Category Archives: Covid-19

Question: The latest Base Hospital Memorandum from April 6th says we are to withhold suction via an endotracheal or tracheostomy tube unless using a closed system suction unit. Does this mean we are to withhold suction ONLY via endotracheal or tracheostomy tube? Can we suction an airway full of vomit or blood?

In a previous response to a question, it was mentioned that the SGA is an effective way to create a closed system and reduce risk of aerosolization when ventilating. Would it then be reasonable to go directly to the SGA in the setting of VSAs, to further protect all those involved in the resuscitation from possible aerosolization with an OPA/BVM?

Questions regarding intubation. Should we be opting for aggressive airway management with intubation or SGA on VSA patients as well as severely obtunded non-asthmatic patients where patient presentation would allow? Should this take precedence over ACLS drugs during cardiac arrest? When intubated with inline filter in place are we permitted to BVM an normal rate?

*UPDATED* Question: Regarding the removal of "inability to ventilate" consideration for narcan. In a pt who fails the covid screening, and who has overdosed on opiates, spontaneous resp rate <8, low says. Are we to withhold BVM and apply hi-flo mask at 8L and give narcan? Or use BVM as usual to assist ventilations prior to narcan administration. Its the use of the BVM in this pt that is the question

Question: The latest Memo regarding oxygen delivery states "IN ALL CASES where adult patients require high concentration oxygen, use high-concentration/low flow masks with a hydrophobic submicron filter" and then later reads that high concentration oxygen be avoided unless SGA. The instructions for the FLO2MAX mask our service carries instructs you to set the oxygen flow-meter to 15lpm, or to level prescribed by a physician. What do you recommend we set the flow meter at if we use these masks?

Question: What is the best method to cover the King LT suction port? You mentioned this practice during your 2nd podcast.

*UPDATED* Question: A work email came out on April 8 2020 that lists OBHG recommendations. On the list it states to withhold BVM ventilation in all spontaneously breathing patients that do not improve with BLS airway maneuvers and high conc/low flow mask with filter at 10L/min. A site from OBHG on March 20 2020 states to use BVM in patients with a resp rate < 6 or >40 and sats below 85% with oxygen or ETCO2 >50 and increasing by 5 %. I have also read to limit flow rates no higher than 5 L/M on April 8th it mentions 10 L/M. Can you please confirm a change has been made?

Question: Was just reviewing the SWORBHP document that came out yesterday, just hoping for a little clarification RE bronchoconstriction. In the document it states that we should consider IM administration of Epinephrine for severe respiratory distress w/ cough, hx. asthma. It also states that we should consider using MDI salbutamol only for severe respiratory distress without a cough... My understanding of it would be that we want to keep a surgical mask on the pt. to minimize risk of droplet transmission via cough which you can’t do while administering medication via MDI. I understand that if the pt. Has a cough we should use epinephrine as our first line medication same as we normally would if the pt. Is apneic but Are we to be considering these two separate cases for use of these medications and not giving them concurrently during this pandemic? Just wondering as I did not see it specify whether or not we should considering withholding ventolin if there is a cough.

Question: Who can receive IM epi under the new COVID-19 considerations?

Question: Why did we receive the latest OBHG recommendations today (Monday, Apr 6th) when they are dated April 3rd?

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