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INFLUENZA / Possible pneumonia- CONSIDER COVID 19 Infection Uncomplicated flu: Fever (100° to 103°F - no fever in some), chills, cough, sore throat, muscle aches, runny or stuffy nose, HA, malaise and fatigue. Vomiting and diarrhea more common in young children.More severe S&S: High fever, shaking chills, pleuritic chest pain, productive cough of thick yellow-green mucusComplications: pneumonia, ear or sinus infections, dehydration.Suspect pneumonia if: Temp >100°F (37.8°C), productive cough, isolated crackles; SpO2 <95%; HR >100Standard precautions / DisinfectionFor close contact (w/in 6 feet of pt with suspected flu): Droplet Precautions and BSI:Nonsterile gloves for contact w/ potentially infectious material; hand hygiene immediately after glove removalIf fever and coughing: Surgical mask on pt and mask on each EMS responder (surgical masks, N95, or higher respirator masks) when appropriate.Consider wearing disposable isolation gowns and face shields including eye protection when splashes or sprays of respiratory secretions or other infectious material are possible.Disinfect stethoscope heads and other frequently-handled items after each patient. General recommendation: In ambulance, thoroughly clean all planes and crevices; spray with System-approved disinfectant registered by the EPA to kill viruses (norovirus, rotavirus, adenovirus, poliovirus) and TB.If using a spray, hold dispenser 10” from surface and atomize with quick short strokes, spraying evenly on (potentially) contaminated areas until wet. Allow wet dwell time per manufacturer’s instructions. Prefer products with 1 minute dwell time. After that, wipe down with a clean towel dampened with clean water then dry thoroughly. Remove/clean residue that may be left behind from disinfectant.seq level2 \h \r0 Mild illness/low risk for complications:IMC: Supportive care. If called w/in 24 hours of onset, encourage pt to see PCP to receive anti-viral agent. Encourage rest, fluids, and non-aspirin OTC pain relievers and fever reducers. Cough suppressants, decongestants, and antihistamines may alleviate symptoms. Moderate to Severe complications Respiratory failure with severe hypoxemia and hypercarbia may occur in pts with flu-associated pneumonia or exacerbation of underlying airway diseaseGive O2 and bronchodilators/HHN as indicated. IF COVID-19 Suspected- AVOID Aerosol Generating PROCEDURE Assist ventilations with 15 L O2/BVM prn for pneumonia progressing to acute lung injury or ARDS. Consider need for CPAP with in-line neb (ALBUTEROL/IPRATROPIUM standard dose) COVID19 AMENDMENT-ASSIST PATIENT WITH ALBUTEROL MDI to 8 puffs as alternative dosing with HHNAssess for sepsis, time-sensitive pt.Risk factors for serious FLU complicationsAsthma; Chronic lung disease (COPD; cystic fibrosis)Endocrine disorders (e.g. diabetes mellitus)Heart disease (congenital heart disease, HF, CAD)Kidney, liver, metabolic disordersNeurological and neurodevelopmental conditionsObesity with a BMI of 40 or higherAdults 65 years and olderChildren <5 years old, but especially those<2 yearsPregnant women and those up to 2 weeks post-partumPeople in nursing homes and long-term care facilities; weakened immune systemPulmonary embolism: Common, difficult to diagnose, and potentially lethal if missed. Time sensitive ptSize/location determines S&S. Consider possible PE if: Hx: Previous venous thromboembolism (VTE) or pulmonary embolism; venous stasis (surgery or prolonged immobilization w/in last 30 d); recent trauma/damage to lining of vessels (CV disease: atherosclerotic changes; HTN, injected drug use; central line; or other IV medical device, inflammation from direct infection, diabetes; smoking); hypercoagulable state (malignant: cancer currently active or considered cured w/in last year; hematologic (pregnant), or medication induced (oral hormone use). Also consider presence of air, fat or amniotic fluid as source of emboli.S&S Acute onset pleuritic chest pain; unilateral lower limb pain/edema; tachypnea disproportion to fever and tachycardia; SpO2; small, square capnography waveform and very low reading (increased dead space and hyperventilation); HR ≥100; cough may be productive with hemoptysis; shockIMC based on the patient presentation, VS, and signs of shock/instability. 12 L ECG.Definitive Rx of embolus due to blood clot may be fibrinolysis – rapid transport to hospital ................
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