The Clinical Diagnosis and Treatment for New Coronavirus Pneumonia

187 Pages·2020·2.779 MB·English

by  Fanjun Cheng, Yu Zhang

The Clinical Diagnosis
and Treatment for New
Coronavirus Pneumonia
Fanjun Cheng
Yu Zhang
Editors
123
The Clinical Diagnosis and Treatment
for New Coronavirus Pneumonia
Fanjun Cheng • Yu Zhang
Editors
The Clinical Diagnosis
and Treatment for New
Coronavirus Pneumonia
Editors
Fanjun Cheng Yu Zhang
Department of Internal Medicine Department of Pharmacy
Union Hospital, Tongji Medical College of Union Hospital, Tongji Medical College of
Huazhong University of Science and Huazhong University of Science and
Technology Technology
Wuhan Wuhan
China China
ISBN 978-981-15-5974-7 ISBN 978-981-15-5975-4 (eBook)
https://doi.org/10.1007/978-981-15-5975-4
© People's Medical Publishing House, PR of China 2020
Jointly published with People's Medical Publishing House, PR of China
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Preface
Wuhan, China, as the initial place for the outbreak of COVID-19, not only had the
cases from the earliest time, but also one of the largest infected populations until
now. At the beginning of this outbreak, the Chinese government gathered profes-
sional and experienced medical staff to support Wuhan nationally. Meanwhile, 46
hospitals were designated as specialized institutions for the COVID-19 patients. 16
mobile cabin hospitals were newly built to accept patients with mild or moderate
symptoms, and 7 large general hospitals were designated for severe or critical cases.
The West Campus of Wuhan Union Hospital, affiliated with the Tongji Medical
College of HUST, is the one of the medical centers which accepted the largest num-
ber of severe and critical patients during the epidemic. By 24:00 on March 20, 2020,
a total of 1671 severe and critical COVID-19 patients were treated in the hospital.
The number of patients who had been successfully cured and discharged from the
hospital was 1069, and 147 patients died. At that time, there were still 401 severe
and critical cases in-house.
By making full use of its comprehensive medical power combined with special-
ists’ skills of the 18 medical teams supporting Hubei, the West Campus of Wuhan
Union Hospital has achieved better therapeutic accomplishments through compre-
hensive and personalized treatment, combined with early rehabilitation and psycho-
logical intervention. COVID-19 patients may also have medical conditions such as
pregnancy, parturition, and urgent surgical conditions. It is still a great challenge to
deal with these situations appropriately while ensuring the cure of COVID-19 and
the protection of the medical staff.
Based on the “Guidelines for the diagnosis and treatment of COVID-19” issued
by the National Health Commission of PRC, this manual is prepared not only by
referring to the research results of modern medicine and combining with the spe-
cific circumstances of patients, but also by considering the allocation of medical
resources. The content of this manual includes medical administration under emer-
gent circumstances, prevention and control of nosocomial infection, clinical experi-
ence on the diagnosis and therapy, radiographic inspection, laboratory diagnosis,
inhibition of inflammatory cytokine storm, convalescent plasma therapy, TCM, etc.
It is a collection of wisdom and practice of medical institutions at the highest level
in China to cope with COVID-19. We believe the publication of this manual will
benefit the countries which are currently dealing with COVID-19.
v
vi Preface
One Earth, One Family. During the pandemic, nobody can step aside. China’s
practice experience and outcome to combat COVID-19 will enable the rest of the
world not to start from scratch but continue in China’s footsteps and fight the pan-
demic more effectively. As the Chinese government is exporting anti-epidemic per-
sonnel and materials to the world, we collected valuable information and experience
from Wuhan Union Hospital by 18 medical troops from 12 provinces nationally
during the past 2 months. We wish it is helpful for the prevention and control of
COVID-19 in other countries.
Wuhan, China Fanjun Cheng
March 26, 2020 Yu Zhang
Acknowledgments
The book is written and finally published with the support of all parties, including
the full cooperation of the medical management personnel from the West Campus
of Wuhan Union Hospital, and the unremitting efforts of medical and nursing staff
from 21 national medical teams mainly composed of those from Union Hospital.
These medical professionals organized and wrote the contents of this book in their
spare time after high-intensity work shifts treating COVID-19 patients. Our special
thanks also go to Mr. Anbang Cheng, a volunteer who has just graduated from the
Faculty of Agricultural, Life and Environmental Sciences in the University of
Alberta, and temporarily suspends his study at the Faculty of Environmental Science
in the University of Melbourne due to the epidemic. In addition to providing volun-
teer service in the hospital logistics, he also made basic and great efforts for the
English translation and organization of the book after the volunteer service. He is
also the volunteer with the longest period of service in the West Campus of Wuhan
Union Hospital for the COVID-19 prevention and control in Wuhan.
We would like to thank Dr. Zhongbo Hu from Case Western Reserve University,
USA, and Mu Hu, Solon High School Student, Solon, OH, USA, for their timely
and free services in finalizing the English manuscript, and the People’s Medical
Publishing House and Springer Publishing Company for their recognition of the
book, which makes our experience and knowledge more accessible and helpful to
other patients and people engaged in pursuit of preventing and treating COVID-19.
Wuhan, China Fanjun Cheng
April 19, 2020 Yu Zhang
vii
Contents
1 Emergency System of Designated Hospital for COVID-19 . . . . . . . . . . 1
Yong Gao, Yuncheng Li, Jian Luo, Hua Wang, Ying Su, Hui Chen,
Xiaodan Han, and Hongbo Wang
1.1 Emergency Organizations and Their Responsibilities . . . . . . . . . . . . 2
1.1.1 Establishment of Emergency Medical Department . . . . . . . . 2
1.1.2 Innovation of Emergency Medical Administration . . . . . . . . 3
1.1.2.1 E stablishment of the Discussion System
for Emergency Response to Difficult
and Complicated cases, as well as Severe,
Critical, and Death Cases . . . . . . . . . . . . . . . . . . . . . 3
1.1.2.2 C ontinuous Optimization of the Quality Control
Mechanism of Emergency Medical Services . . . . . . 4
1.1.3 Emergency Nursing Management . . . . . . . . . . . . . . . . . . . . . 4
1.1.3.1 E stablishment of Emergency Nursing
Management System . . . . . . . . . . . . . . . . . . . . . . . . . 4
1.1.3.2 Reasonable Allocation of Nursing
Human Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
1.1.3.3 F ormulate Relevant Systems, Processes,
and Emergency Plans to Ensure the Safety
and Efficiency of Nursing Work . . . . . . . . . . . . . . . . 5
1.1.3.4 P reparation of Ward Environment, Instruments,
Equipment, and Materials . . . . . . . . . . . . . . . . . . . . . 6
1.1.3.5 T raining and Assessment for Strengthening
Prejob Knowledge and Skills . . . . . . . . . . . . . . . . . . 7
1.1.3.6 I mplementation of Nursing Quality Management . . 7
1.1.3.7 S trengthening of Psychological Nursing
and Humanistic Care for Patients . . . . . . . . . . . . . . . 8
1.1.3.8 P ay Attention to the Physical and Mental Health
of Nursing Staff in the Isolation Ward Area . . . . . . . 9
1.1.4 Emergency Logistics Management
in Designated Hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
1.1.4.1 P romote the Leading Decision-making Position
of Logistics Support Organizations. . . . . . . . . . . . . . 9
ix
x Contents
1.2 Basic Medical Quality Management . . . . . . . . . . . . . . . . . . . . . . . . . 10
1.2.1 Ward Rounding System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
1.2.1.1 T hree-level Physician Ward Rounding System . . . . . 10
1.2.1.2 A ttending Physician Ward Rounding System . . . . . . 10
1.2.2 On Duty System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
1.2.2.1 F irst-line Doctor on Duty System . . . . . . . . . . . . . . . 11
1.2.2.2 S econd-line Doctor Duty System . . . . . . . . . . . . . . . 11
1.2.3 Consultation System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
1.2.3.1 General Consultation . . . . . . . . . . . . . . . . . . . . . . . . 11
1.2.3.2 Emergency Consultation . . . . . . . . . . . . . . . . . . . . . . 11
1.2.3.3 Surgical Consultation . . . . . . . . . . . . . . . . . . . . . . . . 12
1.2.3.4 Ordinary Consultation Mode . . . . . . . . . . . . . . . . . . 12
1.3 Admission and Treatment Process of COVID-19 . . . . . . . . . . . . . . . 12
1.3.1 Principles for Admission and Treatment of COVID-19
Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
1.3.2 Process for Admission and Treatment
of COVID-19 Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
1.4 Medical Treatment Process for Pregnant Women . . . . . . . . . . . . . . . 13
1.5 Disposal Process of Remains of Patients with COVID-19 . . . . . . . . 14
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
2 Hospital Infection Prevention and Control Against COVID-19 . . . . . . 17
Li Jiang, Qian Liu, Yunzhou Fan, Yan Jin, Fanjun Cheng,
and Yong Gao
2.1 Regional Isolation and Management . . . . . . . . . . . . . . . . . . . . . . . . . 18
2.1.1 Daily Cleaning and Disinfection Process
for Public Areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
2.1.2 Cleaning and Disinfection System for Fever Clinic . . . . . . . 19
2.1.3 Daily Cleaning and Disinfection System
in Isolation Ward Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
2.1.4 Terminal Disinfection System in Isolation Ward Area . . . . . 22
2.2 Staff Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
2.2.1 Work Discipline of Medical Staff . . . . . . . . . . . . . . . . . . . . . 23
2.2.2 Precautions for Medical Staff to Take Public
Transportation During COVID-19 . . . . . . . . . . . . . . . . . . . . . 24
2.3 Personal Protection in Different Scenes . . . . . . . . . . . . . . . . . . . . . . . 24
2.3.1 Personal Protection of Medical Staff . . . . . . . . . . . . . . . . . . . 25
2.3.1.1 P ersonal Protective Equipment and Application . . . . 25
2.3.1.2 Hand Hygiene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
2.3.1.3 P ersonal Protection for Specific Groups . . . . . . . . . . 26
2.3.1.4 P recautions for Removing Protective Equipment . . . 26
2.3.2 Prevention and Treatment Process for Accidental Entry of
Patients or Medical Staff Wearing Contaminated Protective
Articles in the Clean Area . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
2.3.3 Emergency Treatment Process for Occupational
Exposure of Medical Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Contents xi
2.4 Biosafety Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
2.4.1 Infection Prevention and Control for Novel Coronavirus
Specimen Collection and Transportation . . . . . . . . . . . . . . . . 28
2.4.1.1 P rotection of Sampling Personnel . . . . . . . . . . . . . . . 28
2.4.1.2 R equirements for Sampling Rooms in Fever Clinic . 28
2.4.1.3 Placement of Specimens . . . . . . . . . . . . . . . . . . . . . . 29
2.4.1.4 O ccupational Protection of Specimen Transporting
Personnel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
2.4.1.5 Specimen Transportation . . . . . . . . . . . . . . . . . . . . . 29
2.5 Patient Transfer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
2.5.1 Inter-hospital Transfer, i.e., Transfer Between
Medical Institutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
2.5.1.1 Transfer Workflow . . . . . . . . . . . . . . . . . . . . . . . . . . 30
2.5.2 In-hospital Transfer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
2.5.3 Patients Who Need to Be Transferred in Hospital
Due to Special Examinations . . . . . . . . . . . . . . . . . . . . . . . . . 31
2.6 Digital Support for Epidemic Prevention and Control . . . . . . . . . . . . 32
2.6.1 Vigorously Carry out Internet Diagnosis and Treatment
to Deal with the Epidemic . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
2.6.2 Reduce Work Intensity and Infection Risk
of Medical Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
2.6.3 Teleconference, Consultation, and Training System . . . . . . . 33
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
3 COVID-19 Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Hui Xing, Lian Yang, Mingxing Xie, Jing Wang, Yadan Wang,
Fanjun Cheng, Yu Hu, and Weimin Xiao
3.1 Laboratory Testing for SARS-CoV-2 Infection . . . . . . . . . . . . . . . . . 36
3.1.1 Nucleic Acid Test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
3.1.1.1 Sample Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
3.1.1.2 Nuclei Acid Testing . . . . . . . . . . . . . . . . . . . . . . . . . . 37
3.1.2 Specific Neutralizing Antibody Test . . . . . . . . . . . . . . . . . . . 37
3.1.3 Pathogen Detection in Secondary Infection . . . . . . . . . . . . . . 37
3.2 Biochemical Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
3.3 Lung Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
3.3.1 Imaging of Lungs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
3.3.1.1 CT Scan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
3.3.1.2 K eys for CT Diagnosis . . . . . . . . . . . . . . . . . . . . . . . 40
3.3.1.3 K ey for Examination and Imaging Diagnosis
of Beside X-Ray . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
3.3.1.4 K ey Points in Imaging Diagnosis of Severe
Pneumonia on Bedside X-Ray Plain Film . . . . . . . . 43
3.3.1.5 COVID-19 Pneumonia Follow-Up . . . . . . . . . . . . . . 45
3.3.1.6 Discharge Criteria 45
3.3.2 Interventional Radiology Therapies . . . . . . . . . . . . . . . . . . . . 45