Thoughts and tips from a weekend on-call looking after COVID-19 patients:

1. PPE is hot (not like that perverts). Make sure you stay well hydrated in between on breaks, also empty your bladder before you get into AGP PPE if you're staying in it a while

2. Removing PPE is a pain, and dangerous as any droplets can land on you and cause infection. Have a buddy watch you do it. To make things easier, think through when donning the order you'll have to take it off to make sure straps don't get all tangled etc.

3. CPAP seems to be a very useful tool, both as a ceiling of care treatment, and to defer/prevent intubation. Over the weekend our threshold of putting patients on CPAP fell, most seemed to tolerate this.

4. Further to the above, make sure your unit / hospital has sufficient CPAP machines but also circuits and bits for it. Some CPAP/NIV machines can be used as ventilators and might be part of your ITU surge plan so bear that in mind.

5. Fluid requirement was low in many of these patients, and as with most ARDS it would be wise to adopt a conservative fluid regimen. I generally only gave IV fluids if shocked or oliguric/anuric

6. VTE has been reported to be a significant problem in ITU, in patients who had CTs there was significant "incidental" PE burden. In medicine we've ensured patients have appropriate VTE prophylaxis given. @mvizcayc might enlighten more.

7. Most patients admitted were given IV antibiotics for suspected suprainfection as per local anti-infective policy, hard to differentiate between bacterial and viral or both.

As crisis goes on this might need to be reviewed to ensure antibiotic stewardship. @dr_luke_moore

8. Team huddles / meetings, whilst good for morale and ensuring comprehensive handover, needs to be concise and maintain social distancing. Otherwise you risk them turning into mini-SARS2-CoV-incubators.

9. Patients will come in with other non-COVID things too. One had a panic attack and hypocapnic hyperventilation (discharged with reassurance), another had a PE (admitted and treated).

It's important not to miss the usual things causing breathlessness and fevers.

10 a. Emotionally the post-take round can be quite draining, having a lot of discussions about resuscitation and ceilings of care, often in the heat of acute illness, with no family for patients to fall back on, can be tough on both patients and team.

10 b. Important to make sure that your team has sufficient breaks, spot signs of both physical and emotional strain and allow them the timeout they need, debrief as needed.

Human factors are as important as PPE to allow us to be effective.

(Cannot believe I just wrote that, I sound like hat guy)

11. WASH YOUR HANDS or use hand gel, it's important normally but now more than ever. Our estates team have been running off their feet keeping soap and alcohol gel dispensers topped up, thank you.

Will share more insights as they come.