Anaesthesia
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On 30 January 2020, the World Health Organization (WHO) declared that the outbreak of a coronavirus disease-2019 (COVID-19) was a public health emergency of international concern. The WHO guidance states that patients with (COVID-19) should be managed by staff wearing appropriate personal protective equipment; however, working whilst wearing personal protective equipment is unfamiliar to many healthcare professionals. ⋯ The simulations revealed several important latent risks and allowed us to put corrective measures in place before the admission of patients with COVID-19. We recommend that staff working in clinical areas expected to receive patients with COVID-19 conduct in-situ simulation in order to detect their own unique risks and aid in the creation of local guidelines of management of patients with COVID-19.
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It is unclear how the recent local and international focus on systems issues and human factors in 'can't intubate, can't oxygenate' events has impacted institutional preparedness in Australia and New Zealand. This study attempts to capture a snapshot of current practices in Australian and New Zealand teaching hospitals with regard to preparedness to prevent and manage 'can't intubate, can't oxygenate' events. All Australian and New Zealand College of Anaesthetists' teaching hospitals were invited to complete an online survey consisting of 33 questions on terminology, equipment, cognitive aids, training and quality assurance. ⋯ A lack of consistency with the terminology used around 'can't intubate, can't oxygenate' both within and between the two countries was also identified. This survey has revealed a generally reassuringly high degree of institutional preparedness to prevent and manage 'can't intubate, can't oxygenate' events across both countries but with strong regional differences in approaches. Little is known of the institutional practices outside these countries, making international comparison difficult.
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Practice Guideline
Consensus guidelines for managing the airway in patients with COVID-19.
Severe acute respiratory syndrome-corona virus-2, which causes coronavirus disease 2019 (COVID-19), is highly contagious. Airway management of patients with COVID-19 is high risk to staff and patients. We aimed to develop principles for airway management of patients with COVID-19 to encourage safe, accurate and swift performance. ⋯ The fundamental principles of airway management in these settings are described for: emergency tracheal intubation; predicted or unexpected difficult tracheal intubation; cardiac arrest; anaesthetic care; and tracheal extubation. We provide figures to support clinicians in safe airway management of patients with COVID-19. The advice in this document is designed to be adapted in line with local workplace policies.
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Novel coronavirus 2019 is a single-stranded, ribonucleic acid virus that has led to an international pandemic of coronavirus disease 2019. Clinical data from the Chinese outbreak have been reported, but experiences and recommendations from clinical practice during the Italian outbreak have not. ⋯ In particular, we describe key elements of clinical management, including: safe oxygen therapy; airway management; personal protective equipment; and non-technical aspects of caring for patients diagnosed with coronavirus disease 2019. Only through planning, training and team working will clinicians and healthcare systems be best placed to deal with the many complex implications of this new pandemic.