When to refer: Respiratory complications

Tutorial presented by Dr Simon Barry, Respiratory Consultant and National Respiratory Clinical Lead.

In this tutorial Dr Simon Barry provides an overview of the acute and long-term complications of COVID-19, some of the symptoms that patients might present with, the primary care workup of these patients, and when to consider referral to secondary care.

The serious complications of acute COVID-19 infection involve a pneumonitis of the lungs, which can result in hypoxaemia. The return to normalcy in the lung can take time; evidence suggests that those patients who have been admitted to an Intensive Care Unit for a severe pneumonitis, up to 10% of these patients will still have some abnormalities on a CT scan 3 months later.

The patients might experience breathlessness for a prolonged period, partly due to damage to the lung tissue, but also due to deconditioning. The vast majority of people will return to normal (pre-COVID-19 infection) levels of breathlessness.

The primary care workup of these patients should include the following steps:

  1. Chest auscultation, for signs of crackles
  2. Pulse oximetry
  3. Chest radiograph
  4. Spirometry (where appropriate, considering the AGP risk)

If each of these are normal, the patient can be largely reassured that lung pathology is unlikely. If the chest auscultation or chest radiograph showed any abnormality, this would warrant a CT scan, and a referral to secondary care.

When to refer: Cardiac complications

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