Current numbers of Spain Cases in Spain Confirmed cases Deaths - - PowerPoint PPT Presentation

Javier Benito Director Pediatric Emergency Department Cruces University Hospital – Bilbao – Basque Country - Spain Chairman Spanish Society of PEM

Current numbers of Spain

Confirmed cases Deaths Recovered

Cases in Spain

COVID-19 Cases by age

COVID-19 Cases by age and clinical situaJon

PED episodes/week during COVID-19 pandemic PED - CUH

200 400 600 800 1000 1200 1400 2ª Feb 3ª Feb 4ª Feb 1ª Mar 2ª Mar 3ª Mar 4ª Mar 5ª Mar 1ª Abr 2ª Abr 3ª Abr

School Closure Lockdown

Consequence

• Transforming hospitals to COVID-19
• Diversion of human and material resources to care for adult paJents
• ConcentraJon of Primary Care, ED and hospitalizaJon in few centers.
• LimitaJon of face-to-face a\enJon

Concern for delayed arrival to the emergency department in some paJents

How is your Pediatric Emergency Department organised ?

• Two separate paJent flows, from triage to hospitalizaJon, COVID-19 and

Non COVID-19.

• One person per child and in COVID-19 flow both with surgical mask.
• PPE instrucJons for professionals a\ending COVID-19 and Non-COVID-19

flow.

• Professionals who care for unstable paJents, complete PPE.
• Avoid aerosols (nebulizaJon and HFO).
• Maintain usual criteria for hospitalizaJon. Individualized management of

children with predisposing disease.

• Perform SARS-CoV-2 PCR on paJents assigned to COVID-19 flow requiring

hospitalizaJon.

• Laboratory tests and X-rays according to clinical symptoms and severity.

How is your Pediatric Emergency Department organised?

• Radiología:
• Reconocimiento: Rx 2 limpio

EPI

*Recogida de PCR en pacientes previo a ingreso si precisa

• Radiología:
• Zona ambulatoria: Rx 1 sucio
• Reconocimiento: Rx sucio

Estancia máxima 24 horas Estancia máxima 18 horas

FLUJO PACIENTES. URGENCIAS PEDIATRIA. HU CRUCES

Ambulatorio 1,2,3 Nivel IV Nivel V Triaje zona interna UP, mostrador Nivel II Nivel III Área de Reconocimient

• Consulta

Fast- track Ciertos niveles III Nivel IV-V Nivel II Ciertos niveles III Área de Evolución Alta Planta* Alta Planta Alta Área de Reconocimiento Planta* Alta Área de Evolución Planta 1 adjunto 1 MIR 1 enfermera 1 adjunto externo 1/2 MIR 1 adjunto 1 enfermera 1 MIR 1 enfermera

SERVICIO DE URGENCIAS DE PEDIATRÍA. HU CRUCES. 26/03/2020

No Trauma Trauma Inestable Estable Sala de Curas Sala de espera en Ambulatorio 4 1 adjunto 0/1 MIR 1 enfermera Admisión: mascarilla quirúrgica al paciente y un familiar Triaje UP en el lugar de siempre

¿Fiebre y/o Cuadro respiratorio?

Paciente crídco Área de Estabilización 1 enfermera 1 AE

EPI

SI NO

EPI

Triaje UP en el lugar de siempre

La 3ª persona de triaje: limpia

• Two separate paJent flows:
• COVID-19 Flow (Fever and/or respiratory symptoms). Surgical mask for the

paJent and one parent/caregiver.

• PPE:
• Respiratory protecdon

FFP2 respirator

• Eye protecdon

Goggles or face shield

• Body protecdon

Long-sleeved water-resistant gown

• Hand protecdon

Gloves

• Non COVID-19 Flow
• PPE:
• Respiratory protecdon

FFP2 respirator

• Hand protecdon

Gloves

How is your Pediatric Emergency Department organised?

How can you define a suspect case of coronavirus infecJon?

How do you manage the suspect paJent in the Emergency Department?

• Tesdng (PCR):
• PaJents with risk factors for poor evoluJon
• PaJents with fever or respiratory symptoms who require hospital admission due to clinical criteria
• Neonates with fever
• Consider in paJents with radiological evidence of pneumonia, even if outpaJent management
• Admission COVID-19 +: In general, the usual admission criteria are maintained
• Neonates with fever
• Hypoxemia (satO2 <92%) or moderate / severe respiratory distress that does not improve aier

bronchodilator treatment

• General poor condiJon, lethargy
• Refuse feeding
• Apnea
• Consider admission in paJents with risk factors for poor evoluJon
• Treatment in the ED: Avoid nebulizers and HFO

How do you manage the suspect paJent in the Emergency Department?

• It is recommended that paJents who require admission have a blood

test (hemogram, coagulaJon, venous blood gas, biochemistry with LDH, PCR and PCT) and a chest X-ray (ideally portable).

• Consider the uJlity of chest ultrasound if available and trained

personnel are available

• Treatment in the SUP
• SupporJve therapy
• Avoiding nebulizaJon and HFO
• Cephalosporin 3rd generaJon if suspect bacterial superinfecJon

How do you manage the suspect paJent in the Emergency Department?

• Clinical criteria
• PCR SARS-CoV-2 posiJve

Which criteria do you use to define a coronavirus infected paJent?

• Radiología:
• Reconocimiento: Rx 2 limpio

EPI

*Recogida de PCR en pacientes previo a ingreso si precisa

• Radiología:
• Zona ambulatoria: Rx 1 sucio
• Reconocimiento: Rx sucio

Estancia máxima 24 horas Estancia máxima 18 horas

FLUJO PACIENTES. URGENCIAS PEDIATRIA. HU CRUCES

Ambulatorio 1,2,3 Nivel IV Nivel V Triaje zona interna UP, mostrador Nivel II Nivel III Área de Reconocimient

• Consulta

Fast- track Ciertos niveles III Nivel IV-V Nivel II Ciertos niveles III Área de Evolución Alta Planta* Alta Planta Alta Área de Reconocimiento Planta* Alta Área de Evolución Planta 1 adjunto 1 MIR 1 enfermera 1 adjunto externo 1/2 MIR 1 adjunto 1 enfermera 1 MIR 1 enfermera No Trauma Trauma Inestable Estable Sala de Curas Sala de espera en Ambulatorio 4 1 adjunto 0/1 MIR 1 enfermera Admisión: mascarilla quirúrgica al paciente y un familiar Triaje UP en el lugar de siempre

¿Fiebre y/o Cuadro respiratorio?

Paciente crídco Área de Estabilización 1 enfermera 1 AE

EPI

SI NO

EPI

Triaje UP en el lugar de siempre

La 3ª persona de triaje: limpia

For paJents: healthy, suspect or infected do you have separate paths in pediatric emergency department?

In the pediatric emergency department do you have also a program of screenig for parents or caregiver?

• InstrucJons for tesJng family members with symptoms in primary

care

What are the clinical pictures that you have found in children with coronavirus infecHon?

• Mild respiratory symptoms in paJents with risk factors for poor evoluJon
• Pneumonia
• BronchioliJs
• Few severe cases

Martes, 29 de mayo de 2012