Clinical decision algorithm to guide care advice messages
Clinical decision algorithm to guide care advice messages
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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 younger than 2 years old, evaluate for life-threatening conditions:
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- 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
- Exposures: In the last 2 weeks before sick:
Determine disposition
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- 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):
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- Any non-severe shortness of breath; or
- Fever + ≥1 comorbidity; or
- Cough + ≥1 comorbidity
(Encourage tele-health options)
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- 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)
- Provide education (Refer to Care Message A):
- Dispositions:
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