Clinical Pathway for Evaluation and Treatment of Patients
with Active COVID-19 Infection
- History & Physical Exam
- Symptoms, Exposure
- Consider MIS-C
- Initiate Isolation Precuations
- Multisystem Inflammatory Syndrome in Children (MIS-C)
- Guidance for Initial Evaluation of:
- Possible MIS-C
- Guidance for MIS-C/Shock
- Guidance for Initial Evaluation of:
- Neurologic Manifestations
- COVID Toes
- Fever, sore throat, cough
- Myalgias
- No respiratory distress
- No O2 requirement
- Adequate hydration
- New O2 requirement
- Not rapidly escalating
- Not requiring CPAP, BiPap, or intubation
- Escalation in baseline respiratory support, PICU not required
- Hypoxia or respiratory distress requiring
- Invasive or non-invasive ventilation
- SIRS/sepsis/multisystem organ failure
- Escalation in baseline
- Invasive or non-invasive ventilation requiring PICU admission
- Rapidly deteriorating clinical condition that does not yet meet these criteria
Supportive Care, Discharge
Admit to Special Treatment Room on unit designated for COVID-positive patients
Admit PICU with Appropriate Precautions
- Assure hydration
- Guidance on use of NSAIDS, ACEi, ARB
- Monoclonal Antibody Therapy
- Anticoagulation not recommended
- Antivirals not recommended
- Steroids
- As indicated for asthma, other existing conditions
- Evaluate for presence of other symptoms
- Oxygen, IVF as indicated
- Consider ID for patients requiring supplemental O2 or in patient where COVID-directed therapies is considered
- Guidance on use of NSAIDS, ACEi, ARB
- Anticoagulation
- Consider Remdesevir – ID consult recommended
- Steroids
- As indicated for asthma, other existing conditions
- Initial Labs for Critical Illness
- Consider ID consult for patients requiring supplemental O2 or in any patient you are considering COVID-directed therapies
- Consider DIRT consult if immunomodulatory therapies are being considered
- Guidance on use of NSAIDS, ACEi, ARB
- Anticoagulation
- Consider:
- Bariticinab not recommended
Additional Inpatient Care Resources
Discharge/Deceased care
- Recovering from COVID
- Re-Testing with new symptoms
- General COVID Discharge Instructions
- Guidance for Return to Sports for Patients with COVID-19 for General Pediatricians
- Guidance for Return to Sports for Patients with COVID-19 for Pediatric Cardiologists
- Care of Deceased Patient
- CHOP Outpatient Testing: Screening and Scheduling a Test
Posted: June 2020
Revised: June 2020, July 2020, August 2020, September 2020, November 2020, February 2021, March 2021, June, 2021
Authors: K. Chiotos, MD; D. Davis, MD; C. Kerman, MD; J. Gerber, MD; J. Lavelle, MD
Revised: June 2020, July 2020, August 2020, September 2020, November 2020, February 2021, March 2021, June, 2021
Authors: K. Chiotos, MD; D. Davis, MD; C. Kerman, MD; J. Gerber, MD; J. Lavelle, MD
References
- NIH COVID Treatment Guidelines
- IDSA Guidelines on the Treatment and Management of Patients with COVID-19
- CDC Clinical Care Guidance for COVID-19
- Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with COVID-19
- Remdesivir for the Treatment of Covid-19 – Preliminary Report
- Consensus‐Based Clinical Recommendations and Research Priorities for Anticoagulant Thromboprophylaxis in Children Hospitalized for COVID‐19–Related Illness