Pearls for Ox-Vent Specific to COVID-19
1. You will need to keep trying until you find what works for the patient.
2. Your standard approach to most clinical situations will change.
3. Stay up to date with REBELEM and the Internet Book of Critical Care.
It’s Complicated
Please see Salim Rezaie‘s post on his website REBELEM discussing theories of lung disease in COVID-19.
More from REBELEM, Anand Swaminathan covers the science and logistics of awake proning.
Suggestions we have for awake proning:
- Quite often these patients can prone themselves!
- Normal pillows and blankets can offset pressure if you do not have access to fancy massage therapist tables/cushions.
- Teach your patient about shifting their weight while prone to avoid pressure sores and nerve injuries from laying still.
Code blues have taken extra steps for protection. Again, REBELEM has a wonderful post on this.
Some specifics for nurses we suggest:
- There is no emergency in a pandemic that requires you to rush into a room without appropriate PPE.
- See bullet number one.
- Limit team members in the room to the essentials.
- Consider applying a mechanical chest compression device to reduce environmental stimuli and free team members.
- Use a portable defibrillator because it will limit contamination to all of the crash cart equipment.
Creme de la Creme
This excellent post by Salim summarizes his evidence based thoughts. This is a truly remarkable read!
Mechanical Ventilation from the Internet Book of Critical Care
From the minds of Josh Farkas and Adam Thomas, this section on Ox-Vent specific to COVID-19 covers their evidence based opinion on invasive mechanical ventilation strategies.