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CORONAVIRUS
WORCESTERSHIRE INTENSIVE CARE GUIDELINES AND RESOURCES
This page includes the resources rapidly designed to manage the critical care response to the coronavirus pandemic in Worcestershire.
Disclaimer: Attempts are made to update guidelines as soon as they change, although this relies on robust communications, and my availability to update.
Some information is being shared to ensure all staff are fully appraised of the departmental leaderships planning strategies - rules are not set in stone, and changes may be rapidly made.
PERSONAL PROTECTION
Trolley set up with PPE and instructions
PPE IN ICU
ICU nurse in PPE in red zone, another preparing to don in amber zone with buddy in green zone
RED
AMBER
GREEN
Doffing a coverall/overall safely
COVERALLS
WRH ICU divided into 2 bedded pods with temporary partitions, now upgraded to permanent
COVID SCREENING SWABS FOR TRANSFERS IN AND OUT OF ICU
Document outlining timing of, and which CCVID-19 swabs to do when organising transfer in or out of ICU bed
DECISION SUPPORT TOOL
UK ICS published clinical guidance on assessing whether COVID-19 patients will benefit from critical care, and an objective approach to capacity challenges
CLINICAL FRAILTY SCORE
DECISION SUPPORT FORM
NICE published suggested form to be completed at critical care triage if required. A trust modified version is available via bluespier... in clinical viewer: choose “new document” on the left, pick “critical care” from the left hand list, “ICU” from the next and “decision support form”.
DECISION MAKING
Tools to support medical admissions decision making on requirement for critical care referral/involvment
COMMUNICATION WITH PATIENTS & FAMILIES
DIFFICULT PHONE CONVERSATIONS
Local guideline on communicating to relatives over the phone, and links to trust, and national support facilities
Chelsea and Westiminster Hospitals infographic on how to approach difficult phone calls with relatives of critically ill
This link from 'vitaltalk' provides more advice on difficult phone conversations, including in resource limited situations
Instructions on using skype or facetime to allow relatives to see patients in ICU using ICU IPADs. Code for accessing Ipads in handover folder, along with unredacted document with icu login details.
CHECKLISTS
COVID-19 SAFETY BRIEF
COVID-19 specific additions to twice daily safety briefs
INTUBATION & LINES TROLLEY SET UP
Checklist for pre-preparation of kit with everything you will need to initially intubate & stabilise
Preprepared trolley
INTUBATION TEAM BRIEF
Checklist to run through to make sure all kit and drugs ready and prepared, and other COVID-19 specific considerations
VENTILATORS
Worcestershire uses Evita 500s and Savina ICU ventilators on ICU, along with Oxylog 3000 transport ventilators in ED and ICU. Anaesthetic machines have advanced ventilators (Maquet Flowi)
INITIAL VENTILATOR SETUP
initial vent setup including where viral filters should be attached
Drager Oxylog
We have a number of Drager oxylogs across site, more may become available from central government. If repurposed to ventilate for long periods - refer to these instructions
MAQUET FLOWi ANAESTHETIC MACHINES
Worcestershire set up and troubleshooting guide to using the Maquet anaesthetic machines for ICU patients
Hamilton T1 transfer ventilators (on transfer trolleys)
VG70 Ventilators
VG70 Ventilator
PHARMACY IN COVID-19
COVID-19 specific pharmacy guidelines/policies
INSULIN (in event of pump shortage)
NG FEEDING
(in event of feeding pump shortage)
Standard Drugs by Infusions in ICU
Insulin regimens to avoid the use of CVRIIs in the event of shortage in infusion pumps, where CVRII is not essential
Regimens for NG feeding by intermittent bolus or cyclic feeding to allow pump sharing (11 hour regimen) in the event of having insufficient enteral feed pumps (V1 6.4.20)
Document showing commonly used drugs by infusion in ICU
Anticoagulation for COVID-19
Document delveloped in colaboration with the haematology department to advise on enhanced thromboprophylaxis for critically ill COVID-19 patients
ISTH document on anticoagulation in COVID-19, with information on the validity of APTT and anti-Xa testing. We do offer in house anti-Xa testing for the indications noted in the document.
Corticosteroids, antivirals, IL6 inhibitors, and COVID-19 neutralising antibodies for COVID-19
For all most up to date local guidance, use the trust Microguide app on your phone or follow this link for the webpage.
Follow this link to the Blueteq NHS authorisation website (you will need a login)
RESEARCH TRIAL PARTICIPATION
Information on research trials that the trust are participating in for COVID-19 patients
We are recruiting into the RECOVERY trial on wards, and the REMAP-CAP trial in ICU
Click Here or follow the 'RESEARCH' tab at top of this website to view COVID-19 research that we are participating in along with information on the trials and training
MANAGEMENT OF RESPIRATORY FAILURE
PRONE POSITIONING
Video detailing Worcestshire method to move patient to prone position with only three staff members
POSITIONING FROM PRONE TO SUPINE
Video detailing Worcestshire method to move patient back to supine position with only three staff members
LUNG ULTRASOUND IN COVID-19
Lung ultrasound is probably one of the most useful imaging modalities, and can be done at the bedside - here is a guide to what you may see
Got some more time on your hands..... follow this link to a LITFL video tutorial on lung Ultrasound in COVID - it is sensational!
Here is the link to the lung US documentation form
Psychological support
Events are likely to be extremely stressful. In addition to psycholocical support from friends, family, and colleagues, professional support can be sought - further information in download.
For online resources/downloads/self help, follow this link to unmind - free to NHS workers dealing with COVID-19 crisis
NHS 'Pandemic Working Together Hoodies'
Our very own, talented Dr. Ben Coombs has designed a crest to represent the coming together of numerous NHS specialties to support patients during the COVID-19 pandemic. You can buy your own at a reduced rate by following the link
Delivery is to the anaesthetic dept unless you pay for delivery to home address
Crest
Birds - watching over patients by day and night
Lantern - Royal College Nursing crest (Florence Nightingale lady of the lamp)
Strong arm holding healing light (Chartered Society Physiotherapists)
Rod of Asclepius - healing professions
Opium poppy - analgesia
Curare vine - muscle relaxation
Mandrake - sedation
Coca leaf - local anaesthetic
Open book - new learning and knowledge
Helmet - battle
OTHER USEFUL RESOURCES
Useful sites providing information relevant to patient management
Guidance Hub for UK bodies information (FICM,AAGBI,RCOA, ICS)
Guideline NICE re: COVID-19 Critical Care
Surviving Sepsis Campaign Guidelines for Covid-19
Resus Council Infographic on CPR in COVID-19
Succinct review of what is currently known and management advice from EMCrit
Kings Hospital Clinical Evidence Summary COVID-19
Useful information from Northampton Critical Care group
Haematologitcal/Thromboprophylaxis considerations webinar (ISTH) 9/4/20
West Midlands Network critical care Transfer Service (phone Tel – 0300 200 1100)