COVID-19 Emergency Intubation Checklists
March 27, 2020
Donning of PPE for COVID-19 Intubation
- Remove all personal items (personal stethoscopes, watches, phones, jewelry, etc)
- Shoe covers placed
- Gown placed
- Mask placed (N95 OR PAPR)
- Eye protection placed (your personal glasses are inadequate)
- Double Gloves
- Gloves should cover gown cuffs and sleeves
- Head Covering placed over ears (disposable)
- Second mask placed over N95 (regular surgical mask) and over your head covering.
- Before you go into the room, double check all team members to ensure proper PPE
What to bring in the room for the intubation
- Video laryngoscope with nothing in drawers or on the back of the tower
- Amber box that laryngoscope blade will go in and black cap if needed for particular blade
- Kleenz spray
- ETT, opened, checked for cuff leak, syringe attached
- Stylet, lubricated and placed into the ETT
- Induction drugs
- Emergency drugs likely to be used
- Sedative gtt for after the intubation
- Flush syringes
- Suction catheter and tubing if not already in the room
- Laminated Doffing checklist
What to leave in the hallway with the resident and/or anesthesia technician
- Other emergency airway supplies: Bougie, LMA, ETTs, trach kit, etc. unless you think you are likely to use them
- Ultrasound and kits for arterial line, central line, etc.
- Zoll and crash cart
Airway Management Checklist
- Anesthesiologist preoxygenates with 100% O2 for 5 minutes
- Mask seal on patient is tight and not lifted
- Use bag-valve mask with HME filter
- Use flutter or slight squeeze to keep valve open if patient is not breathing deeply on own
- Anesthesiologist directs RN to give induction medications and flush with 20 mL Saline
- Anesthesiologist performs laryngoscopy with videoscope
- RT or RN holds cricoid pressure as directed by anesthesiologist
- Tube is Placed
- RT or RN removes stylet slowly
- RT inflates cuff
- RT attaches HME filtered circuit (or can use bag valve mask with filter and portable capnography indicator)
- RT auscultates breath sounds
- RT takes control of tube
- Anesthesiologist disassembles laryngoscopy blade from power supply cords and places laryngoscope blade in the amber box after placing black cap (CMACs) onto port.
- RT to hold ET tube during this time
- Anesthesiologist and RT secure tube together using established device
- Additional procedures are done by anesthesiologist as needed by primary team (This is the same team that intubated the patient)
- Central Line
- Arterial Line
- Additional IV access
- NGT or OGT placement
- Chest Tube Placement
- RT confirms cuff pressure maintained between 25-30cm H20.
- RN sprays laryngoscope blade (with cap if needed) and closes box. Wipes down box with wipe and hands to personnel outside for transport to SPD
- RN or anesthesiologist wipe down the video laryngoscope tower and then pass to personnel on outside where a second wipe down occurs. Bleach wipe on wheels.
- Additional procedures are done by anesthesiologist as needed by primary team (This is the same team that intubated the patient)
Doffing of PPE for COVID-19 Intubation
- Staff members will begin doffing near the doorway giving each other enough room to avoid contaminating each other
- Use hand sanitizer on last set of gloves
- Remove gloves and gown together, slow downward motion out in front of your body, rolling it in a ball
- Hands, wrists and forearms are sanitized
- Put on clean gloves (optional)
- Eye protection is removed and wiped down
- Shoe covers removed
- Sanitize hands or gloves
- Head cover is removed
- Sanitize hands or gloves
- Outer mask is removed and discarded
- Remove gloves if wearing them
- Hands are sanitized
- Leave the room and close the door
- The N95 is removed and placed in a Ziploc bag, not completely sealed to avoid moisture trapping, labeled with your name and saved. If the mask is wet from sweat or secretions, discard it.
- Wash hands with soap and water to your elbows.
- If you feel you have contaminated through or around your PPE, please wash with soap and water (shower if necessary) and change into clean scrubs.
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