EM:RAP Live: COVID-19 Update | March 25th 2020

On this Special Edition of EM:RAP Live, join Drs. Evie Marcolini, Scott Weingart, Anand Swaminathan, David Talan, Dara Kass, Jenny Beck-Esmay, and Mel Herbert for the latest on the COVID-19 pandemic. This show will focus on critical care, intubation, Bipap, myocarditis, the latest news and literature, viewer questions, and more!

brendan c. -

If one worked in a shop where there was no resource issues, would you ever recommend NIV over intubation? It is still early in my hospitals COVID curve and I see no reason to favor NIV. I feel risks of leaks/ high risk exposure outweigh benefits in a "perfect" environment . Also for the sake of argument eliminate negative pressure rooms availability .

Mel H. -

The experience in hard hit areas is that NIV has to happen as you run out of vents and to reduce vents days. We are adding to the CorePendium chapter now. Also Scott Weingart has some videos of how to create a NIV setup with minimal leak and no machine. https://www.youtube.com/watch?v=C78VTEAHhWU#action=share and https://www.youtube.com/watch?v=QEMBJXfEd2M

brendan c. -

My question was in the an area where there are plenty of ventilators, is there any good role for NIV given the risks e.g. leaks, undetected aerosol (thanks for your previous super speedy reply. I was showing colleague my question and saw your answer!! amazing!!) perhaps Weingardt could weigh in?

Erica T. -

what type of neck PPE are you recommending? do you have any examples

Jenny B. -

Great content, and thanks for putting up so much good info at such a critical time.

As far as discharging suspected COVID cases with return precautions, you had mentioned asking patients to check their own pulse ox at home. I know certain Samsung phones have the ability to check a pulse ox in their health app, along with their pulse. Would this be a possible option to recommend to patients with mild symptoms who we discharge home, in order to save them some money on buying a pulse ox?

Mel H. -

I think sport watches with pulse OX are a good screen. I am not sure how tested they are at low saturations but they are probably ok.

Byron F. -

How about your stethoscope use? Do you wipe down between each patient, or use a disposable with each patient?

Mel H. -

Don't use it - that is what a lot of people in the thick of it is saying - it doesn't add to the history and pulse ox usually.

Byron F. -

could we get a list of the items dr weingart listed for the ventilator connection setup to bring into the room to intubate?

Mel H. -


Art P. -

Can you use the Weigart cpap closed system without a self-inflating bvm?

Laura C. -

Some of my partners are isolating themselves from their family before even having symptoms suggestive that they are positive for COVID. Is it safe to be working and sleeping in the same bed as my spouse if I am asymptomatic?

Mel H. -

There is asymptomatic carriage - so it is all about risk management. I know some people have high risk family members in the house and have self quarantined. Others get home, take off their clothes, go straight to the shower and try and live a normal home life.

Amelia R. -

Listened to this earlier today. What do you think of this? https://thinkingcriticalcare.com/?fbclid=IwAR1ybv_DMR5LbSQnmYsTQ8d5Gm58yoZmMF8Rx48aeIDzTm2StP3mx78VkiY

Kayla M. -

Please comment on the safety and utility of oxygen delivery via nonrebreather masks in terms of aersolization exposure.

Marc V B., P.A. -

Has anyone thought of using glutathione in the treatment of the lung involvement with COVID 19 to reduce lung inflammation or the use of Icatibant to reduce Laryngeal edema prior to intubation

Oli F. -

In this podcast it is acknowledged that there is very little evidence right now in regards to the transmission mode of this particular virus. For this reason I think we have to be careful with our PPE recommendations.

1) There was a suggestion that some believe there is a "deep state" conspiracy regarding some of the CDC recommendations. However in the same statement there is acknowledgment of very little data about transmission modes and healthcare worker risk. So the question really is should we over or under protect? In any case I think we should be encouraging debate until more data is available.

1) In this podcast it is acknowledged that with a sneeze the airway velocity is tremendous. However intubating a completely paralyzed patient is thought to be higher risk of aerosolized virus. What is the mechanism of this? I agree intubation is high risk, however is a high velocity cough or sneeze lower risk? Or are they both high risk?

Ian L. -

Scuba Divers ought be recruited there are doctors who scuba dive and and scuba divers have the knowledge of the maximum Personal Protective Equipment. -

peter e. -

We are not hit as hard yet in SF, but it's coming soon. Listening to your advice on PPE and the intubation.
Saw this ingenious setup and plan to try this as well.
Do you think something like this would be helpful.

Mel H. -

Might help - there are now a number of similar setups suggested

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