talk with them nicely and explain patient problems to them. 

> As they are in PPE kit, they are tired of situation and afraid of their health. They serve without drinking water, heard that some doctors use diaper, so please understand their state as well. Tough they are using PPE kit, they are prone to covid and many doctors have died too. So be calm.

6) When doctors/sisters neglect the work or PGs may not be highly known then the experienced doctor. Follow below points. 

> Try to get contacts of your known doctor and see if he/she would guide you remotely by sending the reports to them in whatsapp. If not, visit some best doctors at their clinic with softcopy of required reports. If pulmologist consultation required, as in this covid case needed, visit their clinic for their advice.

> During initial stage, if patient condition is critical, it is better to stay with patient. 

> If possible, rub the patient hands, back and tell them to do mild exercises slowly what ever is possible.  

> Track Insulin dosages being given to patients based on their sugar/diabetic levels. 

Usually PGs or sisters or brothers follow chart to give insulin based on GRBS value. If this is fallowed, there may be more ups and downs of sugar level. So, in that case, follow below points

a) If GRBS is below 100, based on chart insulin is not given. In that case too, make sure some 5 units of insulin is given. 

b) Usually GRBS is checked 2 times, morning and night. If patient needed, make sure to check GRBS 3 times a day. 

c) Suppose morning GRBS is 415, and night GRBS is 200. In that case, @night insulin is given based on night reading. Please see to that, morning reading is also tracked and little more insulin is given.   

> If some tests are not done at government hospital, request them to do so, if they are not, try to get the tests done by yourself by collecting the patient samples. 

> If covid antibody tests required, once patient recovers, make it done outside, if facility not available at hospital.

> When remedisvir is given, please track patients and repeat CBC, RFT, LFT, sr ferritin, D-Dimer, CRP

>Network yourself with hospital staffs, sisters, brothers, oxygen cylinders , blood collectors, doctors, which would help you. 

7) Boost the patient confidence, remove their social stigma of getting covid, If required, you can do remote consultation with video call to patient with physiologist.  

8) Tell patient to recite god prayers, as you know brain is devil and it is difficult to stop the thoughts roaming in mind. Especially ladies, they think about home, is food prepared at home, is water filled etc... 

9) Play god prayers like Hare Krishna Hare Krishna Krishna Krishna Hare Hare, Hare Rama Hare Rama Rama Rama Hare Hare in their mobiles and tell patient to follow it. 

10) Make sure other home members are in good state, track their health and if anyone has some symptoms, first preference is to get their tests done, if positive, give proper treatment. 

> Though symptoms is not there to home members, get their tests done, as many covid cases are asymptotic / may be infection is in early stage. If covid infection is detected and correct treatment is given at early stage, patient will be cured soon. 

> Try to see if covid test RT-PCR sample for home members is collected at home place. co-ordinate with Tehsildar for this help. 

> It is better to give for RT-PCR test rather than Antigen / Fixed test.

Note: 

Antigen covid test - Nose sample collected, result is known immediately.

RT-PCRcovid test - Nose and Throat sample collected, result in 1 or 2 days. 

> If oxygen saturation is maintained, it may not be needed for patient admission at hospital. But see the condition at your house, make sure some one is there at home to take care of other home member who is positive.  

> Boost the confidence of home members too. Co-ordinate with neighbors, remember they may act abnormal.  

> Along with home members, RT-PCR can be collected for neighbors @home if sample is collected at home. 

11) Give hot water to patient. Make sure patient takes more water and see that hot water is available to patient all the time. 

12) Try to keep buffer food to patient in hot box, so that patient can have when they feel hungry.

13) Initial days are critical, if patient sustains 10 days, there is more possibility of patient recovery. As any organs gets damaged in initial stage.  

14) If patient is serious, they may not able to eat anything, at that time, arrange ragi or rava ganji or ragi malt and liquid items to them. If they are unable to eat, feed in spoon. 

15) Make sure, the one who visits hospital takes care of their health too. This was my look at hospital. 

Face shield                    -  https://amzn.to/3lUuG3W

Disposable pull Overs  -  https://amzn.to/3o66tJW

N95 masks                    -  https://amzn.to/2Tap3SQ

Hand gloves                  -  https://amzn.to/3lUF0ZK

                                                      

Surrounding hospital 

Below are Precautionary measures for the one who visits hospital.

> Remember if you are good, patient will be good. If you take care of yourself and tell the patient that you are taking care of yourself in all the ways, Patient would feel good. 

> Spend time to exercise on yourself when ever you get time. Like when patient is eating, just sit and stand some times which will energize you. 

> Have covid diet, spend time on yourself too. Drink hot water and follow all the precautionary measures described at below link:

https://wayofliferj.blogspot.com/2020/10/covid-precautions.html

15) Research on injections, and treatment to be given and trending things in your free time, as this may helpful in patient treatment. 

16) Plasma therapy - This is not yet approved by AIIMS as it has its own side effects, but when there is no other option to save the patient, doctors go with Plasma therapy. 

15) Don't worry if relatives, friends do not come for help. Try to manage everything by planning the things and making time table to yourself on priority. 

16) If patient is diabetic, and sugar levels are not controlled, make sure proper diabetic diet is given.

Diabetic diet / BP / Healthy diet

https://wayofliferj.blogspot.com/2020/09/healthy-diet.html

17) Patient has to sleep upside down, sideways as this is good for oxygen flow into lungs. 

18) Breathing exercises at hospital for lungs recovery.

a) Spirometer - https://amzn.to/3dFpiz5

https://www.youtube.com/watch?v=PjuwGLflyPA&ab_channel=RajatChauhan

b) Balloon - https://amzn.to/3lYqnEX

https://www.youtube.com/watch?v=chBCqco6grY&ab_channel=DrKKAggarwal

c) Juice straw - https://amzn.to/3dQkcjD

https://www.youtube.com/watch?v=wab-i0kYMjs

19) Do not loose hope in GOD, be bold, encourage patient , boost confidence in them for speedy recovery.