{"id":1680,"date":"2020-04-14T16:20:23","date_gmt":"2020-04-14T16:20:23","guid":{"rendered":"http:\/\/hfhpulm.com\/info\/?p=1680"},"modified":"2020-07-14T18:09:48","modified_gmt":"2020-07-14T18:09:48","slug":"micu-coronavirus-covid-19-information-2020-03-13","status":"publish","type":"post","link":"https:\/\/hfhpulm.com\/info\/?p=1680","title":{"rendered":"MICU Coronavirus (COVID-19) Information"},"content":{"rendered":"<p><span style=\"text-decoration: underline;\"><strong>HENRY FORD COVID-19 UPDATES<br \/>\n<\/strong><\/span><\/p>\n<p><a href=\"https:\/\/onehenry.hfhs.org\/departments\/infectionpreventionandcontrol\/Pages\/Covid-19.aspx?utm_campaign=covid-19&amp;utm_source=covid-19-update&amp;utm_medium=email&amp;utm_content=&amp;utm_term=covid-home\"><strong><em>Henry Ford Health System COVID-19 Information<\/em><\/strong><\/a><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"text-decoration: underline;\"><strong>IMPORTANT DOCUMENTS<br \/>\n<\/strong><\/span><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/04\/HFH-ICU-COVID-19-Updates-June-12-2020.pdf\" target=\"_blank\">HFH ICU COVID-19 Updates June 12 2020<\/a><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/Oxygen-type-and-mask-choice-COVID_Final.pdf\" target=\"_blank\">Oxygen type and mask choice (COVID)_Final<\/a><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/COVID-ICU-Meeting-Minutes.pdf\" target=\"_blank\">COVID ICU Meeting Minutes<\/a><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/COVID19-Response-Team-Resource-Sheet.pdf\" target=\"_blank\">COVID19 Response Team\/Provider Team Resource Sheet<\/a><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/Employee-Health-COVID-19-HCW-Policy-Workflow-V4.pdf\" target=\"_blank\">Employee Health COVID-19 Health Care Worker Policy Workflow<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"text-decoration: underline;\"><strong>RESEARCH<\/strong><\/span><\/p>\n<p>As of 04\/20\/2020, HFH will begin enrolling in both the PREFACE and ACADEMiCC trials.<br \/>\nThe attached documents outline\u00a0inclusion and exclusion criteria.<br \/>\nPlease contact the study research coordinators or Sara Hegab with any potential candidates.<\/p>\n<p><strong>Jackie Day<\/strong> 16-1254. After hours 734-673-5961<br \/>\n<strong>Sheri Renaud<\/strong> 16-1791. Cell:\u00a0519-984-2360<br \/>\n<strong>Roel Almario<\/strong> 16-3558 Cell:\u00a0586-383-3558<br \/>\n<strong>Sara Hegab <\/strong>313-492-2210<\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/04\/Prevention-of-Respiratory-Failure-Addressing-COVID-PREFACE-trial.pdf\" target=\"_blank\">Prevention of Respiratory Failure Addressing COVID (PREFACE trial)<\/a><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/04\/Anti-Coagulation-for-ARDS-Disruption-Emerging-in-COVID-19-Care-ACADEMiCC-Trial.pdf\" target=\"_blank\">Anti-Coagulation for ARDS Disruption Emerging in COVID-19 Care (ACADEMiCC Trial)<\/a><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/04\/Convalescent-Plasma.pdf\" target=\"_blank\">Convalescent Plasma<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"text-decoration: underline;\"><strong>ICU\/GPU MANAGEMENT DOCUMENTS<\/strong><\/span><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/COVID-Intubation-Airway-Management-Protocol.pdf\" target=\"_blank\">COVID Intubation &amp; Airway Management Protocol<\/a><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/COVID-Management-Guideline-Version-03.27.2020.pdf\" target=\"_blank\">COVID Management Guideline Version 03.27.2020<\/a><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/04\/Remdesivir-protocol.pdf\" target=\"_blank\">Remdesivir protocol<\/a><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/04\/Covid-19-ICU-Patient-End-of-Life-FAQs-Final.pdf\" target=\"_blank\">Covid-19 ICU Patient End of Life FAQs Final<\/a><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/04\/COVID-19-Guidelines-Maintaining-and-Discontinuing-Isolation-Update.pdf\" target=\"_blank\">COVID-19 Guidelines &#8211; Maintaining and Discontinuing Isolation<\/a><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/COVID-team-checklists-and-tips.pdf\" target=\"_blank\">COVID team checklists and tips<\/a><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/COVID-Confirmed-Case-Management-Workflow-3-24-20.pdf\" target=\"_blank\">COVID Confirmed Case Management Workflow 3-24-20<br \/>\n<\/a><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/N95Respirator-Guidelines-for-COVID-patients.pdf\" target=\"&quot;_blank\">N95 Respirator Guidelines for COVID patients<br \/>\n<\/a><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/COVID-19-Oxygen-Requirements-at-Henry-Ford-Hospital-for-patients-and-care-units.pdf\">COVID-19 Oxygen Requirements at Henry Ford Hospital for patients and care units<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"text-decoration: underline;\"><strong>COVID RESOURCE UTILIZATION DOCUMENTS<\/strong><\/span><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/FINAL-VERSION-COVID-HF-Guidelines-V-16.pdf\" target=\"_blank\">HFH COVID Resource Utilization Guidelines<\/a><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/Changing-Code-status-talking-points-4.3_.pdf\" target=\"_blank\">Changing Code status talking points 4.3_<\/a><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/Covid-Withdrawal-of-Mechanical-Ventilation.pdf\" target=\"_blank\">Covid Withdrawal of Mechanical Ventilation<\/a><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/Comfort-Care-Withdrawal-at-End-of-Life-Draft-4.2.2020-COVID-19.pdf\" target=\"_blank\">Comfort Care Withdrawal at End of Life COVID 19<\/a><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/mSOFA-for-Patient-Triage-Inpatient-Providers.pdf\" target=\"_blank\">mSOFA for Patient Triage Inpatient Providers<\/a><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/Correlation-of-MSOFA-Total-Score-and-Hospital-Mortality.pdf\" target=\"_blank\">Correlation of MSOFA Total Score and Hospital Mortality<\/a><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/Downtime-Resp-Distress-Observation-Scale-document.pdf\" target=\"_blank\">Downtime Resp Distress Observation Scale document<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><strong>PERSONAL EQUIPMENT (PPE)<\/strong><br \/>\nPPE recommendations are Droplet Plus (surgical mask, eye protection, gown and gloves); however, N-95 masks should continue be worn for all aerosol-generating procedures including intubation, extubation, open airway suctioning, bronchoscopy, tracheostomy and trach care, chest physiotherapy and nebulizing therapy.\u00a0 Continue to wear N-95 masks for patients on BiPAP or high flow.\u00a0 Patients need to be in a room with a closed door.<\/p>\n<ul>\n<li>There is the introduction of <a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/New-Blue-Gowns-2020-04-09.pdf\" target=\"_blank\">New Blue Isolation Gowns<\/a> on 4\/9\/2020<\/li>\n<li><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/PPE-Guidelines.pdf\" target=\"_blank\">Henry Ford Hospital Guidelines<\/a>\u00a0for the use of PPE<\/li>\n<li>Donning and doffing signage\/instructions is posted in all PUI rooms.\u00a0 PPE video for COVID-19:\u00a0<a href=\"https:\/\/youtu.be\/bG6zISnenPg\">https:\/\/youtu.be\/bG6zISnenPg<\/a><\/li>\n<li>Cardiac arrest guidelines (adapted from IM) for ICU COVID positive patients are listed in a separate post.<\/li>\n<\/ul>\n<p><!--more--><\/p>\n<p><strong>MEDICATION GUIDELINES AND INFO<\/strong><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/Henry-Ford-Hospital-COVID-19-Treatment-Drug-Information-Quick-Sheet-3_31_2020.pdf\" target=\"_blank\">Henry Ford Hospital COVID 19 Treatment Drug Information Quick Sheet 3_31_2020<\/a><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/Rocuronium-Dosing-Table_3.29.2020v2.pdf\" target=\"_blank\">Rocuronium Dosing Table<\/a><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/Hydroxychloroquine-and-Chloroquine.pdf\" target=\"_blank\">Hydroxychloroquine and Chloroquine FAQs<\/a><\/p>\n<p><strong>RESOURCES<\/strong><\/p>\n<p>Renal effects of COVID (this document has undergone peer review)<br \/>\n&#8211;Examples of subjects addressed include ACE-2, histopathology, filter clotting on RRT, initiation of RRT, and home dialysis.<br \/>\n<a href=\"http:\/\/www.nephjc.com\/news\/covidaki\" target=\"_blank\">http:\/\/www.nephjc.com\/news\/covidaki<\/a><\/p>\n<p><a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/Covid-and-RAAS-NEJM-2020-03-30.pdf\" target=\"_blank\">Covid and RAAS (NEJM 2020-03-30)<\/a><\/p>\n<p><strong>LOCATION\u00a0<\/strong><br \/>\nPlease refer to the COVID update document to see where patients are currently being ruled out\/treated<\/p>\n<ul>\n<li>PH patients on vasoactive infusions will continue to be housed in MICU pod 3.<\/li>\n<li>Given positive COVID patients in several units, <strong>lung transplant patients are now being cohorted in MICU pod 5 (6N)<\/strong> to the extent there is private room bed availability.<\/li>\n<li>The State of Michigan has asked all facilities to keep patients where they all and Henry Ford Hospital is only accepting transfers that are true level of care situations for COVID patients.\u00a0 <strong>HFH is not accepting outside patients with COVID for ECMO<\/strong>.\u00a0 <strong>During this time of high patient capacity, we will continue to accept non-COVID outside transfers for level of care <em>if we can add value.\u00a0 <\/em>MICU fellows who receive a request for a transfer in which we likely can offer no value should discuss this with the ICU staff on call and the decision can be made to decline the transfer<\/strong>.<\/li>\n<li>The governor\u2019s mandate limiting hospital visitors remains in effect and no visitors are allowed for ICU patients with the following exceptions:\u00a0 1 visitor is allowed at the bedside of minors in the MICU and 4 visitors are allowed to be at the bedside of a hospice\/comfort care patient or critical\/actively dying patient.\u00a0 All visitors need to be screened for COVID 19.<\/li>\n<\/ul>\n<p><strong>\u00a0<\/strong><br \/>\n<strong>PROCEDURES<\/strong><\/p>\n<p>There is an <span style=\"text-decoration: underline;\">ICU Procedure team<\/span> available to aid with usual ICU procedures.\u00a0 The protocol is <a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/03\/ICU-LINE-TEAM-PROTOCOL-002.pdf\" target=\"_blank\">here<\/a><\/p>\n<p><span style=\"text-decoration: underline;\">Bronchoscopies<\/span>, sputum induction and open suctioning should be avoided until COVID is ruled out.<br \/>\nIf a bronchoscopy is needed for something life threatening, Interventional Pulmonary should be consulted and will discuss the indication with the attending staff.<\/p>\n<p>Per Dr. Simoff,\u00a0 if you find yourself in a position that you must do a bronch and\u00a0IP is not immediately available please follow the following recommendations on anyone on a vent:<\/p>\n<ol>\n<li>\u00a0Paralyze patient first (adjust vent before if needed)<\/li>\n<li>FiO2 to 100%<\/li>\n<li>Place ventilator on standby while still connected to the system. Wait for exhalation to complete.\u00a0 Then and only then disconnect, this will greatly reduce the risk of exposure.<\/li>\n<li>Perform procedure, if needed, reconnect to give several breaths for oxygenation.\u00a0 Then repeat 3.<\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p><span style=\"text-decoration: underline;\">Intubations<\/span> should be done with rapid sequence intubation (RSI) and therefore, COVID positive patients or COVID PUIs requiring intubation should all have intubation performed by anesthesia. \u00a0RSI without bag-mask ventilation is recommended.\u00a0 During the apneic period, a bag-valve-mask with a PEEP valve can be passively held on the patient&#8217;s face to maintain positive pressure.\u00a0 The CDC recommends attaching a viral filter if available to the bag-valve mask before the procedure if available.\u00a0 <strong>Patients being ruled out for COVID or those positive for COVID who require intubation should NOT have routine chest x-rays done post intubation.\u00a0 <\/strong><\/p>\n<p><span style=\"text-decoration: underline;\">Tracheostomy<\/span>: There is a\u00a0<a href=\"http:\/\/hfhpulm.com\/info\/wp-content\/uploads\/2020\/04\/Tier-1-Tracheostomy-Guidelines-During-COVID-19.pdf\" target=\"_blank\">Tier 1- Tracheostomy Guidelines During COVID-19<\/a>\u00a0available<\/p>\n<p>&nbsp;<\/p>\n<p><strong>OTHER IMPORTANT FACTS<\/strong><\/p>\n<ul>\n<li>Limit the number of number of HCP exposure by having the same resident\/APP, fellow and staff in a given unit enter the room together on rounds.\u00a0 Remainder of resident or APP team should not enter the room.\u00a0 Medical students should not take care of these patients and should not enter the room.<\/li>\n<li><em>Healthcare workers who take care of a COVID-19 positive patient need to take and document their temperature twice daily.<\/em><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>HENRY FORD COVID-19 UPDATES Henry Ford Health System COVID-19 Information &nbsp; IMPORTANT DOCUMENTS HFH ICU COVID-19 Updates June 12 2020 Oxygen type and mask choice (COVID)_Final COVID ICU Meeting Minutes COVID19 Response Team\/Provider Team Resource Sheet Employee Health COVID-19 Health Care Worker Policy Workflow &nbsp; RESEARCH As of 04\/20\/2020, HFH will begin enrolling in both [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[123,9],"tags":[],"class_list":["post-1680","post","type-post","status-publish","format-standard","hentry","category-covid","category-micu"],"modified_by":"Michael Lazar","_links":{"self":[{"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/posts\/1680","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1680"}],"version-history":[{"count":98,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/posts\/1680\/revisions"}],"predecessor-version":[{"id":1954,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/posts\/1680\/revisions\/1954"}],"wp:attachment":[{"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1680"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1680"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1680"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}