The clinical manifestations of syndrome of lung obstruction due to epidemic toxin described in Chinese protocol for severe

The symptoms described in traditional Chinese medicine

Therapeutic Guidelines: Symptoms of COPD

Chinese protocol clinical classification of symptoms

Pathology changes in Chinese protocol

WHO Temporary Document: Acute respiratory distress syndrome symptoms (ARDS)

Clinical manifestations: hot and red face, cough, yellow and sticky phlegm

“Jinkui Yaolue (Synopsis of Golden Chamber)” Cough, chest pain, cough sputum, sputum has pus and blood, asthma, cannot lie flat, must breathing on the bed, ascites, abdominal distension, and constipation

Moderate cases: increased shortness of breath, short of breath during walking, limited daily life, cough and expectoration, acute exacerbation requires glucocorticoids. FEV1 ≈ 40% - 59% estimated value

Common cases: with fever, respiratory symptoms, imaging findings of pneumonia

The lungs show different degrees of consolidation. Serous fluid, fibrin exudate and transparent membrane were found in alveolar cavity. Alveolar septal vascular congestion, edema, mononuclear and lymphocyte infiltration and clear thrombosis can be seen. Lung tissue focal hemorrhage, necrosis, can appear hemorrhagic infarction. Partial alveolar exudation and pulmonary interstitial fibrosis. Part of the bronchial mucosa epithelium in the lung was detached, and mucous and mucus plug were found in the cavity. A few alveolar hyperinflation, alveolar septal rupture or cysts formed

Onset: New respiratory symptoms or aggravation of existing symptoms appear within one week after the diagnosis of clinical disease. Chest imaging: Bilateral pulmonary turbidity, which cannot be fully explained by pulmonary effusion, lobar or pulmonary atrophy, or pulmonary nodules. Cause of edema: respiratory failure, which cannot be fully explained by heart failure or fluid overload. If there are no risk factors, an objective assessment (e.g. echocardiography) should be performed to exclude hydrostatic pressure edema. Degree of oxygenation (adult):

· Mild ARDS: 200 mmHg < PaO₂/FiO₂ ≤ 300 mmHg (PEEP or CPAP ≥ 5 cm H₂O or nonmechanical ventilation) Moderate ARDS: 100 mmHg < PaO₂/FiO₂ ≤ 200 mmHg (PEEP ≥5 cmH₂O or nonmechanical ventilation)

· Severe ARDS: PaO₂/FiO₂ ≤ 100 mmHg (PEEP ≥ 5 cmH₂O or nonmechanical ventilation) When PaO₂ value is not available, SpO₂/FiO₂ ≤ 315 indicates ARDS (including patients without mechanical ventilation)

· Degree of oxygenation (Children; Note: OI = Oxygenation Index, OSI = Oxygenation index using SpO₂)

· Positive pressure noninvasive ventilation or full face mask CPAP ≥ 5 cm H₂O: PaO₂/FiO₂ ≤ 300 mmHg or SpO₂/FiO₂ ≤264

· Mild ARDS (Invasive ventilation): 4 ≤ OI < 8 or 5 ≤ OSI < 7.5

· Moderate ARDS (Invasive ventilation): 8 ≤ OI < 16 or 7.5 ≤ OSI < 12.3

· Severe ARDS (Invasive ventilation): OI ≥ 16 or OSI ≥ 12.3

Or sputum with blood, breathless and suffocated, and tired

“Wenyi Lun (The Epidemic Febrile Disease)”: At the beginning of the epidemic, people were afraid of cold before they got fever. Later, they only felt hot but were not afraid of cold. Early illness 2 - 3 days, day and night fever, headache body pain, white moss on the tongue. In the middle, the coating on the tongue will turn yellow and infect the stomach. Heavy stage of yellow tongue, Heart stuffy, abdominal distension, and vomiting

Severe cases: shortness of breath after slight activity, severe restriction of daily activities, frequent expectoration of sputum, chronic cough, glucocorticoid for acute exacerbation, FEV1 < 40% estimated value

Severe cases: Adults who conform to any of the following criteria: 1) Onset of shortness of breath, RRN30 times/min; 2) In resting state, oxygen saturation < 93%; 3) Arterial partial pressure of oxygen (PaO₂)/fraction of inspired oxygen (FiO₂) < 300 mmHg (1 mmHg = 0.133 kPa) Cases with chest imaging that shows obvious lesion progression within 24 - 48 hours > 50% shall be managed as severe