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Beyond Advanced Cardiac Life Support. Do we have to change our practice in COVID Era?
3 MagMain changes in recommendations
Personal Protective Equipment for Advanced Life Support interventions need to be at maximum level of protection of full body, eyes and airways.
CAT 3 level of protection 4 (at least) for the full body
FPP2/N95 airway filter for team members who are NOT directly involved in airway management, ventilation or manual chest compressions
FPP3/N99 airway filter for providers who are directly involved in airway management, ventilation and manual chest compressions.
Face shield and protective googles are strongly suggested
Mechanical Chest compressors devices are the gold standard to perform cardiac massage. They reduce contacts and contamination risk and team member exposure to contaminants.
Adhesive disposable pads are the only option to check rhythm and deliver shock. Dispose non-disposable, manual pads.
Passive O2 administration (via simple face mack at a rate of 15l/m) during chest compressions is the first option over bag mask ventilation when performing Basic Life Support waiting for advanced airway management.When using a Bag Valve Mask always put a HEPA/HME filter between Bag and mask to avoid contamination
Hold chest compressions when performing airway managment
Cover patient head with a transparent plastic foil to minimise virus spreading and contamination when performing airway management and bag mask ventilation
Tracheal intubation using a video laryngoscope is the first line option for advanced airway management to minimise contamination.
If video laryngoscope is not available Extraglottic devices are an acceptable first line option
Use all the implementation to improve intubation first passage success:
Video laringoscopy
Bougie
RAMP positioning
Suctioning (SALAD technique)
Use all the implementation to improve Extraglottic device placement
Laryngoscope for tongue displacement and mouth opening (DO NOT USE hands)
Deflate cuff
Lubrificate the device
Whatever plan you apply use an HEPA/HME filter immediately after the ventilation device
Use disposable cover and disposable gel to perform Ultrasound during chest compressions
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Tag:ACLS, COVID-19, Emergency Medicine guidelines, emergenza, emergenza sanitaria territoriale, medicina d'urgenza, medicina d'urgenza preospedaliera