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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)