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Trends Anaesth. Crit. Care ; 2020.
Article in English | ELSEVIER | ID: covidwho-526628


Background: Airway management for patients with COVID-19 poses a significant infection risk to clinicians. As such, some providers have adopted the "COVID intubation box", a cuboid barrier which which separates the clinician from the airway. While this device has limitations, there is promising evidence on its effectiveness. Aim: To summarize the history, evidence, and limitations of the popular intubation box design. Furthermore, we share our modified design and experiences from airway simulations. Methods: Using our prototyping and validation facilities, our team designed and iteratively improved our device to arrive at a final design. The expert panel, consisting of anesthesiologists, infection control staff, and emergency clinicians, trialed the device using airway simulation mannequins and provided feedback. Results: Our final device features a dome shape, increased height, wider arm port diameter, additional side port for assistants, and drapes to reduce viral escape. Feedback from simulations was overall positive, especially noting that the height and arm port diameter facilitated arm motion within the box. The infection control team preferred the unique dome shape for safe disinfection. Conclusion: Our intubation box overcomes several challenges and criticisms of the popular intubation box. This device is an important harm reduction tool for clinicians during this COVID-19 pandemic.

Stroke ; 51(6): 1891-1895, 2020 06.
Article in English | MEDLINE | ID: covidwho-26794


Background and Purpose- Hyperacute assessment and management of patients with stroke, termed code stroke, is a time-sensitive and high-stakes clinical scenario. In the context of the current coronavirus disease 2019 (COVID-19) pandemic caused by the SARS-CoV-2 virus, the ability to deliver timely and efficacious care must be balanced with the risk of infectious exposure to the clinical team. Furthermore, rapid and effective stroke care remains paramount to achieve maximal functional recovery for those needing admission and to triage care appropriately for those who may be presenting with neurological symptoms but have an alternative diagnosis. Methods- Available resources, COVID-19-specific infection prevention and control recommendations, and expert consensus were used to identify clinical screening criteria for patients and provide the required nuanced considerations for the healthcare team, thereby modifying the conventional code stroke processes to achieve a protected designation. Results- A protected code stroke algorithm was developed. Features specific to prenotification and clinical status of the patient were used to define precode screening. These include primary infectious symptoms, clinical, and examination features. A focused framework was then developed with regard to a protected code stroke. We outline the specifics of personal protective equipment use and considerations thereof including aspects of crisis resource management impacting team role designation and human performance factors during a protected code stroke. Conclusions- We introduce the concept of a protected code stroke during a pandemic, as in the case of COVID-19, and provide a framework for key considerations including screening, personal protective equipment, and crisis resource management. These considerations and suggested algorithms can be utilized and adapted for local practice.

Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Stroke/diagnosis , Stroke/therapy , Triage/methods , Algorithms , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Emergency Medical Services/methods , Humans , Personal Protective Equipment , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Stroke/complications