Notes from the Front Lines: w/ 2nd wave bearing down on us, important to review what we know

Oxygen
- HFNC + CPAP can avoid intubation
- If patient altered, CPAP unlikely to be enough
- CPAP resources will be strained so know how to make your own https://bit.ly/3bF17hN 

Notes from the Front Lines: Awake proning https://bit.ly/2VJEwf3 
- Incr alveoli available for gas exchange
- Improve O2 delivery to perfused areas
- Institute a protocol
- Mattresses can help http://prone2help.org  @prone2help

Notes from the Front Lines:
HD instability post-RSI common
- Have norepi gtt ready or push dose epi in hand
- Bring CVL + A-line kit into room at start
- Femoral CVL + A-line may be preferred as PTX very poorly tolerated

Notes from the Front Lines: Dexamethasone https://bit.ly/3dKSIMh 
- 6 mg Q24
- Overall 28d mortality NNT = 33
- Mech Vent 28d mortality NNT = 8.5

If pt requires O2, GIVE DEX

Notes from the Front Lines: AC
- Incr risk stroke, PE, DVT etc. "COVID and a clot"
- Best practices unclear
- Good VTE prophylaxis in all admitted pts
- Consider risk/benefit of full dose AC for critically ill (one algorithm below)

Notes from the Front Lines: Drug Shortages
- Running low/out of typical sedation/analgesia meds common
- Important intubated pts sedated: encourage synchrony w/ vent + avoid extubation

Thanks @painfreeED @emupdates @DrAlexisLa @PharmERToxGuy @srrezaie for review

Notes from the Front Lines: PPE
- Likely we'll see shortages again
- N95 reuse a necessity
- Vaporized H2O2 + UV light best methods
- Time approach (1 day on, 3 days off) pragmatic solution https://bit.ly/3bwnC94 

Notes from the Front Lines: Mental Health
- Unique mental health challenges for HCWs
- Take time to care for yourself

EMRAP w/ @BernardChangMD https://bit.ly/2Fy7gSr  + https://bit.ly/3dwaYJa 

Notes from the Front Lines: #FOAMed Resources
CorePendium: https://covid.emrap.org/ 
REBEL EM: https://rebelem.com/rebel-covid19/ 
EMCrit: https://emcrit.org/ibcc/covid19/ 
FOAMCast: https://foamcast.org/2020/05/15/covid-19-literature-update/