Moderator EMEDPA Posted August 11, 2021 Moderator Share Posted August 11, 2021 So in the interest of expediting care we have a few layers of workup in my EDs for folks with covid not needing bipap or intubation: 1. I want a test and I feel fine or have minor sx: test and d/c 2. I want a test or I know I am + and has low sats <92%: add cxr and labs. Consider home on oxygen and steroids 3. As per #2, but with dimer > 1.0. add CTA of chest to r/o PE. #3 is my issue. lots of literature supports checking dimers in covid + patients, but they are all high and most are > 1, so these folks end up with (mostly) needless CTAs. Anyone have a better method for deciding who gets the CTA? wells, perc, and Geneva are all out the window because of covid. We need an MD calc r/o PE algorithm in covid + patients.... Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted August 11, 2021 Share Posted August 11, 2021 I don't have a great way to rule-out the CTA but they definitely get it if they're in a-fib or have the traditional tachycardic & tachypneic. I've seen a number of new onset a-fib's from PE's d/t COVID. 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 11, 2021 Author Moderator Share Posted August 11, 2021 I have no issue with someone I would otherwise work up for PE, but apparently a lot of the old rules are out the window with covid. Not tachycardic or tachypneic? No risk factors other than covid? Look! A PE..... Quote Link to comment Share on other sites More sharing options...
BirdDogPA Posted August 14, 2021 Share Posted August 14, 2021 Emedpa, I’ve been in the same situation and have looked into this topic of D Dimer and Covid patients. My critical care doc says it’s helpful on their side to predict outcome ie high D Dimer patient doesn’t do so well. So with that in mind all admits get a d dimer at my shop. If it’s positive we generally do scan. If I’m leaning more outpt tx I will get one if they are PERC pos. Have actually caught a few PEs in young healthy Covid pos patients. For now I’ll be liberal with the D Dimers. 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 14, 2021 Author Moderator Share Posted August 14, 2021 9 minutes ago, BirdDogPA said: Emedpa, I So with that in mind all admits get a d dimer at my shop. If it’s positive we generally do scan. How are you defining positive in Covid patients? The normal 0.5 or age adjusted or > 1.0? Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted August 15, 2021 Share Posted August 15, 2021 I use age adjusted. Also, every COVID (+) patient I admit gets 324 ASA daily. 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted August 15, 2021 Author Moderator Share Posted August 15, 2021 40 minutes ago, ohiovolffemtp said: I use age adjusted. Also, every COVID (+) patient I admit gets 324 ASA daily. We have been doing lovenox, but asa also makes sense. Quote Link to comment Share on other sites More sharing options...
BirdDogPA Posted August 22, 2021 Share Posted August 22, 2021 On 8/14/2021 at 1:09 PM, EMEDPA said: How are you defining positive in Covid patients? The normal 0.5 or age adjusted or > 1.0? I use age adjusted. We do lovenox as well. Quote Link to comment Share on other sites More sharing options...
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