WLAVA:COVID19 ED Airway

Revision as of 15:50, 23 April 2020 by Zahir.basrai (talk | contribs)

Last Updated: 4/9/20

COVID Airway Intubation

Airway Supplies

  • Airway carts are located across charge nurse station. These have PAPR, PPE, and airway equipment including viral filters.
  • Code is 1212
  • In an airway emergency - grab cart, new Red Airway Box from Med room, Aerosol Box
  • Glidescope Go Blades:
    • We are running low on the S4 blades (larger blades).
    • Please consider using the S3 blades instead as it is unclear when we will receive a resupply of this.
    • Jonie has some in her office if needed to safeguard them from being stolen.
  • PAPR, belt, tube, and hood are REUSABLE only the plastic cover over breathing tube is disposable.
  • Clean PAPR hoods thoroughly with sani-wipes when doffing to decease pathogens.
  • PAPRs and the Paprs hoods will be cleaned by SPS so after you are done using it, place in a biohazard bag and leave it in the dirty Utility room of the actual Unit where you intubated.
    • Contact SPS M-F 41811, Weekends 310-987-8710 or 323-497-4585. They will pick up, clean and deliver back to ED.

3rd Overnight Weekday 11p-7a and Weekend 7p-7a (COVID-19) Attending Duties

  • Airway management for crash COVID patients.
  • Help other attendings with ED patient load.
  • At the beginning of the shift, complete daily item log as below.

DAILY LOG

  • The COVID Airway Shift Attending must check the Airway Carts x2 and new red Airway Box in the med room every day.
  • The DAILY “Sign-off Log” and the “Item Checklist” are on separate clipboards on top the Airway Cart.
  • Best practice is to refill the cart after an intubation because you know what is missing.
  • This daily log is a double check / insurance.
  • You also need to check that the COVID medication bags medications are NOT expired.

Clipboard.jpg COVID Airway Item Checklist

AIRWAY RED BOX IN MED ROOM

  • Stored in Med Room
  • Check Daily (3 essential items)
    • Glidescope Go (CHECK BATTERY)
    • Grab and Go Bag (premade ones in Yellow Duffel Bag)
    • COVID Medication Bag

Red box.jpg

AEROSOL (ACRYLIC/PLEXIGLASS) BOX

  • Stored in the Doctor's station.
  • This is available for use and is not mandatory.
    • Added layer of protection (giant splash guard).
  • We recommend you practice using it on simulation dummy before deploying for COVID19 airway.
  • Bed 4 has intubating manakin for you to practice.
SUGGESTED WORKFLOW FOR AIRWAY BOX
  • Remember to put what you need inside the box before intubating:
    • BVM with HEPA filter, suction, vent tubing, glidescope, tube, tape to secure tube.
  • You have the option of draping the other end (extra drapes available on the counter along with tape)
  • After securing tube, attache the viral filter/BVM OR continuous capnometry if you have that set up.
  • Remove the box from the patient and leave it in the room for at least 30 minutes over sink (to allow aerosols to clear) then retrieve for cleaning.

Box sink.jpg

  • Sterilize after use with germicidal wipes thoroughly and allow it to dry.
    • Buddy can clean this along with glidescope. Should wear full PPE.

AIRWAY GENERAL INFORMATION

  • Treat All Intubations as PUIs:
    • It is up to your discretion if you want to PAPR vs N95
      • Please wear the recommended level of PPE GLA ID recommends for aerosolizing procedures.
    • Please remember to document your PPE in CPRS note.
    • In CPRS write an "Intubation Note" or "Emergency Physician Airway Response Note" (if no intubation performed)

BASIC TECHNIQUE TO TEMPORARILY SECURING AN ET TUBE

SECURING AN ET TUBE WHILE USING AN AIRWAY BOX

DEMONSTRATION OF USING A PONCHO WHILE INTUBATING

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