COVID-19: Example hospital protocols: Difference between revisions

Revision as of 02:43, 13 April 2020

All protocols are hospital dependent, please check with your hospital administration for existing protocols

This page is for sharing hospital protocols from various institutions. Please add from your institution.

Pre-oxygenation
- NC @ 6 L/min
- HFNC controversial
  - Consider facemask or other facial covering to prevent aerosolization
- CPAP mask modified with bio-filter

CPAP mask with viral filter

- - If not available, use BVM with bio-filter
  - Apneic oxygenation
Personnel in room
- Intubating physician (most experienced)
  - Physician administers meds
  - Nurse may enter room once circuit is closed to minimize exposure
- Respiratory therapist
Personnel outside
- Nurse to enter room once circuit closed
- Personnel to record/obtain unanticipated supplies
- Personnel to enter electronic orders if needed
PPE
- CAPR/PAPR preferred
- Otherwise
  - N95 with surgical mask cover recommended
  - Eye goggles with side shielding
  - Hair cover
- Body suit preferred, otherwise surgical gown
- Double gloves recommended
- Doffing
  - All doffing in anteroom preferred
  - All PPE except facial covering doffed inside room
  - CAPR/PAPR/mask should be doffed immediately outside
  - Assign personnel to guide doffing process
Equipment
- Video laryngoscopy (only bring into room what’s required)
  - Direct laryngoscopy NOT recommended
- ETT tube with backup unopened from packet
- CPAP mask or BVM with bio-filter
- Bougie (unopened from packet)
- RSI meds pre-drawn (sedation should be pre-ordered)
- Have other equipment ready for central & arterial lines outside
Nursing
- Set up monitor outside door with extension tubings
- Minimize need for mult room entry
Technique
- Consider using face hood

Demonstration of an intubation box

Use auto CPR device if available
Cover face with plastic or bed sheet to minimize aerosolization
Minimal personnel
- RT
- 2 providers to switch if manual CPR
  - If physician needed for RSI then physician/nurse
  - Otherwise nurse/nurse
Preselected resuscitative meds in bag
Consider terminating code if no response after pre-planned number of rounds

ASPR TRACIE COVID-19 Hospital Triage/Screening Resources ^[1]
Brigham & Women's Hospital Protocols- ^[2]
Massachusets General Hospital protocols- ^[3]
Department of Defense Practice Managment - ^[4]
Bedside checklist: File:Harbor COVID checklist v3-21-20.pdf
Harbor DEM COVID airway management guide File:Harbor COVID Airway Management v3-16-20.pdf
Proper donning and doffing with reusable goggles and stethoscope File:Procedure for Reuse of Faceshields and Goggles 3-19-2020.pdf
Summary of Harbor consensus guidelines for COVID ARDS management File:Clinical Cheat sheet.pdf

Authors:

@@ Line 32: / Line 32: @@
 *** Consider facemask or other facial covering to prevent aerosolization
 ** CPAP mask modified with bio-filter
-[[File:CPAP with Bio Filter.jpg|thumb]]
+[[File:CPAP with Bio Filter.jpg|thumb|CPAP mask with viral filter]]
 *** If not available, use [https://www.youtube.com/watch?v=c9h2I8n9Ptk&feature=youtu.be BVM with bio-filter]
 *** Apneic oxygenation
@@ Line 70: / Line 70: @@
 * Technique
 ** Consider using [https://intubationbox.com/ face hood]
+[[File:Using Intubation Box.jpg|thumb|Demonstration of an intubation box]]
 ** RSI by most experienced personnel
 ** Meds:
@@ Line 94: / Line 95: @@
 * HEPA filter as close to patient as possible
 * Consider establishing an area for incoming crash intubation from EMS
+** It may be more efficient to bring patient to ED room for RSI
+*** Cover patient's face with mask and/or sheet to minimize aerosolization
+*** Consider apneic oxygenation during transport to room
+*** Have pre-designated route to minimize exposure to staff and ED environment
+*** Receiving team should be transporting patient
 ==CPR==