Patient Treatment Guidelines

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COVID-19 Initial and Ongoing Lab and Imaging Guidelines

Last update: April 17, 2020

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Initial diagnostic studies

  • CBC with differential
  • Basic Metabolic Panel, Magnesium
  • Hepatic function panel
  • LDH
  • CRP
  • D-dimmer
  • Fibrinogen
  • Thromboelastograph (TEG; not rapidTEG or heparinase TEG)
  • Troponin
  • CPK
  • PTT/INR
  • Procalcitonin
  • Triglycerides
  • EKG
  • Continuous QTc monitoring on telemetry
  • Chest imaging - if not done already to confirm infiltrates

Daily labs

  • CBC
  • BMP

Every other day labs

  • Hepatic function panel
  • LDH
  • CRP
  • D-dimer
  • Troponin
  • CPK
  • Triglycerides

If clinical worsening – in addition to daily labs

  • Hepatic function panel
  • LDH
  • CRP
  • D-dimer
  • Fibrinogen
  • Thromboelastograph (TEG; not rapidTEG or heparinase TEG)
  • Anti-Xa levels per protocol (to dose adjust DVT prophylaxis)
  • Troponin
  • CPK
  • INR
  • Procalcitonin
  • Ferritin
  • Fibrinogen
  • EKG
  • Expert opinion recommends against pro-BNP

Laboratory and other diagnostic testing considerations

We believe that tests and procedures which require entering/exiting rooms and moving between patients requiring PPE use should undergo heavy scrutiny, and perhaps be deferred unless there is a compelling medical indication. The overarching concern is the conservation of PPE. The list includes:

  • Chest X-ray (CXR)
    • Avoid routine imaging; obtain only if it will change management
    • Consider ultrasound as first line to evaluate for pneumothorax
  • Computed Tomography (CT scan)
  • Magnetic Resonance Imaging (MRI)
  • Electrocardiograms (EKG)
  • Echocardiography – both transesophageal (TEE) and transthoracic (TTE)
    • Consider handheld bedside echo
  • All ultrasound studies (transcranial dopplers (TCDs), abdominal ultrasounds, exams for DVT)
  • Electroencephalography (EEG)
  • Renal replacement – intermittent hemodialysis, continuous renal replacement therapy (CRRT)

We also believe in limiting unnecessary PPE-requiring interactions with patients to only those with a compelling medical indication, including:

  • Reducing overall number and frequency of lab draws
    • Reassess the need for any standing lab draws on a daily basis
    • Add-on labs to previously drawn specimens whenever possible
  • Consolidating medication administration times
    • Work with pharmacy to batch and minimize administration times
    • Consider IV extension tubing to keep IV channels outside of isolation rooms (depending on current ID/IP guidelines)
  • Minimizing frequency of patient assessments
    • Promptly remove hourly nursing neurovascular checks as soon as no longer necessary
    • Consider reducing frequency of vital signs in stable patients

Disclaimer

These documents and content on this website are guidelines during the COVID-19 pandemic. Because new information is released rapidly, these documents can be updated or changed at any time. These documents are in no way to be considered as a standard of care and the content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. The information in these documents is provided with no guarantees, accuracy, or timeliness. All content in these documents and website are for informational purposes only and do not constitute the providing of medical advice.