Zachary Aust, M.D., and Nate Bonfanti, M.D., highlight the priorities for critical care medicine during the COVID-19 pandemic. All intubations presumed COVID positive RSI (unless contraindicated) Most experienced clinician intubates Video laryngoscopy Large ETT (8.0 . COVID-19 INTUBATION CHECKLIST (Challenge and Response) SET UP (Outside patient room) 4 Core Roles Identified 1) Most experienced airway proceduralist 2) Airway assistant 3) Team leader/drugs administrator, in-room assistant 4) Outside runner Discuss Airway Strategy Plan • Administer intubation drugs (if no RN present). COVID-19 CONTROLLED INTUBATION CHECKLIST March 8, 2020 L.Mazurik MD FRCPC . (1) Of The primary consideration in preparing the IR service for COVID-19 is prevention of intra hospital transmission so as to protect patients and health care workers (HCW) from being contaminated or infected, while providing safe IR care for patients. Furthermore, it is recommended to be familiar with and use a simple cognitive aid for airway rescue designed to be referred to in real-time during an evolving airway crisis. When the COVID-19 airway response team is called to perform an intubation, they are ready to proceed with minimal delay and maximum safety. Intubation: Document: Type: Source: Theatres Intubation Checklist v1.7: PDF: OUH: OUH COVID-19 Tracheal Intubation Procedure - video v4 (checklist v1.9) w/ Intubation Team prefix text. COVID Intubation Checklist. Identify plan for getting plan D (Surgical Airway – scalpel + BVM) into room if needed. Tracheal intubation of the patient with COVID-19 is a high-risk procedure for staff, irrespective of the clinical severity of disease. 5 things to know about tracheal intubation in COVID-19.pdf. Box 1: Steps for the in-room setup portion of the granular COVID-19 protected intubation checklist. The authors sought to create a quality improvement framework to ensure safe practices f … Things to Gather • CMAC Pocket Set- Up or McGrath • Blade for CMAC or McGrath Safe – for staff and patient.. COVID-19 Airway Algorithm.pdf Using COVID intubation checklist , identify all equipment required for Plan A to C prior to entering the room. • Determines additional procedures needed. Figure 2: COVID-19 endotracheal intubation checklist Concurrently, this team of emergency physicians liaised with the anesthesiologists at our hospital to develop a dedicated team of physicians for all emergency intubations and resuscitations of potential COVID-19 patients. COVID-19 checklist Intubation Post intubation Results & Reflections (what we found) General comments Whole process to intubation took 45 mins Domestic side room needs cleared and cleaned. Optimal management is not yet known. 5. Last update: March 30, 2020. Clinical Guidelines; Protected Emergency Procedures; Ventilation Considerations ... Assessing the Airway - LEMON method from iEM. No Comments on Pre-oxygenation for COVID-19 intubation Careful attention to pre-oxygenation of any patient with severe hypoxic respiratory failure prior to airway management can be life-saving. AIIC [image]. Working Laryngoscope (VL . PLEASE NOTE: Whenever an airway-related RRT is required, please call as a Code Blue/Medical Emergency-Cardiac arrest and include COVID for any patient on a bio-contained unit. Leave the Intubation trolley outside the room with the runner. BACKGROUND: The high frequency of aerosolizing procedures in the ICU, including endotracheal intubation, places clinical staff at elevated risk of contracting the 2019 coronavirus (COVID-19). Severely ill covid-19 patients tend to linger on ventilators longer than other intubated patients, some for weeks. COVID-19 Intubation/Critical Care Pre-entry Checklist For Providers To bring inside room: Inside room Glidescope (use the one in Blue with empty basket) (Only bring in blade(s) you will be using + Glidescope stylet) Airway Bag (includes the following) o ETT (7 & 7.5) with syringe for cuff o Stylet o BVM o OG tube with syringe, lube and tape Preoxygenate Consider CPAP Optimise Patient Fluid bolus? Intubation Protocol.pdf. Example of Protected intubation checklist one-pager. During admission, decisions to escalate care, such as intubation or CPAP initiation will be preceded by a Team Huddle (RN, RT & MD). This checklist is designed to be read, item by item by the intubater’s assistant. Intubation Checklist for COVID19 Patient Safety of the health care team is paramount and during a pandemic, health care worker safety is prioritised over the patient. COVID-19 AGMP PPE. INTRODUCTION — The novel coronavirus disease 2019 (COVID-19 or nCoV) and other respiratory infections can be transmitted to clinicians involved in their care, particularly during aerosol-generating procedures (eg, endotracheal intubation and extubation). This study captured 68 intubations in SAS COVID-19 Airway Management Infographics . Infection control to limit transmission is an essential component of care in patients with suspected or documented COVID-19. • When possible, at the time of admission and prior to intubation, conversations should be had with the patient (and their legally authorized surrogage via Prepare Airway Equipment. travel, physical distancing): 1-888-COVID19 (1888-268-4319) or text 604-630-0300 BC Centre for Disease Control | BC Ministry of Health Critical COVID + Patient Response Preparing for Emergency Endotracheal Intubation Checklist Task üDetail Comments Gather Supplies and Equipment; Team Assignments Assign staff * Note names in comments In room (Hot Zone) Clinician Respiratory Tech Nurse inside the door for hand-offs, meds Nurse for patient care ROLE ASSIGNMENT 2. G:\COVID-19/COVID-19 Intubation checklist 25032020.docx DURING AIRWAY MANAGEMENT A viral filter should always be between the face-mask/ETT and chosen breathing circuit Aim for no manual face-mask ventilation (i.e. 6. more pearls: make sure cuff is inflated prior to manual ventilation. Working Laryngoscope (VL . 2. (e.g. • Review Pediatric Intubation Checklist (on back) prior to intubation with team. Prepare Airway Equipment. Working Suction + Suction Catheter. Use the dedicated COVID Code Bag (anesthesia tech stock room) for airway supplies, but LEAVE BAG OUTSIDE OF PATIENT ROOM. Simulated training in full PPE using a well-designed COVID-compliant guideline & algorithm (Figures 1 & 2) together with a cognitive aid such as the Vortex approach (Figure 3) and specific COVID-19 intubation checklist (Figure 4) is required to achieve prompt and complication-free intubation … Breathing Circuit + Viral filter + Facemask. real-time gap analysis to track adherence to COVID-19 intubation safety protocols. Verbalise indication for intubation 3.oleAloer cat l s 4. Download . The clinical situations with the highest risk for HCW infection and the most significant resource utilization involving a COVID-19 patient are intubation and cardiopulmonary arrest. In that context, a before and after study would tell us almost nothing about checklists. Ensure HEPA filter attached between mask and circuit, distal to the EtCO2 sampling line Video laryngoscope + RSI drugs Plastic bag inside bin for contaminated equipment Plastic sheet or intubation box if using Only essential airway equipment on cart to minimize contamination of clean equipment ver. Intubation Checklist for Suspected/Confirmed COVID-19 Pediatric Patients TEAM POSITIONING FOR INTUBATION Inside room Outside room Author: ACH Medical Code Committee: Created 4/9/20, Updated N/A Approved Frank Belmonte We would like to show you a description here but the site won’t allow us. Breathing Circuit + Viral filter + Facemask. Using COVID intubation checklist , identify all equipment required for Plan A to C prior to entering the room. Churchill House 35 Red Lion Square London WC1R 4SG +44 (0)20 7280 4350 Info@ics.ac.uk Pre-Induction Assessment. COVID-19 was first described in Wuhan, China in December 2019 and is now a global pandemic. For example, the first time an intubation checklist was introduced at my emergency department, we were preparing for COVID. 5. Specific, step-by-step guidance to perform safe endotracheal intubation in the setting of COVID-19 are … Equipment/Supplies: i. STAT INTUBATION . AIIC [pdf]. Covid-19 Airway guidelines Full.pdf. 18 Panelists from five continents and multiple clinical specialties participated in a three-round modified Delphi technique to identify potential … G:\COVID-19/COVID-19 Intubation checklist 25032020.docx DURING AIRWAY MANAGEMENT A viral filter should always be between the face-mask/ETT and chosen breathing circuit Aim for no manual face-mask ventilation (i.e. cuffed ETT Calculate. Duties: • Completes clinical order set – COVID 19 intubation. Pre-Intubation Patient Optimization (when possible) Check Correct hypotension (IVF, NE), correct acidosis, pre-oxygenate with NRB Assign Roles IN Team: Team Lead (usually Intubator unless RT intubates), RN, RT or intubation assistant This summary is intended to help healthcare facilities optimize supplies of disposable N95 filtering facepiece respirators when there is limited supply during the COVID-19 pandemic. Intubation … BACKGROUND: The high frequency of aerosolizing procedures in the ICU, including endotracheal intubation, places clinical staff at elevated risk of contracting the 2019 coronavirus (COVID-19). Dr. Setnik created the COVID-19 Suspected or Confirmed Airway Management Checklist to assist with team organization and preparation when faced with the need to intubate a patient. Guideline Summary-Protocol.pdf. Check IV access functioning and connect IV fluid. Consider using all recommended COVID-19 PPE for all resident encounters on the memory care unit, which includes face mask, eye protection, gloves, and gown. Please see examples below of a COVID-19 Airway Trolley Template and Emergency Intubation Plan ; Minimise aerosolisation of virus by: Avoid HFNC - … and may not be familiar with current COVID-19 ICU practices. SAFE Airway Society COVID-19 Airway Management and Intubation Checklist Safe Airway Society @SafeAirway #SAFE #Airway #Management #Intubation #Checklist #COVID19 #CriticalCare Contributed by Dr. Gerald Diaz Use of an intubation checklist can reduce exposure risk and thus acts as a potential safeguard. Communicate effectively within the facility and plan for appropriate external communication related to COVID-19; The following checklist can help hospitals assess and improve their preparedness for responding to a community-wide outbreak of COVID-19. Churchill House 35 Red Lion Square London WC1R 4SG +44 (0)20 7280 4350 Info@ics.ac.uk Non-medical inquiries (ex. Article. • Suspected COVID-19 patient – a patient with COVID-19 like symptoms or risk factors for COVID-19 (recent travel outside Canada, close contact of confirmed case, close contact of known outbreak) General Principles for Pre-Intubation Management 1) The use of appropriate PPE and effective hand hygiene must be followed to ensure staff protection. So increasing oxygen requirements his set to now 88%. To the Editor: The video by Shrestha et al. Here is the Alfred ICU intubation checklist. Use of an intubation checklist can reduce exposure risk and thus acts as a potential safeguard. An example of a COVID-19 intubation checklist is also provided . traditional RSI) once medications are given Intubation during the COVID-19 outbreak is one of the more dangerous procedures for our teams. Removal of (doffing) personal protective equipment (PPE). Use dedicated COVID Video Laryngoscope (anesthesia tech stock room) with bougie and two blades – in progress ii. Menu. During surgery the correct setting of operative room (OR) is mandatory to reduce the risk of contamination. Search all guides using the search box above and pressing enter or clicking These videos have been created to support the OUH managing COVID-19 patients. Hopefully can assist as a template for local intubation planning in your institution. If intubation is likely needed, review Intubation checklist and process All C-Team members RT to prepare equipment, instruments needed Charge RT Following precautions apply: • ... Riley NICU COVID-19 Process Flow Checklist . The rapid community transmission of the novel SARS-CoV2 virus (COVID-19) has led to significant incidence of acute hypoxic respiratory failure around the world. being an aerosol generating procedure, specific steps and preparation must be undertaken to minimize risks to not just patients during intubation but to us as well. MAYO CLINIC: COVID-19 Pediatric Intubation List# All intubations presumed COVID positive. preferred intubation technique ^ Use. Due to the nature of intubation (and extubation!) The important changes to our airway checklist are: Negative pressure room for intubation (ideally ICU preferred) Dedicated COVID-19 airway team. COVID PATIENT . COVID-19 CHECKLIST FOR PAEDIATRIC INTUBATION IN PICU Dr C Davison 2 INTUBATION IN PICU 1. preferred) Back-Up supplies in sealed double bag Hands-free communication to outside. COVID-19 RSI Checklist Staff safety first 1. . The Alfred ICU Guideline for Intubation of Critically Ill Patients has recently been updated with an Appendix outlining modifications for suspected COVID19 patients. Algorithms, Checklists and Visual aids. Standardization of equipment, roles and procedures is essential. Pre-Intubation Patient Optimization (when possible) Check Correct hypotension (IVF, NE), correct acidosis, pre-oxygenate with NRB Assign Roles IN Team: Team Lead (usually Intubator unless RT intubates), RN, RT or intubation assistant Avoid BMV if … Working Suction + Suction Catheter. Use COVID airway checklist inside room (paper version in intubation pack) – (Appendix 7) Planning: Negative Pressure room or single room with closed door if negative pressure unavailable Attending leads developed the Intubation Safety Checklist (ISC) as well as the COVID-19 Intubation Note template (both described in the following section) and initiated the implementation of designed protocols in the ED, ICU, and ORs. Midlands coronavirus ICU group checklist for intubation. Limit the number of healthcare workers in the room. Version 14.1 / 03- 14-2020 Note: Subject to change based on current recommendations. Obtain from Bedside RN or Charge Nurse or Nursing Supervisor: viii. o If in ICU, secure Glidescope and intubation cart . PROTECTED INTUBATION (COVID-19) EQUIPMENT CHECKLIST Pre-oxygenation ☐ Cuff-seal mask ☐ Viral filter ☐ T-piece connected to O2 ☐ BVM connected to O2 Plan A – Video Laryngoscopy ☐ Glidescope w/ blade ☐ Styletted 7.0 (F), 8.0 (M) ETT ☐ Backup ETT one size smaller ☐ Bougie ☐ 10cc syringe ☐ ETT securing device (tape/tie) Six people to perform RSI 2 Ensure maintenance sedation, pressors, end-tidal C02 3. monitoring, anchorfast, lines, sterile gloves, US, NGT, urinary catheter are in the room prior to first checklist Checklist will be performed twice (once outside, once 4. inside) Intubation in COVID. • Rationale: Intubation during the COVID pandemic is high stress procedure. (ii) SARS and MERS – these caused epidemics with high mortality which are somewhat similar to COVID-19. Real-world users’ organically-developed innovations, like the intubation credit card mini-checklist, meet these objectives and we hope … The use of a checklist is recommended when preparing for airway management in a patient with coronavirus disease 2019 (Covid-19). Endotracheal intubation of patients with COVID-19 should be performed by healthcare workers with experience in airway management to minimize the number of attempts and risk of transmission. We sought to determine how the WHO SSC might best be adapted during the COVID-19 pandemic. BEFORE INDUCTION. Emergency tracheal intubation of the child with COVID-19 . COVID-19 Repository. intubation medication weight based dose chart ..... 5 covid-19 intubation pre-entry checklist: regular ed..... 6 covid-19 intubation pre-entry checklist: respiratory unit..... 7 covid-19 pre-oxygenation & intubation packs & critical care Background: The high frequency of aerosolizing procedures in the ICU, including endotracheal intubation, places clinical staff at elevated risk of contracting the 2019 coronavirus (COVID-19). Emergency tracheal intubation checklist COVID-19 –CHILD OUTSIDE ROOM INSIDE ROOM AFTER AND LEAVING qAirway management qInflate cuff before any ventilation qCheck waveform capnography qPush/twist connections qClamp tracheal tube before any disconnection qAvoid unnecessary disconnections qOther Intubating provider in aerosol COVID PPE (PAPR if available, otherwise N95 and faceshield), surgical gown, double gloves; Dedicated RN in aerosol COVID PPE (PAPR if available, otherwise N95 … PPE: Extended gloves, BLUE gown, N95, face shield, bouffant cap; INTUBATORS: Double glove & goggles 3. Specific, step-by-step guidance to perform safe endotracheal intubation in the setting of COVID-19 are limited. Notify senior ED doctor 2. Use of an intubation checklist can reduce exposure risk and thus acts as a potential safeguard. Safety officers were present at all intubations. Coronavirus COVID-19 Intubation Checklist for Suspect and Confirmed Cases of COVID-19 If you have fever, a new cough, or are having difficulty breathing, call 8-1-1. Intubation Checklist for COVID-19 Patients: A Practical Tool for Bedside Practitioners. (see Appendix -- available in the PDF version) Familiarity, availability and use of a simple cognitive aid for airway rescue, that is designed to be referred to in real-time during an evolving airway crisis, is recommended. The model included an Intubation Safety Checklist, a standardized documentation template for intubations, obtaining real-time feedback, and weekly multidisciplinary team meetings to review data and implement improvements. 4 - Wait for 60 seconds after meds were pushed. After entry to the room, the steps are pre-intubation checklist and post-intubation. Each hospital will need to adapt this checklist to meet its unique needs and circumstances. This contains: (i) Four coronaviruses which are widely distributed and usually cause the common cold (but can cause viral pneumonia in patients with comorbidities).

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