How to prepare and respond to Coronavirus (COVID – 19)
Dr. Shaji Skaria, MD
Intensivist and Pulmonologist
Dr. Amir Amiri MD
ICU, Acute Care Surgery & Trauma
Healthcare Worker safety concerns:
Close respiratory monitoring of PUI and COVID-19-positive patients.
The MICU team should be notified EARLY if there is a COVID or PUI patient with worsening respiratory status and will keep a list of all COVID patients in the hospital for monitoring purposes. Avoiding crash intubations is essential. When the intubation of a COVID-19 patient or PUI is needed (outside of the ED), intubation will be conducted by a designated COVID/PUI airway team consisting of a specified attending and fellow.
Notify intensivist EARLY if there is a COVID or PUI patient with worsening respiratory status. Avoiding crash intubations is essential. Intubation (outside of the ED) will be conducted by the intensivist, who will be caring for the patient (or anesthesiologist, if intensivist is unavailable).
The intensivist should be aware of PUI within this hospital and kept aware of any PUI/COVID-19 patient whose status is worsening.
Patient safety concerns:
What to do:
Need for supplemental oxygen in PUI or COVID-19-positive patients
Intubation of PUI and COVID-19-positive patients
Extubation of PUI and COVID-19-positive patients
Extubation is also an aerosolizing procedure and RT should don appropriate PPE and perform in a closed room. To avoid airway emergencies of PUI and COVID-19 patients who are being extubated, extubation should only proceed when attending physicians are present but need not be in the room at the time.
ICU Procedures and Interventions
All patients should have early and documented code status discussion focused on goals of care around intubation and resuscitation. Admitting physician or ED physician should place palliative care consult upon admission. Goal is Palliative Care consult with family and patient within 24hr of admission with prognosis and goals of care discussed specific to COVID experience.