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    Apsf Coronavirus Airway Management Infographic

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    Febrian Naufaldi
    This document provides recommendations for airway management of patients with suspected coronavirus (2019-nCoV) infection. It recommends: 1) Personal protective equipment should be available and protocols reviewed for proper donning and doffing to avoid self-contamination. 2) Suspected patients should not be brought to common areas and should be managed in a designated operating room with posted signs. 3) Intubation should be performed early by experienced professionals to avoid emergency intubation without protective equipment. Proper protective equipment, monitoring, and rapid sequence intubation is recommended to minimize aerosolization of the virus.

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    Apsf Coronavirus Airway Management Infographic

    Uploaded by

    Febrian Naufaldi
    19 views1 page
    This document provides recommendations for airway management of patients with suspected coronavirus (2019-nCoV) infection. It recommends: 1) Personal protective equipment should be available and protocols reviewed for proper donning and doffing to avoid self-contamination. 2) Suspected patients should not be brought to common areas and should be managed in a designated operating room with posted signs. 3) Intubation should be performed early by experienced professionals to avoid emergency intubation without protective equipment. Proper protective equipment, monitoring, and rapid sequence intubation is recommended to minimize aerosolization of the virus.

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    This document provides recommendations for airway management of patients with suspected coronavirus (2019-nCoV) infection. It recommends: 1) Personal protective equipment should be available and protocols reviewed for proper donning and doffing to avoid self-contamination. 2) Suspected patients should not be brought to common areas and should be managed in a designated operating room with posted signs. 3) Intubation should be performed early by experienced professionals to avoid emergency intubation without protective equipment. Proper protective equipment, monitoring, and rapid sequence intubation is recommended to minimize aerosolization of the virus.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    19 views1 page

    Apsf Coronavirus Airway Management Infographic

    Uploaded by

    Febrian Naufaldi
    This document provides recommendations for airway management of patients with suspected coronavirus (2019-nCoV) infection. It recommends: 1) Personal protective equipment should be available and protocols reviewed for proper donning and doffing to avoid self-contamination. 2) Suspected patients should not be brought to common areas and should be managed in a designated operating room with posted signs. 3) Intubation should be performed early by experienced professionals to avoid emergency intubation without protective equipment. Proper protective equipment, monitoring, and rapid sequence intubation is recommended to minimize aerosolization of the virus.

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    Recommendations for Airway Management in a Patient with

    Suspected Coronavirus (2019-nCoV) Infection


    Liana Zucco1, 2, Nadav Levy1,2, Desire Ketchandji3, Mike Aziz3, Satya Krishna Ramachandran1
    1.Beth Israel Deaconess Medical Center Dept Anesthesia, Critical Care & Pain Medicine, Boston, USA
    2. Healthcare Quality and Safety (MHQS), Harvard Medical School, Boston, USA
    3. Oregon Health & Science University, Department of Anesthesiology & Perioperative Medicine, Portland, Oregon, USA

    General
    Your personal protection is the priority. Personal protective equipment (PPE) should be available for
    all providers to ensure droplet/contact isolation precautions can be achieved. Providers and
    organizations should review protocols for donning and doffing PPE. Careful attention is required to
    avoid self-contamination.

    Patients with confirmed or suspected 2019-nCoV infected cases:


    o Should NOT be brought to holding or PACU areas
    o Should be managed in a designated OR, with signs posted on the doors to minimize staff exposure.
    o Should be recovered in the OR or transferred to ICU into a negative pressure room. Ensure a high
    quality HMEF (Heat and Moisture Exchanging Filter) rated to remove at least 99.97% of airborne
    particles 0.3 microns or greater is placed between the ETT and reservoir bag during transfers to
    avoid contaminating the atmosphere.

    Plan ahead:
    o For time to allow all staff to apply PPE and barrier precautions
    o Consider intubation early to avoid the risk of a crash intubation when PPE cannot be applied safely.

    During Airway Manipulation


    Apply:
    o Disposable mask, goggles, footwear, gown and gloves. Consider adopting the double
    glove technique.
    o Standard ASA monitoring should be applied before induction of anesthesia.
    o N95 mask at a minimum should be utilized. PAPR devices may offer superior
    protection when manipulating an airway of an infected patient.

    Assign:
    o Designate the most experienced anesthesia professionals available to perform
    intubation, if possible. Avoid trainee intubation for sick patients.

    Avoid:
    o Awake fiberoptic intubation, unless specifically indicated. Atomized local anesthetic
    can aerosolize the virus.

    Prepare to:
    o Preoxygenate for 5 minutes with 100% FiO2
    o Perform a rapid sequence induction (RSI) to avoid manual ventilation of patient's lungs
    and potential aerosolization of virus from airways.
    o Consider using a video-laryngoscope.

    RSI:
    o Depending on the clinical condition, the RSI may need to be modified. If manual
    ventilation is required, apply small tidal volumes.

    Use:
    o Ensure there is a high quality HMEF (Heat and Moisture Exchanging Filter) rated to
    remove at least 99.97% of airborne particles 0.3 microns or greater placed in between
    the facemask and breathing circuit or between facemask and reservoir bag.

    Dispose:
    o Re-sheath the laryngoscope immediately post intubation (double glove technique)
    o Seal all used airway equipment in a double zip-locked plastic bag. It must then be
    removed for decontamination and disinfection.

    Remember:
    o After removing protective equipment, avoid touching your hair or face before washing
    hands.

    Adapted from Kamming D, Gardam M, Chung F. I.


    Anaesthesia and SARS. Br J Anaesth 2003;90:715-18

    www.apsf.org

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