COVID-19 pneumoniaMANAGEMENT

RESPIRATORY PRESENTATIONS · 12 SECTIONS

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425 items

☷ Legend

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Cardiovascular Presentations66▾

Respiratory Presentations47▾

Acute bronchitis Acute Respiratory Distress Syndrome (ARDS)Acute respiratory failure Apparent Life-Threatening Event (ALTE-BRUE)Aspiration pneumonia Asthma exacerbation Bacterial Tracheitis Bronchiolitis Bronchiolitis (RSV)Chylothorax Community-acquired pneumonia COPD exacerbation COVID-19 pneumonia Croup Croup (laryngotracheobronchitis)Cystic Fibrosis Exacerbation Empyema Epiglottitis Epiglottitis (Pediatric)Fat Embolism Syndrome Foreign Body Aspiration Foreign Body Aspiration (Pediatric)Healthcare-Associated Pneumonia Hemothorax Hospital-acquired pneumonia Legionnaires' Disease Lung Abscess Pertussis Pleural effusion Pleurisy Pneumocystis jirovecii Pneumonia Pneumocystis Pneumonia Pneumomediastinum Pneumothorax (Simple)Pneumothorax (traumatic)Psittacosis Pulmonary Alveolar Proteinosis Pulmonary contusion Pulmonary Edema (Non-cardiogenic)Sarcoidosis Exacerbation Smoke Inhalation Injury Spontaneous pneumothorax Status Asthmaticus Sudden Infant Death Syndrome (SIDS)Tension Pneumothorax Tracheal Stenosis Viral Pneumonia

Neurological Presentations77▾

Gastrointestinal Presentations63▾

Genitourinary and Reproductive Presentations44▾

Infectious Disease Presentations146▾

Trauma Presentations88▾

Toxicologic Presentations67▾

Psychiatric Presentations25▾

Musculoskeletal and Rheumatologic Presentations89▾

Dermatology Presentations21▾

Environmental and Exposure Presentations26▾

Hematologic and Oncologic Presentations30▾

Pediatric-Specific Presentations13▾

Endocrine and Metabolic Presentations42▾

ENT and Maxillofacial Presentations21▾

Ophthalmologic Presentations15▾

Obstetric Presentations17▾

Systemic and Miscellaneous Presentations15▾

01Approach to the Critical Patient/attcp34

Triage and immediate priorities

›Initial stabilization

›If airway compromise or impending fatigue, prepare intubation and ICU activation

›If SpO2 < 90% on room air, supplemental oxygen escalation pathway

›If shock, septic shock bundle and early vasopressor strategy

›If altered mental status, hypoxemia and hypercapnia evaluation

›Infection control

›Droplet and contact precautions for suspected viral pneumonia

›Airborne precautions for aerosol generating procedures

›If intubation or NIV, negative pressure room when available

›Monitoring targets

›Continuous pulse oximetry

›Cardiac monitoring for hypoxemia and myocarditis risk

›Frequent reassessment interval 15 to 30 minutes during oxygen escalation

Oxygenation and ventilation goals

›Oxygenation goals

›SpO2 target 92% to 96% for most adults

›SpO2 target 88% to 92% for chronic hypercapnic respiratory failure history

›If escalating oxygen requirement, early ICU consultation trigger

›Escalation ladder

›Nasal cannula 1 to 6 L per minute

›Simple face mask 6 to 10 L per minute

›Nonrebreather 10 to 15 L per minute

›High flow nasal cannula with humidification and heated circuit

›Noninvasive ventilation for selected patients with close monitoring

›If persistent work of breathing or refractory hypoxemia, intubation pathway

›Awake proning

›If hypoxemia on conventional oxygen, trial awake prone positioning

›If intolerance, lateral decubitus positioning alternation

Hemodynamic support and fluids

›Perfusion strategy

›Conservative fluid strategy for hypoxemic respiratory failure risk

›If hypotension with poor perfusion, crystalloid bolus reassessment by dynamic markers

›If vasopressor required, norepinephrine first line

›Thromboembolism risk mitigation

›Pharmacologic VTE prophylaxis unless contraindicated

›If high bleeding risk, mechanical prophylaxis

02History/hx44

Presenting syndrome and timeline

›Symptom profile

›Dyspnea

›Cough

›Fever or chills

›Pleuritic chest pain

›Fatigue and myalgias

›Anosmia or dysgeusia

›Timeline anchors

›Symptom onset date

›Day of illness at presentation

›Progression pattern

›Recent worsening within 24 to 48 hours

›Severity markers at home

›Reduced oral intake

›Syncope or presyncope

›Home pulse oximetry readings

›Exertional desaturation symptoms

Risk factors for severe disease

›Host risk factors

›Age 60 years or older

›Chronic lung disease

›Cardiovascular disease

›Diabetes mellitus

›Chronic kidney disease

›Chronic liver disease

›Immunocompromise

›Obesity

›Exposure and prevention context

›Known COVID-19 exposure

›Recent congregate setting exposure

›Recent travel

›Vaccination status and last dose date

›Medication and treatment context

›Current immunosuppressants

›Recent systemic corticosteroids

›Prior antiviral use for current illness

›Anticoagulation baseline therapy

Pitfalls and alternate trajectories

›Atypical presentations

›Isolated hypoxemia with minimal dyspnea

›Delirium in older adults

›Gastrointestinal predominant symptoms

›Late complications suspicion

›New chest pain and syncope for pulmonary embolism concern

›New focal neurologic deficit for stroke concern

›Palpitations for myocarditis or arrhythmia concern

03Physical Exam/exam32

Vital signs and general assessment

›Severity features

›Respiratory rate elevation

›Accessory muscle use

›Inability to speak full sentences

›Altered mental status

›Cyanosis

›Perfusion features

›Hypotension

›Cool extremities

›Delayed capillary refill

Respiratory exam

›Work of breathing

›Tachypnea pattern

›Paradoxical breathing

›Fatigue signs

›Lung findings

›Crackles

›Decreased air entry

›Wheeze with reactive airway component

›Bedside red flags

›Silent chest

›Stridor

›Hemoptysis

Extrapulmonary findings and complications

›Cardiovascular findings

›New murmur

›Signs of heart failure

›Arrhythmia

›Thromboembolic clues

›Unilateral leg swelling

›Calf tenderness

›Neurologic assessment

›Delirium screen

›Focal deficit screen

04Differential Diagnosis/ddx22

Life threatening respiratory causes

›Critical mimics and overlaps

›Pulmonary embolism ICD-10 I26.99

›Acute respiratory distress syndrome ICD-10 J80

›Acute respiratory failure with hypoxemia ICD-10 J96.01

›Acute heart failure with pulmonary edema ICD-10 I50.9

›Myocarditis ICD-10 I40.9

›Tension pneumothorax ICD-10 J93.0

›COVID-19 related entities

›COVID-19 ICD-10 U07.1

›Pneumonia due to COVID-19 ICD-10 J12.82

›SNOMED CT term COVID-19 pneumonia

Infectious pulmonary causes

›Alternative infections

›Community acquired bacterial pneumonia ICD-10 J18.9

›Influenza pneumonia ICD-10 J10.00

›RSV infection ICD-10 J12.1

›Aspiration pneumonia ICD-10 J69.0

›Pneumocystis jirovecii pneumonia ICD-10 B59

Noninfectious pulmonary causes

›Inflammatory and exposure causes

›Acute eosinophilic pneumonia

›Hypersensitivity pneumonitis

›Drug induced pneumonitis

›Interstitial lung disease flare

05Laboratory Tests/lt35

Core labs and end organ assessment

›Baseline evaluation

›Complete blood count for leukocytosis and lymphopenia pattern

›Neutrophilia for bacterial coinfection consideration

›Lymphopenia for viral severity association

›Electrolytes and renal function for antiviral dosing and organ dysfunction

›Creatinine for remdesivir and baricitinib adjustment pathways

›Sodium for dehydration and SIADH consideration

›Hepatic panel for remdesivir eligibility and hepatotoxicity monitoring

›ALT and AST trend for therapy safety

›Venous blood gas or arterial blood gas for respiratory failure severity

›PaO2 in mmHg for P to F ratio calculation

›PaCO2 in mmHg for hypercapnia detection

›Lactate in mmol/L for shock and hypoperfusion screening

›If lactate elevated, sepsis pathway and repeat trend

Inflammatory and thrombotic markers

›Risk stratification adjuncts

›C reactive protein for systemic inflammation trend

›Marked elevation for immunomodulator candidacy consideration

›D dimer for thrombotic risk context

›Elevated value not diagnostic for VTE in COVID-19

›Ferritin for hyperinflammation context

›Marked elevation for cytokine storm pattern support

›LDH for tissue injury context

›Elevation supports severity but nonspecific

Cardiac and coinfection evaluation

›Complication screening

›High sensitivity troponin for myocarditis and demand ischemia

›Rising delta for acute myocardial injury pathway

›BNP or NT proBNP for heart failure overlap

›Elevation supports cardiogenic component but nonspecific

›Procalcitonin for bacterial coinfection adjunct

›Low value supports viral predominant process

›Microbiology when indicated

›Blood cultures for shock or severe sepsis features

›Antibiotics after cultures when sepsis suspected

›Sputum culture when productive cough and severe disease

›If intubated, tracheal aspirate culture

06Diagnostic Tests/dt39

Scoring Systems

›Risk and trajectory tools

›NEWS2 for clinical deterioration risk

›Higher score for higher monitoring and ICU threshold

›ROX index for high flow nasal cannula response

›Lower value associated with higher intubation risk

›PaO2 to FiO2 ratio for ARDS classification

›Mild ARDS 200 to 300 mmHg

›Moderate ARDS 100 to 200 mmHg

›Severe ARDS less than 100 mmHg

›4C Mortality Score for inpatient risk stratification

›Use as adjunct not sole disposition determinant

MRI

›Limited role in acute pneumonia

›Brain MRI for encephalitis or stroke concern when CT nondiagnostic

›Cardiac MRI for myocarditis confirmation in stable patients

›Contraindications with unstable respiratory status and monitoring limitations

›Chest CT indications

›If pulmonary embolism concern, CT pulmonary angiography

›If contrast contraindication, alternative imaging pathway

›If CXR equivocal and diagnosis uncertain, CT chest consideration

›If complication concern, CT for pneumothorax or abscess evaluation

›Typical CT patterns

›Peripheral ground glass opacities

›Bilateral multilobar involvement

›Crazy paving pattern

›Radiation and contrast considerations

›Pregnancy risk benefit framing

›Renal function and contrast nephropathy mitigation

Ultrasound

›Lung POCUS applications

›B lines pattern for interstitial syndrome

›Subpleural consolidations for viral pneumonia pattern

›Pleural line irregularity for inflammatory pneumonitis

›Pleural effusion evaluation

›Cardiac POCUS applications

›LV function estimate for cardiogenic overlap

›RV strain pattern for pulmonary embolism concern

›Pericardial effusion screening

›Vascular ultrasound applications

›Lower extremity compression ultrasound for DVT suspicion

›If positive DVT, treat as VTE without CTPA when unstable

07Disposition/dispo23

Level of care decisions

›ICU indications

›HFNC requirement

›NIV requirement

›Intubation or impending intubation

›Shock requiring vasopressors

›Altered mental status with respiratory failure

›Ward admission indications

›New supplemental oxygen requirement

›Exertional desaturation with limited reserve

›Significant comorbidity with moderate symptoms

›Inability to maintain hydration or medications

›Observation unit considerations

›Borderline oxygen requirement with stable trajectory

›Need for serial exams and ambulatory oximetry

Discharge criteria and follow up

›Discharge safety

›Stable vital signs

›SpO2 at goal on room air or stable baseline

›No increasing work of breathing

›Reliable follow up and return access

›Home supports

›Pulse oximeter access when appropriate

›Caregiver support when frail or older

›Clear return precautions and follow up plan

08Treatment/t97

Supportive respiratory care

›Oxygen therapies

›Nasal cannula

›Flow 1 to 6 L per minute

›Target SpO2 goals section alignment

›Nonrebreather mask

›Flow 10 to 15 L per minute

›If inadequate, HFNC escalation

›High flow nasal cannula

›Initiate flow 30 to 60 L per minute

›Titrate FiO2 to SpO2 goal

›Reassess ROX index trend for failure risk

›Noninvasive ventilation

›If COPD or cardiogenic pulmonary edema overlap, consider bilevel support

›If primary hypoxemic failure, close monitoring for delayed intubation risk

›Positioning and pulmonary hygiene

›Awake proning cycles

›Prone 1 to 2 hours per session as tolerated

›Alternate left and right lateral positions

›Incentive spirometry role limited in acute hypoxemic viral pneumonia

›Fluids and hemodynamics

›Conservative fluids

›Avoid positive balance in hypoxemic respiratory failure

›Vasopressors

›Norepinephrine infusion titration to MAP 65 mmHg

Antiviral therapy for hospitalized pneumonia

›Remdesivir

›Indications

›Hospitalized with COVID-19 requiring supplemental oxygen and early in course per local guideline

›Avoid as sole therapy in advanced critical illness without clear benefit per local protocol

›Dosing

›200 mg IV once on day 1

›Then 100 mg IV once daily

›Total duration 5 days typical

›Extend to 10 days for selected severe cases per protocol

›Monitoring

›ALT trend for hepatotoxicity

›Hypersensitivity reaction monitoring during infusion

›Evidence level tagging

›Class IIa recommendation for selected hospitalized severe COVID-19 per provincial protocol sources

Anti inflammatory and immunomodulator therapy

›Systemic corticosteroids

›Dexamethasone

›Indications

›COVID-19 requiring supplemental oxygen

›COVID-19 requiring mechanical ventilation

›Dose

›6 mg PO or IV once daily

›Duration up to 10 days or until discharge

›Avoidance

›No oxygen requirement and mild disease due to potential harm

›Evidence level tagging

›Class I recommendation for hypoxemic COVID-19 based on mortality benefit trials

›Steroid alternatives when dexamethasone unavailable

›Hydrocortisone equivalent dosing per protocol

›Prednisolone equivalent dosing per protocol

›IL 6 receptor blockade

›Tocilizumab

›Indications

›Severe or critical COVID-19 with systemic inflammation and escalating oxygen support

›Concomitant corticosteroid therapy typical

›Dose

›8 mg per kg IV once

›Maximum 800 mg

›Second dose after 12 to 24 hours in selected cases per protocol

›Contraindications

›Active serious bacterial infection suspicion

›Severe immunosuppression without specialist input

›Monitoring

›ALT and AST trend

›Neutropenia monitoring

›JAK inhibition

›Baricitinib

›Indications

›Severe or critical COVID-19 with high oxygen needs when IL 6 blockade unavailable or as per protocol

›Concomitant corticosteroid therapy typical

›Dose

›4 mg PO once daily

›Duration up to 14 days or until discharge

›Renal dosing

›If eGFR 30 to 60 mL per minute, 2 mg PO once daily

›If eGFR 15 to 30 mL per minute, 1 mg PO once daily

›If eGFR less than 15 mL per minute, avoid

›Monitoring

›CBC for cytopenias

›LFTs for hepatotoxicity

Anticoagulation and bacterial coinfection strategy

›VTE prophylaxis

›Enoxaparin

›Standard dose 40 mg SC once daily

›If BMI high per protocol, 40 mg SC twice daily

›If eGFR less than 30 mL per minute, 30 mg SC once daily or UFH regimen

›Unfractionated heparin

›5000 units SC every 8 to 12 hours

›Therapeutic anticoagulation

›If confirmed VTE, full dose anticoagulation

›If high suspicion PE with instability and imaging delay, empiric anticoagulation decision individualized

›Routine full dose anticoagulation without VTE not recommended without indication

›Antibiotics

›If bacterial pneumonia suspected, community acquired pneumonia regimen per local antibiogram

›If procalcitonin low and no bacterial features, antibiotic avoidance strategy

09Special Populations/sp34

Pregnancy

›Maternal and fetal priorities

›SpO2 target 95% or higher when feasible

›Early obstetrics consultation for moderate to severe disease

›Left lateral positioning when supine hypotension risk

›Medication considerations

›Dexamethasone acceptable for maternal indication in severe disease

›Remdesivir use based on risk benefit and local guidance

›Tocilizumab and baricitinib specialist guided use

›Imaging considerations

›CXR with shielding acceptable when clinically indicated

›CTPA for PE concern when benefits outweigh risks

Geriatric

›Atypical presentations and risk

›Delirium as presenting feature

›Lower fever prevalence

›Rapid decompensation risk

›Medication safety

›Higher steroid adverse effect risk

›Polypharmacy interactions review

›Renal dosing for remdesivir and baricitinib pathways

›Disposition bias

›Lower threshold for admission with borderline hypoxemia

›Home support reliability assessment

Pediatrics

›Typical course differences

›Mild disease predominance

›Viral bronchiolitis overlap in younger children

›Severe complications

›MIS C consideration with fever and multisystem findings

›Viral myocarditis consideration with chest pain and troponin rise

›Respiratory support

›Weight based oxygen device selection

›Early pediatric critical care involvement for escalating support

›Medication considerations

›Steroid and antiviral use per pediatric infectious diseases guidance

›Weight based dosing and age restrictions per protocol

10Background/b27

Epidemiology

›Disease burden context

›SARS CoV 2 causes viral pneumonia with variable severity spectrum

›Highest hospitalization and mortality risk with older age and comorbidities

›Vaccination reduces severe outcomes risk

›Coinfection context

›Bacterial coinfection uncommon at presentation but possible in severe disease

›Viral coinfection with influenza or RSV possible seasonally

Pathophysiology

›Lung injury mechanisms

›Viral cytopathic effect with alveolar injury

›Endothelial injury with microvascular thrombosis

›Dysregulated host inflammation leading to diffuse alveolar damage

›Gas exchange consequences

›V Q mismatch from alveolar filling and atelectasis

›Shunt physiology with refractory hypoxemia in severe disease

›Reduced compliance in ARDS phenotype

›Thromboinflammation

›Increased VTE risk via inflammation and immobility

›D dimer elevation reflects inflammatory and thrombotic activity

Therapeutic Considerations

›Timing dependence

›Antivirals greatest benefit early in viral replication phase

›Immunomodulators greatest benefit in hyperinflammatory and hypoxemic phase

›Steroid rationale

›Mortality benefit in oxygen requiring and ventilated patients

›Potential harm in mild disease without hypoxemia

›Immunomodulator rationale

›IL 6 and JAK pathways implicated in cytokine mediated lung injury

›Benefit greatest with systemic inflammation and escalating oxygen support

11Patient Discharge Instructions/pdi20

Copy discharge instructions

›Home care and monitoring

›Rest and oral hydration

›Antipyretics as needed per label dosing

›Home pulse oximetry if available

›Avoid strenuous exertion until improving

›Return to ED now

›SpO2 90% or lower or rapidly falling readings

›Worsening shortness of breath

›Chest pain

›Confusion or fainting

›Inability to keep fluids down

›Blue lips or severe fatigue with breathing

›Transmission precautions

›Stay home and away from others while symptoms worsening or not improving

›Return to normal activities after at least 24 hours of improving symptoms and no fever without fever reducing medication

›Extra precautions for 5 days after returning to activities

›Well fitting mask in shared indoor spaces

›Improved ventilation and distance when possible

›Hand hygiene and cleaning high touch surfaces

›Testing before high risk contact when feasible

12References/r18

Clinical guidelines and consensus

›CDC Respiratory Virus Guidance update 2024 return to activities after 24 hours improving symptoms and fever free

›CDC media release March 1 2024

›NICE rapid guideline managing COVID-19 updated 2025 corticosteroids for oxygen requiring disease

›Dexamethasone offer when supplemental oxygen required

›Ontario Health Recommendations for Drug Therapy for Adults with Severe to Critical COVID-19 March 21 2025

›Dexamethasone and remdesivir and immunomodulator recommendations for severe and critical disease

›BCCDC hospitalized patient treatment algorithm 2025 immunomodulator use in critical disease

›Tocilizumab and or baricitinib for life support including high flow oxygen

›IDSA COVID-19 guideline dexamethasone recommendations updated 2020 with ongoing hosting

›Strong recommendation for critically ill patients

Evidence based sources

›RECOVERY trial dexamethasone 6 mg daily up to 10 days mortality benefit in hospitalized COVID-19

›NEJM 2021 dexamethasone in hospitalized patients

›Remdesivir plus dexamethasone observational evidence of reduced mortality versus dexamethasone alone

›Clinical Infectious Diseases 2025 cohort analysis

›Tocilizumab trials and meta analyses for severe and critical COVID-19

›REMAP CAP and RECOVERY program evidence base summarized in provincial algorithms

›CDC and Johns Hopkins public health summaries for updated isolation and post return precautions

›Post return precautions for 5 days after resuming activities

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed June 16, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.