COVID-19 Daily Messages

Sharing what we learnt at our Toronto site this week

Date University Health Network Sinai Health System Unity Health - St. Michaels Sunnybrook Health Sciences Sick Childrens Hospital
23-29 March - Dont don PPE until drugs and equipment are prepared and plan discussed. PPE inhibits effective communication.
- Prepare & hang sedation/analgesia infusions prior to intubation, to avoid post-intubaiton restlessness and coughing.
- After intubation, the colorimetric CO2 is slow to respond after a viral filter
- Ensure garbage for PPE is large enough to accomodate multiple staff
- Extubation inside a heliox filled plastic bag!
- Before doing a high-risk procedure (e.g. intubation, proning), don't forget to huddle and "virtually" simulate it outside the room and with the entire team
- Always have a doffing buddy!
- The goggles may fog - we have now antifog solution
- Communication is hard in the rooms - speak loud and clear! And don't forget to use the boards
- Be careful in the anteroom - a lots of contamination episodes were observed today!
- If a portable X-ray is ordered - remember the radiology tech how to properly enter the room and minimize the risk of contamination

1.  If the O2 sat is <94% during/after preoxygenation that an LMA be brought in before proceeding as otherwise there is no alternative to provide ventilation support if the patient is desaturating.

2.Positioning the backup people in the antechamber instead of outside is key as this would have made it easier to speak with them and also have them relay information/equipment more easily.

3. There was no continuous CO2 monitor when we started, and placing this on the monitor caused us to lose the entire monitor for a short period of time. Having it already in place is key but I understand we don’t have that many of them so they are getting moved around.

4.       Crucial at hospital level to clarify commitment of Dept of Anesthesia to be primary intubators for ALL PUI/COVID-19 patients.