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