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COVID-19 Critical Care Guidelines

INTUBATION




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.




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