In Moscow hospitals, new approaches have been introduced for the treatment of infectionConavirus. It was not worse than the pneumoniainitative of the refusal to divide the hospitals to coronavirus and hospitals for the treatment of pneumonia became the first decision of the Committee. “The disease of the lungs of bacterial nature will continue to be treated in pneumonia centers,” the Commissal Department says. “An order was signed on changing the principles of routing patients, diagnosis and adoption of clinical decisions at the level of the reception office, during the stay in the hospital and at the discharge of patients,” said Mr. Hircun.
In the report of the operational headquarters, it is clarified that now patients with COVID-19 are accepted in 13 urban hospitals, hospitals for the treatment of patients with coronavirus infection in a number of Moscow hospitals.
The Department explains that, according to experts, “Specialized hospitals for the treatment of pneumonia were organized on the basis of the forecast of incidence of pneumonia, standardization of treatment and better control over its results”: “But at present, the overwhelming majority of pneumonia are caused by new coronavirus, which in Epidemic conditions are understandable. This trend is particularly clearly noticeable in the last few days. “. According to the head doctor of the medical center in the communion of Denis Protsenko, “the accuracy of existing tests for identifying COVID-19 is 70-80%, and in some cases testing gives false-negative results, and the share of such results is significant.”. “Now, when diagnosing a key role is played by the assessment of a clinical picture in combination with CT or X-ray data,” he is sure.
According to the new recommendations, “If the patient has no test results in the patient, but during the examination in the receiving department, CT-signs of pneumonia-COVID-19 are detected with characteristic clinical manifestations, it is hospitalized in the hospital and is conducted as a patient with a COVID infection. “.
Director of the NII named after Sklifosovsky Sergey Petrikov noted that in practice this scheme already acts: “The ambulance is lucky to us patients with pneumonia and without the results of tests for coronavirus. Upon receipt on the basis of the results of the CT, the characteristic clinic we can already suspect the coronavirus “. The Moscow Department of Health is noted that the city clinical hospital number 52, which has taken patients with pneumonia for several months, “will now become a new coronavirus hospital”. “From the end of February, patients with pneumonia of various etiologists are obtained in the hospital with pneumonia of various etiologists,” Rasser Medical Sciences Mariaan Lysenko.
As the doctor told “alongthecoastcottage” under the conditions of anonymity, a doctor working in one of the infectious hospitals receiving patients with coronavirus infection, “usually in April the number of patients with community-hospital pneumonia decreases due to a total decrease in the incidence of respiratory diseases”:
“If a person has revealed pneumonia now, then it must be regarded as in a high degree of coronavirus patient even with negative PCR studies”.
He explained that “if such a patient is initially not conducted as a patient with a coronavirus infection, then you can lose time to appoint adequate therapy and primarily oxygen support”: “Therefore, it is necessary to begin to treat coronavirus infection even before it is laboratory confirmed”.
Speaking about the new hospitalization algorithm, the expert told that patients with confirmed COVID-19 should be placed on the same floor. Patients who have a high degree of probability of this infection according to CT, most likely also guide them. “Due to the fact that for COVID-19, CT changes are revealed already on the third day of the disease, currently any patient with bilateral pneumonia should be conducted as a patient with coronavirus infection – he continues.- If there are no test results, nor indicators on CT, then the person will go to the provision. And if a person with COVID is subsequently identified in this department, it will be sent to the department where patients with a confirmed diagnosis are already lying “. The doctor noted that “at the stage of elementary sorting in the receiving department, if there is no confirmed test result, it is impossible to separate patients with coronavirus infection and without it, so the accommodation stage in the provisional compartment is required”. “Of course, in such departments, it is necessary to maximize patients in small wards and in compliance with the anti-epidemic regime so that they go in masks, and it did not go better at all, and were constantly in wards equipped with a bathroom and, for example, electric kettle. Then there will be no need to leave the chamber, “says the interlocutor” Kommersant “.
At the disposal of “alongthecoastcottage” there is an order of April 8 on the approval of the doctor’s actions algorithm when the patient is admitted to the hospital with suspicion of community-hospital pneumonia, a coronavirus infection, as well as the procedure for discharge from the hospital of such patients to continue the treatment at home “. So, according to the document, Upon admission to the patient’s hospital with a positive result of the PCR study on RNA coronavirus, In the receiving department, it must be immediately provided with the means of individual protection (mask and gloves). After analyzes, on the basis of clinical data, the doctor’s admission office decides on the hospitalization of the patient to the hospital in the presence of a combination of changes to CT with any of two or more signs: fever (temperature of more than 38.5 degrees), the frequency of respiratory movements from 30, saturation oxygen blood below 93%.
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For The patient’s arrival in the hospital without the result of the PCR study to coronavirus or with a negative test result The primary algorithm of actions is the same as for patients with a positive result: providing individual protective equipment and further examination. “Based on clinical data and results of laboratory and instrumental methods, the doctor of the admission department decides on the hospitalization of the patient in the hospital if there is a combination of changes in CT, corresponding to the average and high probability of coronavirus pneumonia,” is noted in the document. In the patient’s hospital, the patient must be brought with a nasal stroke and a rotogling for analysis on COVID-19, a nasal smear for influenza analysis, as well as a wetting fence for analyzing other etiological agents of pneumonia.
“In the absence of testimony for hospitalization, namely, in the absence of severity of pneumonia, fever, the saturation of oxygen in air is below 93%, shortness of breath and risk factors, the patient is directed to treatment in outpatient conditions (at home), the document says.- At the same time, voluntary consent to obtain medical care in outpatient conditions “. Within two hours, this document must then be sent to the Directorate for Coordination of Medical Organizations Department of the Moscow Department of Health, as well as in a honeycomb, providing primary health care at the patient’s residence. The doctor’s clinic is already the next day to provide a patient for medical observation at the place of residence, “Photographing with simultaneous identification of a citizen by presenting a document certifying the identity”, “Clarification of the patient’s duties to use the remote medical service of the TMIS (Telemedicine Information System) and Special Software "Social monitoring"”. The Polyclinic Doctor should also give living in one residential room with a patient of the decision of the Main Sanitary Doctor of Moscow about finding in insulation mode for 14 days.