Initial patient approach for COVID-19

Early clinical evaluation of patients with suspected or confirmed COVID-19 must prioritize staff safety, rapid stabilization, and identification of life-threatening conditions.

Infection Prevention and Control (IPC)

Infection Prevention and Control is an essential component of patient assessment and must begin before physical examination.

Standard IPC Measures

Healthcare workers must:

• Perform hand hygiene before and after contact

• Wear appropriate Personal Protective Equipment (PPE)

• Ensure patient wears a medical mask

• Maintain ≥ 1 meter distance whenever possible

• Isolate patient in designated COVID area

• Avoid unnecessary staff exposure

• Use dedicated equipment where possible

All precautions must follow risk-based standard precautions at all times during diagnosis, examination, and treatment.

Primary Assessment — ABCDE Approach

The ABCDE method is a rapid structured assessment used to identify and manage immediate life-threatening problems.

A — Airway

Goal: Ensure unobstructed airflow to lungs

Assessment

• Is the patient talking normally?

• Presence of snoring, gurgling, stridor

• Vomitus, secretions, foreign body

• Facial or neck swelling

• Reduced consciousness

Immediate Actions

• Reposition airway (head tilt–chin lift / jaw thrust)

• Suction secretions

• Insert airway adjunct (OPA/NPA)

• Prepare for intubation if airway not protected

B — Breathing

Goal: Assess adequacy of ventilation and oxygenation

Assessment

• Respiratory rate

• Chest expansion symmetry

• Use of accessory muscles

• Cyanosis

• Oxygen saturation (SpO₂)

• Auscultation of breath sounds

Immediate Actions

• Administer oxygen therapy

• Position patient upright

• Treat bronchospasm if present

• Prepare ventilatory support if failing

COVID-19 patients may deteriorate rapidly intoAcute Respiratory Distress Syndrome.

C — Circulation

Goal: Determine adequacy of tissue perfusion

Assessment

• Pulse rate and quality

• Blood pressure

• Capillary refill

• Skin temperature and color

• Signs of bleeding

• Urine output (if catheterized)

Immediate Actions

• Control hemorrhage

• Establish IV access

• Give fluid resuscitation if shock suspected

• Start vasopressors if needed

Watch for development ofSepsisorSeptic shock.

D — Disability (Neurological Status)

Goal: Assess brain perfusion and neurological function

Assessment Tools

• AVPU scale (Alert, Voice, Pain, Unresponsive)

• Glasgow Coma Scale (GCS)

• Pupillary reaction

• Limb movement

• Blood glucose if altered consciousness

Immediate Actions

• Correct hypoglycemia

• Protect airway if GCS ≤ 8

• Treat seizures if present

E — Exposure

Goal: Complete physical inspection while preventing hypothermia

Assessment

• Full body examination

• Skin rash or injury

• Pressure sores

• Signs of thrombosis

• Temperature measurement

Immediate Actions

• Cover patient after exam

• Prevent hypothermia

• Identify complications

Criteria for Immediate Emergency Management

The patient must be treated as severe or critical if any of the following are present:

Clinical Principle

Stabilization takes priority over diagnosis —treat first, investigate after stabilization.