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Even as Italy tries to act to lighten the number of people hospitalized for Covid in intensive care and medical wards, controversies erupt. And parochialism. For weeks now, the Regions, each according to their own criteria, have been preparing guidelines to help less seriously ill patients at home. To date, there is no document that gives unique guidelines for the entire country, there is only a draft that has been under review for days. However, we can be sure that the prompts almost overlap and that in no time they should be merged into a single protocol.
The text, prepared by the working group of the Ministry of Health, which also includes the president of the Higher Health Council Franco Locatelli and other members of the CTS, indicates the drugs to be used in home therapies. Objective: to reduce the pressure on hospitals, by monitoring and managing patients at home.
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What is needed for therapy
the paracetamol is indicated for febrile symptoms, the anti-inflammatory If the patient’s condition begins to worsen, I cortisonici only in an emergency to avoid attacking the immune system. No antibiotics if there are no bacterial superinfections. Heparin for people who have difficulty moving. Do not change the therapies the patient takes for chronic conditions such as diabetes or other cardiovascular disorders. There are no recommendations for supplements or vitamin supplements.
The classification of the disease.
The document also provides classifications of the pathology. The infection is considered mild if the patient has a fever but the absence of dyspnea and radiographic changes. Moderate if pneumonia is present and oxygenation of the blood (to be measured with the finger oximeter) is around 90. Severe when oxygenation is below the threshold, there is a high respiratory rate and pulmonary infiltrations. It is a critical stage disease if there is respiratory failure, septic shock, or multiple organs are compromised.
Positive but asymptomatic
«Those who are positive but have no symptoms – explains Dario Manfellotto, director of the Department of Internal Medicine at Fatebenefratelli Isola Tiberina in Rome and president of Fadoi, the Federation of Internist Hospital Administrators Associations – should stay home away from everyone and not drink nothing. Then he will do the swab again and the doctor will decide, as directed, if he can return to the community.
The essential products
There are two essential basic elements for the care of a patient at home: the antipyretic to lower fever and the oximeter to check the level of arterial oxygen in the blood. Under normal conditions, arterial hemoglobin saturation approaches 100 percent. In the presence of respiratory diseases or critical situations this level tends to drop. Optimal values are around 97-98%. When they drop to 90%, it is known as a reduced amount of oxygen in the blood. Antibiotics should remain in the cabinet unless prescribed by your doctor. “You have to monitor fever, cough and dyspnea – adds Manfellotto – it is clear that if the body is in pain and the oximeter reaches 90, the doctor should be notified immediately. Heparin is recommended for patients who have difficulty moving because they suffer from diseases independent of Covid or because they are weakened by infection.
We arrive at cortisone when a pulmonary compromise occurs, always evaluating the general condition of the patient. Both physical and social. We estimate that 15% of those hospitalized are represented by those who could be cared for at home but also by those who would be alone at home. In most cases, they are very old. We must continue to be able to welcome them.
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The walk test
A test to understand the condition of the positive patient at home is defined as the “6-minute walk test.” “The patient must walk with the oximeter on the finger for a time equal to six minutes – warns Manfellotto – If it remains at good levels, the condition is not a cause for concern. If, on the other hand, the threshold falls to 90 or less, then the alarm should be triggered. There is also concern if a person shows signs of confusion or spends a long time in a drowsy state. Attention, there could be a significant neurological compromise ».
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Last updated: 23:03
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