7F: Acute Biologic Crisis PDF

7F: Acute Biologic Crisis ↠ Post operative surgical intensive care units (SICU) ↠ Emergency department...

7F: Acute Biologic Crisis ↠ Post operative surgical intensive care units (SICU) ↠ Emergency department ↠ Cardiac catheterization laboratory Critical Nursing ↠ Telemetry ↠ Burn units - A specialty of nursing that deals specifically with patients experiencing high dependency, complex life threatening Critical care staff: conditions. ↣ Physician or intensivist ↣ Nurse and nurse aides Critical care nurse ↣ Clinical pharmacist - A registered nurse that provides direct, hands-on care for ↣ Respiratory therapist the critically ill or injured patients that may have extensive ↣ Dietician injury, life threatening disease or who have undergone ↣ Physical therapist, occupational therapists & speech major surgery. therapists Roles: Standards of a healthy work environment ✔ Monitor, support and frequently assess the patient for Skilled communication deterioration and complications - Nurses must be as proficient in communication ✔ Must have specialized knowledge, skills and experience to skills as they are in clinical skills handle life threatening conditions and use technological True collaboration equipment for monitoring patients needing critical care - Nurses must be relentless in pursuing and ✔ Critical nurses also deal with family of the critically ill fostering true collaboration with the rest of the patients to offer support, information and education healthcare team Effective decision making Work Settings of a Critical Care Nurse: - Nurses must be valued and committed partners in ↠ Intensive care units (ICU) making policy, directing and evaluating clinical care ↠ Critical care units (CCU) and leading organizational operations ↠ Cardiac intensive care units (CICU) Appropriate staffing ↠ Pediatric and neonatal care units  - Staffing must ensure the effective match between the patient’s needs and nurse competencies Meaningful recognition - Nurses must be recognized and must recognize others for the value each brings to the work of the organization Authentic leadership - Nurse leaders must fully embrace the imperative of a healthy work environment, authentically live it and engage others in its achievements The ICU set up Bag Valve Mask - Used to manually ventilate a client - Provides positive pressure to a patient who is not breathing or who is breathing ineffectively - It is important to make sure that the face mask is inflated - The basic ICU set up and depending on the client’s needs because it helps seal the area around the nose and the more machines may be needed inside the room. mouth of the patient which will foster a proper amount of PEEP towards the patient’s airway. - The (green tube) has to be properly connected to the oxygen  - The reservoir bag should be inflated while the client is being bagged External pacemaker - A transcutaneous cardiac pacing allows fast, efficient and non-invasive ventricular stimulation in conscious patients Non Invasive Ventilator to treat symptomatic bradycardias which include Atropine - Administration of ventilatory support without using an resistant unstable bradycardia in the ED. invasive artificial airway - Usually used when the client is waiting for a permanent - It has markedly increased over the past 2 decades and pacemaker insertion non-invasive ventilation has now become an important tool Defibrillator in the management of both acute and chronic respiratory failure both in the home setting and in the critical care unit. - A device that is used to restart the heart of shock it back into its correct rhythm - Used when someone has sudden cardiac arrest and the heart will suddenly stop pumping or ineffectively pump - When a patient is in a shockable rhythm such as V-tach and V-fib, then shock will be given to the client.  - Manual defibrillators are used by health professionals Cardiac monitor - This device allows HCT to continuously monitor the patient’s heart rhythm, HR, BP, RR and temperature. - Depending on the kind of attachments the patient has, this can monitor CVP, end tidal CO2, and many more Wall and Portable Suction Machine - REMEMBER: Make sure that the portable suction machine Emergency Carts is plugged in. - Aka emergency trolley or the crash cart - It is a set of trays, drawers or shelves on wheels that is Color Coded IV tubes used in hospitals for transportation and dispensing of emergency medication or equipment outside of medical or - The more critically ill the client is, there will also be more surgical emergency for life support protocols to save a contractions. patient’s life.  Leg󰈀󰈗 󰈤󰈏󰈼k󰈻: 1. Advance directives A. Living will - Written documents that direct treatment in accordance with patient’s wishes in the event of a terminal illness - Needs 2 witness B. Durable power of attorney for health Routine work in the ICU: - designates an agent or surrogate to make 1. Creating a baseline head to toe assessment at the start of decisions for him/her in the event that they cannot the shift and monitoring for deterioration do those decisions on their own 2. Administering medications and continuous monitoring or response to medication to titrate accordingly 3. Interventions to promote patient’s hygiene 2. Autonomy 4. Documentation a. Client has the right to refuse medical tx 5. Address concerns or questions from the family b. DNR Basic Assessment Tools: c. Anatomical Gift / Organ donation ✔ GCS ✔ Neurovascular assessments 3. Restraints ✔ Cranial nerve assessment a. to ensure physical safety ✔ Pupillary assessment b. It has to have a written order that will specify the ✔ Skin assessment duration, circumstances under which the ✔ Over all head-to-toe assessment restraints are to be used c. Should not cause harm or be used as punishment.  - Physical Restraints will serve as a last resort. Oftentimes when a client is physically restrained then they can also be given chemical restraints (Sedatives) and once they are calm and asleep, then the physical restraints will be removed. - It is also important to have the doctor’s order and also when the client is on physical restraints, the nurses would have to fill up the neurovascular observation monitoring form. Other ways to restraint a patient include: ⇒ A caregiver holding a patient in a way that restricts the person's movement 4. Informed Consent ⇒ Patients being given medicines against their will to - agreement to allow something to happen based on a full restrict their movement disclosure: ⇒ Placing a patient in a room alone, from which the person is ✔ risks, benefits not free to leave ✔ alternatives ✔ consequences of refusal of treatment - This should be signed by the client and the health care provider with a WITNESS. - This is required for: ✔ routine treatment ✔ hazardous procedures ✔ treatment programs ✔ research / experiments Acute Respiratory Distress Syndrome (ARDS) Pathophysiology of ARDS: - Severe inflammatory process causing diffuse alveolar damage leading to sudden pulmonary edema, hypoxemia despite supplemental O2 and amount of positive end-expiratory pressure (PEEP) Etiology: 1. Direct injury to the lungs from: ↦ Aspiration (gastric secretions, drowning, hydrocarbons) ↦ Drug ingestion and overdose ↦ Hematologic disorders (DIC) ↦ Massive transfusions ↦ Cardiopulmonary bypass ↦ Prolonged inhalation of high concentrations of oxygen, smoke or corrosive substances ↦ Trauma (pulmonary contusions, multiple fractures) 2. Indirect injury to the lungs from: ↦ Localized infection (bacterial, fungal, viral Assessment: pneumonia) - Rapid onset within 72 hrs after the precipitating event; ↦ Metabolic disorders (pancreatitis, uremia) resembles severe pulmonary edema ↦ Shock (any cause) ➸ Dyspnea ↦ Major surgery ➸ Tachypnea ↦ Fat or air embolism ➸ Arterial hypoxemia despite O2 supplementation ↦ Sepsis ➸ Decreased lung compliance ➸ Bilateral infiltrates at chest x-ray - which rapidly evolved from the baseline X-ray ➸ Checking for plasma brain natriuretic peptide (BNP) Nursing Diagnoses: - this is important because it is helpful in Impaireed gas exchange: hypoxemia r/t alveolar cell distinguishing ARDS from cardiogenic pulmonary damage edema Ineffective breathing pattern: shortness of breath r/t - A transthoracic echocardiography may be used if pulmonary vascular destruction/ decrease surfactant the BNP is not conclusive Ineffective tissue perfusion: cyanosis r/t alveolar collapse ➸ Increased work of breathing Fear: restlessness r/t unfamiliarity with physical ➸ Accessory muscle use symptoms ➸ Intercostal retractions Interventions: ➸ Crackles on auscultation ➨ O2 supplementation ➸ Decreased level of consciousness Goal: O2 saturations >90% with the lowest possible ➸ Cyanosis Fraction of inspired oxygen (FiO2) and PaO2 of >60 mmHg ➨ Treat underlying cause ➨ Intubation and mechanical ventilation - The use of PEEP helps increase functional residual capacity and reverse alveolar collapse by keeping the alveoli open resulting in improved arterial oxygenation and a reduction in the severity of the ventilation-perfusion imbalance  - This will help them relax and rest and reduce physiologic stress ➨ Neuromuscular blocking agents - Rocuronium, suxamethonium ➨ Bronchodilators - Help open up the airways ➨ Vasopressors - Vasopressin, epinephrine, isoprenaline - These will be given when the client is hypotensive Diabetic Ketoacidosis (DKA) - Absence or markedly inadequate supply of insulin resulting to disorders of metabolism of carbohydrate, protein and fat Main clinical features: ➨ Circulatory support- vasopressors and inotropes Hyperglycemia may be needed for hypovolemia - due to the lack of insulin that will help move - Hypovolemia results from leakage of fluid into the glucose into the cells interstitial space, and decreased cardiac output due to Dehydration and electrolyte loss high levels of PEEP - due to hyperglycemia that will lead to osmotic ➨ IVF replacement diuresis which will result to large amounts of urine ➨ ABG monitoring leading to dehydration and electrolyte loss of the ➨ Nutritional support client ➨ Chest physiotherapy Acidosis Pharmacologic Management: - Since glucose cannot enter the cells and cells are ➨ Sedatives already starving so the liver would rapidly - midazolam, propofol  breakdown fat into ketones to be used as fuel ➸ Tachypnea source and ketones can cause Acidosis ➸ High blood ketone and urinary ketones Etiology: ➸ Polyuria, polydipsia ↦ Decreased or missed dose of insulin ➸ Marked fatigue ↦ infection/ illness ➸ Weakness ↦ Undiagnosed and untreated diabetes ➸ Blurred visions ➸ Headache Pathophysiology: ➸ Blood glucose: 300 and 800 mg/dL (16.6 and 44.4 mmol/L) ➸ Serum bicarbonate: 0-15 mEq/L ➸ pH: 6.8 to 7.3= ACIDIC ➸ PCO2: 10 to 30 mmHg - this is low and it reflects respiratory compensation for metabolic acidosis ➸ Na and K levels will depend on the degree of dehydration ➸ Increased creatinine, BUN and hematocrit due to dehydration Goal: ★ Aimed at correcting dehydration, electrolyte loss, and acidosis before correcting the hyperglycemia with insulin Interventions: Assessment: ➨ Rehydration ➸ N&V - It is important for maintaining tissue perfusion and ➸ Abdominal cramps enhances excretion of excessive glucose by the ➸ Dehydration kidneys ➸ Hypotension due to dehydration a. First 6 to 10 L of fluid due to fluid loss and excretion of ➸ Acetone breath excess glucose b. Moderate to high rates of infusion: 200- 500 mL/hr of - This will be given 12 – 24hrs and is infused Saline separately from the rehydration solutions c. When the blood glucose reaches 300 mg/dL or less, the IV to allow frequent changes in the rate and solution will be changed to D5W to prevent precipitous the content. decline in the blood glucose level - It may be continued from 12-24 hours until ➨ Fluid volume monitoring status and check for signs of fluid the serum bicarbonate level INCREASES to overload from all the rehydration that is given to the client at least 15-15 mEQ/L and until the patient ➨ Strict I/O monitoring can eat. ➨ Blood glucose, ketone and electrolyte monitoring ➨ Hourly blood glucose monitoring - The major electrolyte of concern is POTASSIUM. ➨ D5W infusion to be given when the blood glucose - This tends to be high from the disruption of the reaches 250-300 mg/dL cellular sodium potassium pump when the client is in the acute phase of illness. When the client is HYPERGLYCEMIA HYPEROSMOLAR REHYDRATED, it will lead to an increased plasma volume and will subsequently decrease the NONKETOTIC SYNDROME concentration of serum potassium. - Rehydration would also lead to an increased urinary - A metabolic disorder of type 2 Diabetes excretion of potassium and Insulin Administration - Results from insulin deficiency as a sequelae of an illness enhances the movement of potassium from the that increases insulin demand ECF into the cells. - Severe hyperglycemia increases osmotic diuresis and - Potassium monitoring q2 hrs for the first 8 hours intracellular fluid depletion - 40 mEq/hr of IV potassium may be needed once it - Insulin is present in the body but it is too low to prevent starts to DROP hyperglycemia but enough to break down fat, therefore, - ECG to check for arrhythmias ketosis is not present compared to DKA. ➨Reverse acidosis Insulin infusion Assessment: (The manifestation of HHNS is more or less the same with DKA.) ➸ The difference is that the ketone will not be high. HEPATIC ENCEPHALOPATHY ➸ Hypotension (if the client will be too dehydrated) ➸ Profound dehydration - Life threatening complication due to profound liver failure ➸ Tachycardia leading to the accumulation of ammonia in the blood ➸ Neurologic Signs: - It is a neuropsychiatric manifestation of liver failure that is Confusion associated with portal hypertension and the shunting of Hallucination blood from the portal venous system into the systemic Drowsiness/weakness/paralysis circulation. Seizures due to cerebral dehydration ➸ Blood glucose: 600-1200 mg/dl Causes: ➸ Osmolality > 320 mOsm/kg ↦ Inability of the liver to detoxify by products of metabolism ➸ Electrolytes are consistent with severe dehydration ↦ Enzymatic and bacterial digestion of dietary and blood ➸ Extremely elevated blood glucose concentrations decrease proteins in the GI tract. Circumstances that increase as the patient is rehydrated. Insulin plays a less important serum ammonia level tend to aggravate or precipitate role in the treatment of HHNS because it is not needed for hepatic encephalopathy.The largest source of ammonia is the reversal cause of acidosis such as in DKA. the enzymatic and bacterial digestion of dietary and blood Nevertheless insulin is usually given continuously at the proteins in the GI tract. Ammonia from these sources low grade to treat hypoglycemia and replacements of IV increases as a result of GI bleeding such as bleeding of fluid with dextrose are given after the glucose level has Esophageal varices bleeding or chronic GI bleeding. decreased to the range of 250-300 mg/dl ↦ High protein ↦ Bacterial infection ↦ Uremia Pathophysiology: ➸ Constructional apraxia (Inability to reproduce a simple figure in two or three dimensions.) ➸ Fetor hepaticus (sweet fecal odor to the breath that is presumed to be of intestinal origin) ➸ ECG abnormalities ➸ Disorientation ➸ Coma ➸ Seizures ➸ EEG shows slowing of brain waves, increased amplitude and triphasic waves Assessment: ➸ Mental status change Confusion Mood alteration Altered sleep pattern Unkempt Restlessness at night and sleeps during the day ➸ Motor disturbances Goal: Positive babinski reflex ★ Eliminating the precipitating factor and giving Asterixis (involuntary flapping of the hands) ammonia-lowering therapy Hyperactive then absent deep tendon reflexes Interventions: - This is because the absorption of other fat soluble ➨ Correction of possible reasons for complications such as vitamins as well as dietary fats may also be bleeding, electrolyte imbalance, sedation, azotemia impaired because of the decrease secretion of bile ➨ Reversing underlying liver disease salts into the intestine ➨ Administration of lactulose to expel ammonia via feces ➨ Avoid protein restriction if possible even if the client has (2-3 times per day) Encephalopathy. But for patients who are very protein ➨ IV administration of glucose to minimize protein intolerant, provide additional Nitrogen in the form of an breakdown amino acid supplement. ➨ Antibiotics to reduce ammonia producing bacteria in the ➨ Administration of lactulose to decrease intestinal colon such as metronidazole, neomycin, rifaximin ammonia, and it also reduces intestinal bacterial load ➨ Frequent assessment of neurologic status ➨ Watch out for HYPOKALEMIA if frequent bowel movements ➨ Mental status assessment which includes a daily record of are noted. handwriting and arithmetic - This will show the progress of the client’s mental THYROID STORM/THYROTOXIC CRISIS status - It is an exacerbation of hyperthyroidism or thyrotoxicosis ➨ Strict I & O, body weight monitoring with an abrupt onset ➨ Vital signs every 4 hrs or as frequently needed - Extreme state of thyrotoxicosis ➨ Serum ammonia levels daily ➨ Protein intake 1.2 – 1.5 g/kg of body weight Clinical Manifestations ➨ Enteral feeding if needed ⟹ High fever > 38 C ➨ Assess for edema and bleeding ⟹ Tachycardia > 130 bpm - There is a decrease in Vit. K absorption caused by ⟹ Exaggerated symptoms of hyperthyroidism with the inability of liver cells to use Vitamin K to make disturbances of a major system prothrombin ⟹ Altered neurologic or mental state ➨ Small frequent meals and 3 small snacks per day plus late-night snack before bed Etiology: A. Hyperthyroidism exacerbated by stress such as: ↦ injury ↦ infection of the thyroid / non thyroid surgery ↦ tooth extraction ↦ insulin reaction ↦ DKA, pregnancy ↦ abrupt withdrawal of antithyroid medications ↦ extreme emotional stress ↦ vigorous palpation of the thyroid Pathophysiology: Assessment: ➸ High fever > 38 C ➸ Tachycardia > 130 bpm ➸ Increased BP ➸ Exaggerated symptoms of hyperthyroidism with disturbances of a major system ➸ Altered neurologic or mental state Interventions: A. Immediate measures : lower the temperature, control heart rate and prevent vascular collapse ➨ Hypothermia blanket, ice packs , hydrocortisone and acetaminophen= TEMPERATURE ➨ Humidified oxygen to improve tissue perfusion ➨ ABG monitoring and pulse oximetry ➨ Propranolol with digitalis to reduce severe cardiac ➨ IV fluids with dextrose to replace depleted glycogen stores symptoms in the liver due to hyperthyroid state ➨ Propylthiouracil (PTU) or methimazole to impede thyroid End Stage Renal Disease (ESRD) hormone formation and block conversion of T4 to T3 – It is the final stage of CKD - Has a theoretical advantage in severe thyroid – Kidney damage requires renal replacement therapy on a storm because of its early onset of action and permanent basis capacity to inhibit peripheral conversion of T4 to T3 BUT it has a big risk of liver damage Pathophysiology: ➨ Hydrocortisone to treat shock and adrenal insufficiency - Corticosteroids inhibit peripheral conversion of T4 into T3 and have been shown to improve outcomes in patients with Thyroid storm - Adrenal Axis Dysfunction in the context of Thyrotoxicosis of any degree is documented and responds to exogenous steroid therapy ➨ Iodine to decrease output of T4 from the thyroid gland - Administration of iodine compounds orally or via NGT to block the release of thyroid hormones - These are given at least 1 hour after starting Antithyroid drug therapy Assessment: - Subsequently, thyroidectomy may be performed ❖ Neurologic: after about 7 days of iodine administration ➸ Confusion because Iodine reduces the vascularity of the ➸ Disorientation gland and the risk for Thyroid storm ➸ Weakness ➸ Seizures  ➸ Encephalopathy ❖ Musculoskeletal ❖ Cardiovascular ➸ Loss of muscle strength ➸ Hypertension ➸ Muscle cramps - Due to sodium and water retention and ➸ Renal osteodystrophy leading to DECREASED vit. D malfunction of the Renin-angiotensin aldosterone activation leading to DECREASED Ca absorption system - With the decreased infiltration through the ➸ Pericardial effusion/tamponade glomerulus of the kidney, there is an increase in - Due to retention of uremic wastes products and the serum phosphate level and a reciprocal or inadequate dialysis corresponding decrease in the serum calcium level. ➸ Engorged neck veins ❖ Metabolic & electrolytes ➸ Pitting edema ➸ DECREASED GFR and creatinine clearance ❖ Pulmonary ➸ INCREASED serum creatinine and BUN ➸ Kussmaul type respirations ➸ Acidosis ➸ Shortness of breath - Results from the inability of the kidney tubules to ➸ Tachypnea excrete ammonia and reabsorb sodium ❖ GIT bicarbonate. There is also decreased excretion of ➸ Uremic fetor (Ammonia order of the breath) phosphate and other organic products ➸ Bleeding from GI tract ➸ Hyperkalemia ➸ N&V - Due to decreased excretion, metabolic acidosis, ❖ Hematologic catabolism and excessive intake of potassium in ➸ Anemia the diet or medications or fluids ➸ Thrombocytopenia ➸ Calcium and phosphorus imbalance - Due to decreased Erythropoietin which is a - This is because when the kidney starts to fail, they substance that is normally produced by the cannot remove the excess phosphate from the kidneys that stimulate the bone marrow to produce body. Kidney disease also leads to an increase in RBC production of Parathyroid hormones. The  parathyroid hormone controls the phosphate by ➨ Treat hyperphosphatemia and hypocalcemia through increasing or decreasing the level of phosphate in Calcium and Phosphorus binders the blood. So if there is an increase in production - These bind to dietary phosphorus in the GI tract of parathyroid hormone, this also leads to too - Example: calcium carbonate or calcium acetate much phosphate in the body. If there is too much ➨ Hypertension, Heart failure and Pulmonary Edema phosphate in the body then there will be a antihypertensives, diuretics, inotropic agents reciprocal response or decreased calcium level. (dobutamine) ❖ Integumentary ➨ Monitor I & O and vital signs closely ➸ Pruritus ➨ Metabolic acidosis ➸ Grey – bronze skin color - Sodium bicarbonate (PO or IV) and dialysis ➸ Thin brittle nails ➨ Seizures ➸ Dry flaky skin - IV diazepam or Phenytoin is given ➸ Coarse thinning hair - Raised and padded side rails ❖ Reproductive - Monitor duration and type of seizures ➸ Amenorrhea ➨ Anemia ➸ Decreased libido - Erythrocyte – stimulating agent such as ➸ Infertility recombinant human erythropoietin given SC 3 ➸ Testicular Atrophy times a week This is to achieve 33% - 38% of hematocrit Goal: and 12 g/dL of hemoglobin ★ Maintain kidney function for as long as possible and - Supplementary iron (PO or IV) treatment of reversible factors causing ESRD - Monitor for signs of symptomatic anemia ➨ Hyperkalemia Interventions: - Sodium polystyrene phosphate for acute ➨ Dialysis to decrease uremic waste products in the blood hyperkalemia and control electrolyte balance - Monitor cardiac status  ➨ Dietary control ➸ Chills - Controlled CHON (protein) intake ➸ Muscle aches This is because urea uric acids and organic ➸ Flu like symptoms acids, the breakdown products of dietary ➸ After 2-7 days: and tissue proteins accumulate rapidly in ◌ Dry cough the blood when there is impaired renal ◌ dyspnea clearance ◌ Chest pain - Fluid restriction ◌ hypoxia - Vitamin supplementation ◌ Diarrhea - Monitoring Na and K intake in the diet ➸ chest x-ray: Pneumonia, ARDS w/out identifiable cause ➨ Renal Transplant ➸ SARS-CoV RNA: blood, stools, respi. Secretions ➸ Hematology: lymphopenia, Thrombocytopenia Emerging Diseases Interventions: ➨ Supportive Therapy Severe Acute Respiratory Syndrome (SARS) ◌ Oxygen supplementation / assisted ventilation - A viral respiratory disease caused by the coronavirus ◌ IV fluids - First identified in February 2003 in China ◌ Antibiotics to prevent or treat secondary infections ◌ Close monitoring of vital signs Mode of Transmission: ◌ Cardiovascular support through Inotropes 1. Airborne ➨ Isolation of patient using airborne precaution 2. Indirect spread through surfaces that have been ➨ Corticosteroids for severe inflammatory processes in the contaminated by the virus respiratory tract Assessment: ➸ High fever >38 C SARS CoV 2 (COVID 19) bloodstream with inflammatory proteins called Cytokines. They can kill tissue and damage organs including the heart, - Declared a pandemic in 2020 kidneys and the lungs. - Caused by a new coronavirus ⤥ Acute Respiratory Failure Transmission: ⤥ Pneumonia 1. Droplet ⤥ ARDS 2. Indirect contact with contaminated surfaces then touching - Lungs are severely damaged that fluid begins to the eyes, mouth or nose leak into them. As a result, the body has trouble getting oxygen into the bloodstream. The client Assessment: may need mechanical help (ventilator) until the ➸ Flu like symptoms lungs recover. ◌ chills, fever, dry cough, sore throat, myalgia , ⤥ Acute liver injury fatigue ⤥ Acute cardiac injury ➸ Shortness of breath - It is not known whether this is caused by the virus ➸ Diarrhea itself or due to other causes that pose stress in ➸ Nausea and vomiting the body. ➸ Anosmia ⤥ Acute kidney injury ➸ Severe symptoms: ⤥ Septic shock ◌ Shortness of breath - Sepsis happens when the body’s reaction to an ◌ Chest pain/pressure infection misfires. The chemicals released in the ◌ Loss of speech or movement bloodstream to battle the illness don’t trigger the ◌ Low Oxygen saturations right response and instead the organs are damaged. If the process isn’t stopped, the client Complications: can go to Septic Shock. If BP drops too much, - These may be caused by a condition known as Cytokine septic shock can be fatal. release syndrome or Cytokine storm. This is when an ⤥ Thrombus formation infection triggers the immune system to flood the Interventions: ➨ Mild to Moderate Illness: ◌ Rest ◌ Hydrate ◌ Symptomatic treatment ➨ Severe Symptoms ◌ Antiviral : Remdesivir ◌ Monoclonal antibodies: sotrovimab ◌ Tocilizumab also under trial ◌ Dexamethasone for the inflammatory processes in the body ➨ Other aggressive Supportive Treatment in hospital ◌ Invasive or non invasive ventilation ◌ Cardiovascular support ◌ IVF hydration ◌ Treatment of complications