Primary Care Emergency Service, Cantabrian Health Service, Cantabria, Spain.
Albacete University Hospital Complex, Castilla-La Mancha, Spain.
Int Braz J Urol. 2020 Jul;46(suppl.1):181-194. doi: 10.1590/S1677-5538.IBJU.2020.S123.
COVID-19 disease caused by infection with the SARS-CoV-2 virus produces respiratory symptoms, predominantly of the upper airways, which can progress to pneumonia after 7 days with persistent fever, cough and dyspnea, and even develop a syndrome of acute respiratory distress (ARDS), multi-organ failure and death. Since COVID-19 disease was declared by the WHO there has been a redistribution of the healthcare system for these types of patients, especially in the front line, which is, in primary care, emergencies and in intensive care units (ICU). In primary care, the fundamental role is the diagnosis of the suspected patients, follow-up mainly by telemedicine (specially telephone calls) to detect warning signs in case of worsening and subsequent referral to the emergency department; as well as explaining home isolation measures. In the emergency department, it is included the management of suspicious cases and, if it any risk factor is found, complementary tests are carried out for precise diagnosis and admission assessment; In case of oxygen saturation <95% and poor general condition, valuation is requested for admission to the ICU. Depending on the severity of the patient, he/she would be or not a candidate for invasive mechanical ventilation, which must be performed by trained personnel to prevent the spread of the infection minimizing the risk of contagion. ARDS's treatment strategies include pulmonary protection ventilation, prone position, recruitment maneuvers and, less frequently, oxygenation by extracorporeal membrane. Among the specific treatments for COVID-19 stand out mainly drugs to reduce viral load, although sometimes specific drugs will be needed to treat hyperinflammation, hypercoagulability and concomitant infections. One of the goals to be achieved is for patients to recover and be able to successfully return to work; for this purpose, an adequate physical and psychological rehabilitation program is essential, as about 50% have symptoms of anxiety and depression.
由 SARS-CoV-2 病毒感染引起的 COVID-19 疾病会产生呼吸道症状，主要是上呼吸道症状，在持续发热、咳嗽和呼吸困难 7 天后可能会进展为肺炎，甚至发展为急性呼吸窘迫综合征（ARDS）、多器官衰竭和死亡。自世界卫生组织宣布 COVID-19 疾病以来，医疗系统已经对这类患者进行了重新分配，特别是在一线，即初级保健、急诊和重症监护病房（ICU）。在初级保健中，基本作用是诊断疑似患者，主要通过远程医疗（特别是电话）进行随访，以发现病情恶化的警告信号，并随后转介到急诊部门；以及解释家庭隔离措施。在急诊部门，包括对疑似病例的管理，如果发现任何危险因素，将进行补充检查以进行准确诊断和入院评估；如果血氧饱和度<95%且一般状况较差，则要求评估入住 ICU。根据患者的严重程度，他/她是否适合进行有创机械通气，这必须由经过培训的人员进行，以防止感染传播，最大限度地降低感染风险。ARDS 的治疗策略包括肺保护性通气、俯卧位、募集手法，以及不太常见的体外膜氧合。COVID-19 的具体治疗方法主要是降低病毒载量的药物，尽管有时需要特定药物来治疗过度炎症、高凝状态和伴随感染。要实现的目标之一是使患者康复并能够成功返回工作岗位；为此，必须制定适当的身体和心理康复计划，因为约有 50%的患者有焦虑和抑郁症状。
