key: cord-1052051-7xezlg0n
authors: Arora, Poonam; Kabi, Ankita; Dhar, Mridul; Bhardwaj, Bharat Bhushan
title: Safety sequence intubation: the 10 “P's” algorithm and cognitive aid for airway management in COVID-19 patients
date: 2020-10-15
journal: Braz J Anesthesiol
DOI: 10.1016/j.bjane.2020.08.009
sha: f0679b4fba5c48814d5f1786126ec9e19fc63ee1
doc_id: 1052051
cord_uid: 7xezlg0n

nan

1. Protection: All aerosol generating procedures (AGPs) are to be done in negative pressure isolation rooms with minimum personnel involved. WHO's interim guidance published on March 19 th , on "Rational use of personal protective equipment for COVID-19" recommends, AGP-PPE to include respirator N95 or FFP2 standard, or equivalent, gown, gloves, eye protection and apron. [2] 2. Planning: Assign roles and responsibilities, plan the airway management strategy before entering the isolation room. Quick airway assessment of the patient can be done using MACOCHA score. [3] Subsequently airway plan (plan A to plan D) can be tailored by the team to achieve successful intubation in the first attempt. The team members should practice closed loop communication and watch for cross-contamination.

3. Preparation: This step involves preparation of patient specific airway equipment kit and drugs outside the isolation room. Cricothyroidotomy kit can be kept outside with the runner.

Once inside the isolation room, check and assemble equipment using mnemonic SOAP ME 9. Placement of tube and confirmation: Laryngoscopy should be undertaken with the device most likely to achieve prompt first pass successful tracheal intubation. Using a video laryngoscope is recommended. Additional barrier like plastic sheet tent or box may be used.

Use a standard failed tracheal intubation algorithm with a cognitive aid if difficulty arises.

COVID-19: protecting health-care workers. The Lancet. 2020;395:922. 2. Rational use of Personal Protective Equipment (PPE) for Coronavirus Disease (COVID-19): Interim Guidance

Early identification of patients at risk for difficult intubation in the intensive care unit: development and validation of the MACOCHA score in a multicenter cohort study

Comparison of effectiveness of two commonly used twohand mask ventilation techniques on unconscious apnoeic obese adults

Personal Protective Equipment; AMPLE, Allergies, Medication, Past history, Last meal, Events; RSI, Rapid Sequence Intubation

Bag Mask Ventilation; e-FONA (SBT), emergency Front of Neck access (scalpel-bougie-tube)

Efficiency Particulate Air; DL, Direct Laryngoscope; VL

Positive Pressure Ventilation; NMB, Neuro Muscular Blockers