@wandering_er, a doctor out of Chicago, reports that his hospital is being forced to ration, clean and reuse single-use equipment, and worse – to use scarves and bandanas in place of masks. He’s right to call it “unacceptable.”

We are being asked to ration and reuse, wash/wipe personal protective equipment (PPE) that was meant for single use and we still haven’t seen the worst of this pandemic here in the US. Healthcare workers everywhere are expected to treat and see everyone, all the while @cdcgov saying its okay to use scarves and bandanas when we run out of PPE. That’s unacceptable.

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First of all, #GetMePPE 😷 this is a real problem. We are being asked to ration and reuse, wash/wipe personal protective equipment (PPE) that was meant for single use and we still haven’t seen the worst of this pandemic here in the US. Healthcare workers everywhere are expected to treat and see everyone, all the while @cdcgov saying its okay to use scarves and bandanas when we run out of PPE. That’s unacceptable. Rant over. • 1st potential COVID19 intubation is in the books. Here are some recommendations for intubating a potential/confirmed #COVID19 patient: 🔺Close monitoring of respiratory status; plan for early intubation if deteriorating, allows for better (and safer) intubation 🔺Airborne and droplet precautions & negative-pressure isolation room needed. You need fitted respirator masks (N95 or FFP2) plus gloves & eye protection (face shield/goggles) or PAPR for people who failed N95 (like myself, have a beard) 🔺Use Video Laryngoscopy, 1st attempt success is key (most experienced?), use full paralytic dose, have your backups ready (DL, Bougie etc) 🔺Limit people in room: RT, nurse for meds, airway assistant/second intubator 🔺Cuff fully inflated and viral filter on the ETT prior to bagging/hooking to vent 🔺In adults with COVID-19 and acute hypoxemic respiratory failure on oxygen, SPO2 goal < 96% 🔺Vent Settings: ▫️Low tidal volume (4-8 mL/kg of IBW) ▫️Targeting plateau pressures (Pplat) of < 30 cm H2O ▫️Higher PEEP strategy.❗️If using a higher PEEP strategy (i.e., PEEP > 10 cm H2O), monitor for barotrauma (pneumothorax/pneumomediastium) • ⚠️Stay safe out there and wear your #PPE • 📚 sources: – Society Critical Care Medicine: “Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19)” – EM Crit “Some Additional COVID Airway Management Thoughts” • #EmergencyMedicine #FOAMcc #CriticalCare #Residency #Intern #medicalschool #medstudent #infectiousdisease #FOAM #EMRA #ACEP #PGY1 #internyear #COVID4MDs #covid_19 #anesthesia

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