Updated: Apr 13, 2020
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- Mar 21, 2020
Updated: Jun 23, 2020
INTUBATION
NYGH Protected Intubation Checklists (Present in kit)
NYGH Protected Intubation Pathway (Suggest initial review at home)
Suggested Methods for Preoxygenation
Non-rebreather @ 15L
NO BAGGING initially
BVM with 2 hand mask seal @ max 15 L flow and PEEP valve (consider nasal cannula @ max 5 L underneath)
LMA insertion (also an exit strategy)
General Tips
The devil is in the details - talk through failed airway, reoxygenation, cardiac arrest, post-intubation hypotension, CICO and other anticipated scenarios prior to entering room and assign personnel to specific tasks. i.e. "RN to start compressions while RT calls for help"
Consider intubation for any patient requiring FiO2 > 50%
Prepare all medications and equipment prior to entering room as per checklist
Have a safety officer and second team outside room
All staff must use full enhanced PPE (bouffant cap + fluid resistant gown + face shield with bib + long gloves + N95)
All intubations should be performed by most experienced intubator with minimal staff in room (MD + RT + RN)
Glidescope is preferred over direct laryngoscopy
Paralytic to prevent coughing during intubation
High flow nasal cannula may be used sparingly in non intubating situations with a face mask on top
Clamp ETT tube before disconnecting BVM/connecting vent
Inflate cuff prior to ventilation
Avoid auscultation (confirm with misting and colourimetric CO2 detector)
Avoid BiPAP / nebulizers
PROTECTED CODE BLUE
General Tips
NRB @ 15L, defibrillation pad application and rhythm analysis may occur with usual droplet/contact precautions
All personnel MUST don full enhanced PPE (bouffant cap + yellow gown + face shield with bib + long gloves + N95) PRIOR to initiating chest compressions or intubation
This may result in delays to CPR but MUST be adhered to.
Consider LMA insertion if unsuccessful intubation on first attempt.
OTHER CRITICAL CARE TOPICS:
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- Mar 19, 2020
All personnel should don full enhanced PPE (bouffant cap + fluid resistant gown + neck /face shield + gloves + N95) prior to initiating resuscitative efforts.
This may result in delays to CPR but MUST be adhered to.
Consider LMA insertion if unsuccessful intubation on first attempt.
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