Airborne precaution intubation procedure
PERSONAL PROTECTIVE EQUIPMENTContact precautionsGownDouble gloveBootsAirborne precautionsPowered air purifying respirator (PAPR)Or,N95 mask and eye protectionMEDICATIONSInduction medications (propofol, etomidate, etc.)High dose paralytic to prevent coughing (succinylcholine or rocuronium)Rescue medications (atropine, epinephrine, etc.)AIRWAY EQUIPMENTDisposable handle and blade (mac 3, mac 4, miller 2 available)McGrath available (mac 3, mac 4, D-blade)Suction, ETT, stylet, bougie, back up O2 sourceAMBU bag withPeep valveHEPA FILTERPROCEDUREAttending Anesthesiologist to perform intubationLimit staff in room: CRNA/Resident to pass supplies from box into roomMinimize BMV, aerosolizing infectious particlesPreoxygenate with 100% FiO2 either via BiPAP or AMBU with PEEP valve at 10cm H20. Don’t initiate BiPAP if not on yet to prevent aerosolizationRSI to prevent BMV unless absolutely necessaryAfter induction to prevent de-recruitment- hold positive pressure with AMBU and PEEP valve without providing breaths. Proceed expeditiously to intubation.Inflate ETT cuff prior to ventilationVentilate only after HEPA filter is in circuitRemove outer gloves after intubationCheck tube position with ETCO2 and chest x-ray (avoid auscultation unless necessary)Secure ETTPost procedureRemove PPE according to CDC/MMC guidelinesWash or use alcohol based hand sanitizer once out of roomUse purple top sanitation wipes on all non-disposable equipmentConsider changing into clean scrubs ................
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