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All we need to know about COVID-19 10
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Lecture1.1
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Lecture1.3
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Lecture1.4
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Lecture1.5
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Lecture1.6
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Lecture1.7
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Lecture1.9
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Lecture1.10
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The COVID-19 infection has two phases, the first is the viraemic phase and the second one is the immunologic phase. These two have to be promptly identified and managed appropriately as mentioned above. The critical treatments are oxygen therapy when hypoxic and steroids during severe immunologic phase of the disease. Non Invasive Ventilation and other supportive care including appropriate anticoagulation when needed are crucial and may help to avoid ventilation as prognosis by then can be grim with almost 30-50% mortality.
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HRCT in Covid – Indications and importance of HRCT Thorax:
Indications:
- In patients having co-morbidity above the age of 40 and minimal respiratory symptoms (mild disease: RR < 20, SpO2>94), HRCT may be delayed till the end of first week of symptom onset.
- In patients presenting with moderate disease (RR 24-30 and/or SpO2 90-94) or severe disease (RR> 30 and/or SpO2 <90), HRCT may be done at the earliest possible opportunity. If HRCT facilities are not available, X-ray chest must be performed in these cases.
- In patients with high suspicion of Covid (Symptoms, contact, travel, markers), HRCT may be done if 2 consecutive RT PCR tests are negative. However, presence of typical radiological picture is not conclusive of active disease and must be correlated with clinical picture.
CT severity Score:
- Common score pattern is given out of 25 ( 5 for each lobe)
- A score of 12/25 should alert the treating physician to possibility of development of Covid Associated Respiratory Distress and should be an indication to start steroids and also for hospitalization and intensive monitoring of oxygen saturation and inflammatory markers.
- A score of 8/25 in a patient having co-morbidity should be a warning symptom for accurate vigilance and more frequent monitoring.
- CT severity score has been correlated well with severity of disease and also with outcome in Covid patients. However, one should remember that density of ground glass opacities also has equal importance and therefore, radiologist’s opinion should not only mention the distribution of these opacities but also the density.
- HRCT in a Covid patient having sudden onset of breathlessness may point to thromboembolism (Pulmonary embolism) and HRCT also points to clinical outcome and possibilities of Covid associated pulmonary fibrosis andhelp in deciding “Long Covid Symptoms” and need for anti-fibrotic agents