Important update: Healthcare facilities
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Travel requirements to enter the United States are changing, starting November 8, 2021. More information is available here.

Clinical decision algorithm to guide care advice messages

Clinical decision algorithm to guide care advice messages
Updated Nov. 13, 2020

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  • Ill or caring for someone ill?
  • If “No,” provide education (Refer to Care Message A).
  • If “Yes,” collect needed demographics including age and gender of the patient.
    • If younger than 2 years old, evaluate for life-threatening conditions:
      • Extremely fast or shallow breathing
      • Blue-colored lips or face
      • Not waking up or interacting when awake
      • So irritable that child doesn’t want to be held
      • Seizures
      • Other conditions as per your center’s protocol
    • If “Yes” to life-threatening conditions, call 911 (Refer to Care Message B).
    • If “No,” seek evaluation by outpatient medical provider as soon as possible. (Triage tool not intended for children < 2years) (Refer to Care Message C).
    • If 2 years or older, evaluate for life threatening conditions:
      • Extremely difficult breathing (can’t walk without gasping for air)
      • Blue-colored lips or face
      • Severe or persistent pain or pressure in the chest
      • Severe constant dizziness or lightheadedness
      • Acting confused or unable to wake up
      • Slurred speech (new or worsening)
      • New onset seizure or seizures that won’t stop
      • Other conditions as per your center’s protocol
    • If “Yes,” call 911.
    • If “No,” ask a series of questions.
      • Exposures: In the last 2 weeks before sick:
        • Have contact with someone with COVID-19?
        • Live in/visit a place where COVID-19 spreading?
      • Symptoms:
        • Fever (subjective or measured)
        • Shortness of breath
        • Severe shortness of breath (unable to speak full sentence)
        • Cough
        • Coughing up blood (hemoptysis)
        • Signs of low blood pressure (cold, pale, clammy skin, light-headed)
        • Runny or stuffy nose
        • Sore throat
        • Muscle, body aches, or headaches
        • Fatigue or malaise
        • Nausea, vomiting or diarrhea
        • For (age 2-4 years)
          • Ribs are pulling in with each breath (retractions)
          • Dehydration/decrease urine output
      •  High-risk Conditions:
        • Age ≥65 years
        • Chronic lung disease or moderate to severe asthma
        • Congestive heart failure
        • Diabetes with complications
        • Neurologic conditions that weaken ability to cough
        • People with weakened immune systems
        • Dialysis
        • Cirrhosis of the liver
        • Extreme obesity (Body Mass Index, or BMI greater than or equal to 40)
        • Pregnancy
      • Special Circumstances:
        • Living in nursing home or long-term care facility
        • Healthcare personne

Determine disposition

      • Dispositions:
        • Provide education (Refer to Care Message A):
          • No symptoms/not sick
        • Urgent Medical attention is needed/Go to the ED (Refer to Care Message D):
          • Severe shortness of breath; or
          • Hemoptysis; or
          • Signs of low blood pressure; or
          • Dehydration (only ages 2-4); or
          • Retractions (only ages 2-4)
        • Call a provider within 24 hours (Refer to Care Message E):
            • Any non-severe shortness of breath; or
            • Fever + ≥1 comorbidity; or
            • Cough + ≥1 comorbidity

          (Encourage tele-health options)

        • Contact facility occupational health provider immediately (Refer to Care Message F):
          • Healthcare personnel, and
          • Any non-severe shortness of breath; or
          • Fever; or
          • Any respiratory symptom
        • Contact LTC facility healthcare provider to be seen (Refer to Care Message G):
          • Live in a nursing home/LTC facility and
          • Any non-severe shortness of breath; or
          • Fever; or
          • Cough
        • Stay at home, call provider if you get worse (Refer to Care Message H):
          • Fever + no comorbidity; or
          • Cough + no comorbidity; or
          • Any other symptom, regardless of comorbidity
            (Encourage tele-health options)