WLAVA:COVID19 ED Airway

Last Updated: 4/9/20

COVID Airway

• Reference document:
  • File:COVID intubation guideline update 3.30.20.pdf
• Airway carts are located across charge nurse station. These have PAPR, PPE, and airway equipment including viral filters.
• Code is 1212
• In an airway emergency - grab cart, new Red Airway Box from Med room, Aerosol Box
• Glidescope Go Blades:
  • We are running low on the S4 blades (larger blades).
  • Please consider using the S3 blades instead as it is unclear when we will receive a resupply of this.
  • Jonie has some in her office if needed to safeguard them from being stolen.
• PAPR, belt, tube, and hood are REUSABLE only the plastic cover over breathing tube is disposable.
• Clean PAPR hoods thoroughly with sani-wipes when doffing to decease pathogens.
• PAPRs and the Paprs hoods will be cleaned by SPS so after you are done using it, place in a biohazard bag and leave it in the dirty Utility room of the actual Unit where you intubated.
  • Contact SPS M-F 41811, Weekends 310-987-8710 or 323-497-4585. They will pick up, clean and deliver back to ED.

3rd Overnight Weekday 11p-7a and Weekend 7p-7a (COVID-19) Attending Duties

• Airway management for crash COVID patients.
• Help other attendings with ED patient load.
• At the beginning of the shift, complete daily item log as below.

DAILY LOG

• The COVID Airway Shift Attending must check the Airway Carts x2 and new red Airway Box in the med room every day.
• The DAILY “Sign-off Log” and the “Item Checklist” are on separate clipboards on top the Airway Cart.
• Best practice is to refill the cart after an intubation because you know what is missing.
• This daily log is a double check / insurance.
• You also need to check that the COVID medication bags medications are NOT expired.

COVID Airway Item Checklist

AIRWAY RED BOX IN MED ROOM

• Stored in Med Room
• Check Daily (3 essential items)
  • Glidescope Go (CHECK BATTERY)
  • Grab and Go Bag (premade ones in Yellow Duffel Bag)
  • COVID Medication Bag

AEROSOL (ACRYLIC/PLEXIGLASS) BOX

• Stored in the Doctor's station.
• This is available for use and is not mandatory.
  • Added layer of protection (giant splash guard).
• We recommend you practice using it on simulation dummy before deploying for COVID19 airway.
• Bed 4 has intubating manakin for you to practice.

SUGGESTED WORKFLOW FOR AIRWAY BOX

• Remember to put what you need inside the box before intubating:
  • BVM with HEPA filter, suction, vent tubing, glidescope, tube, tape to secure tube.
• You have the option of draping the other end (extra drapes available on the counter along with tape)
• After securing tube, attache the viral filter/BVM OR continuous capnometry if you have that set up.
• 2nd person (likely RN) will need to bag the patient with viral filter or connect directly to vent.
• Remove the box from the patient and leave it in the room for 30 minutes (to allow aerosols to clear) then retrieve for cleaning.
• Sterilize after use with AF3 thoroughly and allow it to dry.
  • Buddy can clean this along with glidescope.

AIRWAY GENERAL INFORMATION

• Treat All Intubations as PUIs:
  • It is up to your discretion if you want to PAPR vs N95
    • Please wear the recommended level of PPE GLA ID recommends for aerosolizing procedures.
  • Please remember to document your PPE in CPRS note.
  • In CPRS write an "Intubation Note" or "Emergency Physician Airway Response Note" (if no intubation performed)

Other WLA VA Pages

• WLAVA: COVID19 ED Operational Updates
• WLAVA: Enhanced Screening Tent
• EST Provider Orientation
• WLA VA PPE Main Information Page
• WLAVA:Enhanced Screening Tent Telehealth