Thread by @amit_pawa

Wow - incredible work from the @AAGBI producing a webinar on #COVID19 & what we need to know on the frontline.

I have put some of my take home points together in a thread.
Bottom line- I am genuinely worried about what lies ahead, and it is clear, we are not ready for this yet

1. PPE - there are national variations & inconsistencies. Intubation is an Aerosol Generating Procedure (AGP) - maximal protection should be used - what is that though?

2. What drugs are we going to use?
Propofol & Alfentanil vs Isoflurane?
Will we have enough?

3. Equipment- we need more infusion pumps, ventilators, NIV/CPAP machines. Per hospital or Central for redistribution?

4. We are NOT ready. We need to be prepared. We have up to 15 days to get ready

5. Do we need CT scans for diagnosis in all patients? It is NOT practical

5. Contd...
Lung US #POCUS is an extremely useful resource. In Italy, hospitals that waited for CT for diagnosis when presented with 70 pts simultaneously - really struggled. Consider using Lung US at presentation, don’t rely on CT for diagnosis

6. It is going to get V V BUSY

6. Contd.
When it gets busy, we cannot deliver the perfect Intensive care we want to. We have to deliver the best care we can proportional to the number of cases and resources we have.

7. There is no role for HFNO.
Oxygen therapy via Facemask vs Intubation.
At worst cases, NIV?

8. We need to cancel elective work.
We need to train staff, to create space, and prepare in a wartime-like manner.

9. Oxygen in institutions may not be sufficient - the demands likely to be put on our supplies have not been experienced before

10. Up to 1/3 of patients are likely to require Renal replacement therapy. It is unlikely that we will be able to provide this. ?solutions provided via our renal colleagues and haemodialysis machines?

10. Wellbeing is extremely important
ics.ac.uk guidance avail

10 (actually 11!) contd..
Wellbeing:
It is “Ok not to be Ok”
This experience is likely to have long term effects on us all. Ask for help, communicate, use resources available.

There is danger of anxiety, “readiness burnout” and ultimately PTSD

12. Consider non-clinical dilemmas
- although no increased risk with pregnancy, should pregnant staff be frontline?
- Fear of lack/insufficient PPE. What should staff do if that is the case?
- we need to set up ethical support groups to discuss these cases
- Need leadership

13. Useful websites/resources relating to #Covid19

- tinyurl.com/4bodies
Guidance from @ICS_updates @FICMNews @AAGBI @RCoANews

- tinyurl.com/CovidPPE - will have definitive information

14. We need to maximise ventilation surge capacity.
Day 6-12 after symptoms is the worry period. Clinical picture from China is much like a viral pneumonia.

Awaiting guidance regarding:-

-Remdesivir - single organ failure only, no CVS collapse

-Kaletra

15. If we need to use NIV/BIPAP - consider negative pressure side room as this is Aersol generating

16. Stories from Italy and China are real, they are scary, and not like anything we have experienced before.
We need to prepare
We need to work differently
We need to be safe

17. Our supporting, representative and governing bodies have “Got our backs”

We will be working in different ways.

Look after yourselves
Be prepared
Do the best you can.

Thanks @AAGBI

End of thread