INFECTIOUS DISEASE
COVID
PromptSyndromes associated with covid vaccinations
ResponseFrom AstraZeneca vaccine (These are all the same thing…)
- VITT - Vaccine induced immune thrombotic thrombocytopaenia
- VATT vaccine associated thrombosis and thrombocytopaenia
- VIPIT - vaccine induced prothrombotic immune thrombocytopaenia
- TTS - thrombosis with thrombocytopaenia syndrome
PromptSites of clot formation and their clinical features
ResponseVenous sinus thrombosis - Headache, focal neurology, seizures
Splanchnic thrombus - Persistent abdominal pain
PE - chest pain +/- dyspnoea
DVT - leg swelling/pain/colour change
Splanchnic thrombus - Persistent abdominal pain
PE - chest pain +/- dyspnoea
DVT - leg swelling/pain/colour change
PromptPathogenesis of these syndromes
ResponseAntibodies against platelet antigen PF-4 (similar to heparin antibodies in HITT)
PromptVaccine Induced Thrombotic thrombocytopaenia (ViTT) investigations
ResponseFBC - Thrombocytopaenia - If <150 further investigation warranted
D dimer - 5 times upper limit of normal
Fibrinogen - low
Anti PF-4 antibodies - Elevated
D dimer - 5 times upper limit of normal
Fibrinogen - low
Anti PF-4 antibodies - Elevated
PromptTreatment VITT
ResponseNON-heprain anticoagulation (eg: apixaban/rivaroxaban/dabigatran) - Inhibit further anticoagulation.
Fonduparinox s/c if oral contraindicated
?IVIG which inhibits autoantibodies.
Fonduparinox s/c if oral contraindicated
?IVIG which inhibits autoantibodies.
PromptCOVID Guideline formation stakeholders
ResponseHaematology
Path labs - specimines/results
Radiology - imaging
Pharmacy - NOACs etc
Path labs - specimines/results
Radiology - imaging
Pharmacy - NOACs etc
PromptCOVID intubation modifications
ResponseVideo laryngoscope - minimise direct exposure to airway secretions
Clamping of ETT during tube changes - minimise aerosolisation
High dose paralytic agent - Rocuronium 1.5mg/kg - avoid coughing/aerosolisation, improve first pass intubation
Immediate cuff inflation (Before ventilation) minimise aerosolisation
HEPA filters - reduce viral burdon
Intubate in negative pressure room, most experienced airway clinician - Minimise viral exposure
Clamping of ETT during tube changes - minimise aerosolisation
High dose paralytic agent - Rocuronium 1.5mg/kg - avoid coughing/aerosolisation, improve first pass intubation
Immediate cuff inflation (Before ventilation) minimise aerosolisation
HEPA filters - reduce viral burdon
Intubate in negative pressure room, most experienced airway clinician - Minimise viral exposure
PromptCovid specific drugs
ResponsePaxlovid (nirmatrelivir 300 mg/ritonivir 100 mg) x 5 days - risk factors but OK
Remdesivir 200 mg day 1 then 100 mg daily - Admission
Baricitinib or Tocilizumab - ICU
Remdesivir 200 mg day 1 then 100 mg daily - Admission
Baricitinib or Tocilizumab - ICU