James BeckVer 1.1 12/3/20

Covid 19 Intubation – Proposed steps to minimise aerosol generation

Drug boxes to be stored in fridge (daily check by designated member of team – allocated at morning brief)

o Propofolo Rocuroniumo Suxamethoniumo Metaraminolo Ephedrine

Kit Listo To take into the room (if not already in the room):

Water Circuit Face mask Filter (HME) End tidal CO2 sensor and block Correctly sized ET tube Lubricating Gel 20ml Syringe McGrath and correctly sized blade Bougie Oral airway Anchor fast (tube tie) Suction tubing Ventilator tubing Inco pad Pillow Drugs (labelled and drawn up) Saline flushes

o To have outside the room:

Airway trolley - including kit for front of neck access I-gel Mac blade and handle Other ET tubes (size 6, 7 and 8mm) Scissors Mcgills forceps Emergency drug box

Don’t cut ETT– leave space to be able to apply clamp if needed Aim to use videolaryngoscope

Prepare waters circuit and closed suction as below:

James BeckVer 1.1 12/3/20

Preoxygenate with PEEP Administer drugs, RSI, avoid bagging if possible When you remove mask from patient, disconnect kit as shown:

Intubate No ventilation till cuff up Once cuff up connect closed suction as shown:

James BeckVer 1.1 12/3/20

Then circuit and vent (don’t check ventilate with waters circuit):

Then turn on ventilation and confirm CO2/chest rise and fall

If disconnecting to, for example, connect to oxylog:o Pause ventilator

James BeckVer 1.1 12/3/20

o Clamp ETT with blue clamp and gauze (to reduce risk of damage to ETT)o Disconnect distal to CO2 a reapply red cap to vent tubing