Claire Cox

During the coronavirus crisis, nurses may be called upon to assist with a tracheostomy. This article was written before the COVID-19 pandemic, therefore please ensure that all staff involved in this procedure are wearing full personal protective equipment (PPE). Why you should read this article: to ensure your knowledge and skills in assisting in emergency tracheal intubation are up to date to promote a team approach to emergency tracheal intubation within your organisation, which ensures risks to patients are minimised, the trachea and lungs are protected from aspiration, and the airway is secured to understand the evidence base that supports the practice of emergency tracheal intubation.

This report, published by the Association of Anaesthetists, gives recommendations based on clinical experiences of managing patients throughout Italy. In particular, the authors 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. 

Difficult conversations are always needed in healthcare and are important in order to offer informed choice of what treatments will be of benefit to the patient and are important to manage the expectations of patients, families and clinicians. But what is currently happening during the coronavirus pandemic in primary care? What should be best practice? Claire, a clinical outreach nurse, explores this in her latest blog. Imagine... You are 80 years old. You live independently and have a full social life with friends of similar ages. You have no close family; your friends are your family. You are very much part of the community and enjoy life. Every winter you get a ‘bad chest’. You visit the GP when this happens and get antibiotics. This is your only health issue. Being locked down hasn’t been an issue for you. Life is different, but the village you live in has a great support network, you can get shopping delivered, you are connected via the internet to your activity groups – even tai chi on zoom! You receive a phone call from your GP. They state "...with your chest, it's unlikely that you will survive this virus. So, I need to ask you... do you want to be placed on a ventilator and do you want to be resuscitated?" They expect an answer while they are on the phone to you. You have less than 5 minutes to respond. "Errrrrr, yes… I have lots to live for, please do everything you can" is your reply. You put the phone down and cry. You are scared. What now? This is a real case that was told to me this morning. ‘Difficult conversations’ are needed. They have always been needed. Whether that be in primary care or secondary care, these conversations are important. It is important to find out what patients and families wishes are, important to offer informed choice of what treatments will be of benefit and important to manage expectations from both, patient, families and clinicians. Much has been written on how to have these conversations, when to have these conversations and by whom – this advice has been written in a non-pandemic time where people have the time, have up to date, clear information that patients and families can discuss the issues. Some GPs are using the RESPeCT document, its been slow to adopt and spread, but if completed makes the world of difference. Having an open conversation about dying may feel taboo, but you only get to die once (usually)… you may as well do it well. Where I work clinically, all patients who are suspected COVID-19, have a treatment escalation form completed as they are admitted. This informs other clinicians what treatment that patient can receive during their admission. If a patient doesn’t have a treatment escalation discussion, patients may experience unnecessary pain, suffering or futile treatment that they didn’t want, but were unable to say. The treatment escalation form and process we are using has transformed and streamlined our care. We are now able to give the right care to the right patient at the right time. Patients and families are fully informed and are grateful for having the conversation. But what happens during the pandemic in primary care? GPs are unable to wait for their patients to turn up to the surgery to have these conversations. Many of their patients are the most vulnerable, in care homes, the homeless and often difficult to reach. Is a telephone call, out of the blue the best way of having this conversation? GPs have hundred, if not thousands of patients on their case load, how are they to have meaningful conversations during this pandemic with the most vulnerable? This blog is not to highlight the bad practice. It is not a time for naming and shaming. We are learning together. Are you doing things differently? Do you have a solution? Are you a patient and have an idea on how we can do this better?

The ICU & Critical Care Nursing Revision is part of the Intensive Nurse blog. It has been designed and structured to assist revision and learning for anyone who is: new to intensive care units (ICU) and critical care participating in an ICU/critical care nursing program or returning due to COVID-19. This blog is part of the Free Open Access Nursing Education (#FOANed) movement which is a global collaboration utilising technology, social media and the agility to discuss relevant healthcare topics in real time. 

This teaching presentation, by Kings Hospital clinical fellows, is based on ‘Kings clinical summary guidelines’ when caring for a patient with diagnosed COVID 19 This presentation includes: Disease progression Diagnosis Bloods Imaging Radiology Guidelines Investigations Treatment Organ Support Prognosis Treatment escalation planning Palliative care PPE Resuscitation Intrahospital transfer.

This pneumonic is for quick diagnosis / risk assess for coronavirus developed by doctors in Italy.

People with a learning disability have higher rates of morbidity and mortality than the general population and die prematurely. At least 41% of them die from respiratory conditions. They have a higher prevalence of asthma and diabetes, and of being obese or underweight in people. All these factors make them more vulnerable to coronavirus. There is evidence that people with autism also have higher rates of health problems throughout childhood, adolescence, and adulthood, and that this may result in elevated risk of early mortality. This guide, from NHS England, states the following key points should be addressed when assessing and treating a patient with a learning disability or with autism who is suspected of having or is known to have coronavirus: Be aware of diagnostic overshadowing Pay attention to healthcare passports Listen to parents/carers Make reasonable adjustments Understanding behavioural responses to illness/pain/discomfort Mental Capacity Act Ask for specialist support and advice if necessary Mental wellbeing and emotional distress. Please download the full guide for further detail.

This article was published by Medigram, for chief medical officers and chief operating officers of hospitals and health systems to review with their infectious disease teams and chief executive officers. It looks at key lessons and strategies for preventing COVID-19 transmission within hospitals, including Personal Protective Equipment (PPE) standards, workflows, infrastructure. and workforce management. The content is based on the response to COVID-19 on South Korea. 

The emergence in December 2019 of COVID-19, caused by a novel coronavirus, and its subsequent spread around the world, led the World Health Organisation to declare a pandemic on March 11, 2020: the first to be caused by a coronavirus . The virus appears to have originated in bats, with spread to humans likely mediated by an intermediate mammalian. This paper by Dr Nicole Le Saux, discusses the current epidemiology for COVID 19 in children.

This free course from the World Health Organization includes content on clinical management of patients with a severe acute respiratory infection. It is intended for clinicians who are working in intensive care units (ICUs) in low and middle-income countries and managing adult and paediatric patients with severe forms of acute respiratory infection (SARI), including severe pneumonia, acute respiratory distress syndrome (ARDS), sepsis and septic shock. It is a hands-on practical guide to be used by healthcare professionals involved in clinical care management during outbreaks of influenza virus (seasonal) human infection due avian influenza virus (H5N1, H7N9), MERS-CoV, COVID-19 or other emerging respiratory viral epidemics. Learning objectives: By the end of this course, participants should possess some of the necessary tools that can be used to care for the critically ill patient from hospital entry to hospital discharge. Course duration: Approximately 10 hours. Target audience: This course is intended for clinicians who are working in intensive care units (ICUs) in low and middle-income countries.

A trainee ophthalmologist shares his experience with BMJ Opinion of being redeployed to the frontline of COVID-19 preparation and hopes that it will allay fears.

Meditation has been shown to help people stress less, focus more and sleep better. Headspace is meditation made simple, teaching you life-changing mindfulness skills in just a few minutes a day. Get Headspace for free, sponsored by Headspace for NHS Clinical: 1000+ hours of mindfulness and sleep content. Mini exercises for busy schedules.

The international Society for Rapid Response Systems (iSRRS) is the peak international body related to Rapid Response Teams (RRTs) and Critical Care Outreach (CCO) services around the work. The aim of the iSRRS is to improve the prevention of, and response to acute deterioration in hospitalised patients. This guidance includes; What are RRTs and CCO services? What is COVID-19? Why is COVID-19 important to the RRT and CCO service? Overarching principles Safety of the RRT responders Identification of suspected / confirmed cases Use of NIV, CPAP and high flow nasal oxygen Method of activation of the RRT Coordinating a response to a patient with suspected / confirmed COVID-19 Use of non-ICU staff as members of the responding team Training of staff.

Speciality guides for patient management during the coronavirus pandemic. These guides include: Surgical patients Othopaedics Critical care Endocrinology Trauma Acute General medical Burns Cancer ED Paediatrics NIV Rheumatology Management of COVID positive patients Cardiothoracics plastics Max Fax Vascular Spinal Surgery Radiology Cardiology Muscular Skeletal Haematology Maternity TB.

Guys and St Thomas' Hospital NHS Foundation Trust and the National Institute for Health research (NIHR) have developed an app. This app can be accessed by everyone. It will map out symptoms you may have (coronavirus symptoms) even if you feel well. This is part of ongoing research in how this virus is spreading and to understand symptoms. Take 1-minute to self-report daily, even if you are well. Help scientists identify: high-risk areas in the UK who is most at risk, by better understanding symptoms linked to underlying health conditions how fast the virus is spreading in your area.

A careful planning for a pandemic, like COVID-19, is critical to protecting the health and welfare of entire humanity. Hospitals play a very critical role within the health system in providing essential medical care to the community, particularly during the crisis. But hospitals are complicated and vulnerable institutions, dependent on crucial external support and supply lines. During the current outbreak, an interruption of these critical support services and supplies would potentially disrupt the provision of acute health care by an unprepared health-care facility. Any shortage of critical equipment and supplies could limit access to the needed care and have a direct impact on healthcare delivery and panic could potentially jeopardise established working routines. In such scenario, even a modest rise in admission volume can overwhelm a hospital beyond its functional reserve. Even for a well-prepared hospital, coping with the health consequences of a COVID-19 outbreak would be a complex challenge for sure.   WHO hospital readiness checklist shows the key actions to take in the context of a continuous hospital emergency preparedness process. This document is also attached for download.

This document should be used to guide clinicians on the appropriate use of continuous positive airway pressure (CPAP), non-invasive ventilation (NIV), here referring to bilevel positive airway pressure (BiPAP) and high flow nasal oxygen (HFNO, such as OptiflowTM) in patients with confirmed or suspected COVID-19. Published evidence, clinical guidelines and personal communications with colleagues in China and Italy have informed this document. The guidance is not designed to be prescriptive but to provide a useful aid to use alongside clinical judgement. It can be adjusted to suit individual clinical environments. Decisions relating to the escalation of ventilatory support (whether as a trial of treatment, as a ceiling of care, or as a possible bridge to ongoing invasive ventilation) need to be made early and by experienced clinical decision-makers. 

The COVID-19 pandemic has led to a widespread response across the NHS in terms of how staff and the departments and organisations in which they work can help to manage the challenges being faced now and in the coming weeks and months. This includes the need to learn new skills and procedures at short notice, to rehearse the management of complex and potentially hazardous clinical cases in unfamiliar environments, and to be assured that any systems, policies and protocols that are put into action are designed to promote safe, effective care and support staff well-being. There is an important role for simulation as a technique or intervention in this set of unique circumstances, which will be implemented more effectively if integrated and aligned with the many other initiatives aimed at supporting staff and the NHS as a whole. This guidance document seeks to provide a framework to help your local simulation-based endeavours achieve the most benefit for the needs in your organisation and department. Further resources and examples of practice to support each domain of the framework are currently being collated for sharing nationally in the immediate future. Working in collaboration, The Faculty of Intensive Care Medicine, Intensive Care Society, Association of Anaesthetists and Royal College of Anaesthetists have developed this website to provide the UK intensive care and anaesthetic community with information, guidance and resources required to support their understanding of and management of COVID-19. Intensive care practitioners and anaesthetists are integral to the safe and effective care of patients diagnosed with COVID-19, and play a role in informing and reassuring the public about this viral outbreak.