COVID-19 Intubation Checklist Personal protective equipment (PPE) • Standard PPE • N95 or PAPR. • Facemask +/- googles • Gloves, gown. • Consider also (depending on availability): • Hood to cover neck (if unavailable, disposable cap to cover hair). • Two pairs of gloves, under-layer ideally long-cuffed surgical gloves. • Bunny suit for complete body coverage. Medications & pre-planned ETT depth • High dose paralytic (e.g. Rocuronium at least 1.2 mg/kg). • Calculate optimal ETT depth (using MDCalc). Stuff • Video Laryngoscope & Blade • BVM with PEEP valve & viral filter. • Additional viral filter on exhalation port of ventilator. Procedure • Most experienced staff, limit people in room. • Pre-oxygenation: Options may include: • BiPÅP with a two-tube system & viral filter. • BVM with viral filter, PEEP valve, and nasal cannula. • During apnea: • If using BiPÅP: Continue with backup rate. • If using BVM: Hold mask (with PEEP valve) on patient's mouth to prevent decruitment (but don't actively bag the patient). • Inflate ETT cuff prior to ventilation. • Secure ETT at pre-calculated depth. Post-procedure • Meticulous removal of PPE (use ethanol hand wash before and after removal of PPE). Dr. Josh Farkas @pulmcrit via Internet Book of Critical Care @iBookCC #COVID19 #Intubation #Checklist #SARSCoV2 #Management #CriticalCare #Coronavirus
