Numbers at Mount Sinai

Numbers in New York City

Protocols

UW Medicine

COVID-19 Protocols
UW ID Treatment Guidlines - March 19, 2020 - 11 pages
UW Guide for EDs and ICUs
UW Testing Criteria

Evergreen (Seattle)

Lessons Learned (Mar 26, 2020)

Brigham and Women's

CovidProtocols.org
7 Chapters, basic science heavy
BWH ICU Care PDF

Yale

Treatment Algorithm - 13-page PDF, flowcharts and tables

Zhejian Uni

Handbook of COVID-19 Prevention and Treatment - Assembled by First Affliated Hospital, Zhejian University School of Medicine based on their treatment 104 confirmed cases
PDF Download - 68-pages, 28 MB

Handbooks

Coronavirus Tech Handbook
Probably the most comprehensive Google Doc with links, clinical info, and protocols
Frontline Covid Guide
Good consolidation of resources with well-annotated sources
CovidReference.com
110-page PDF, also includes Top 10 papers daily

SCCM

Critical Care for the Non-ICU Clinician
8 learning modules on critical care (e.g. airway and mechanical ventilation) plus 5 additional modules on disaster preparedness

Sinai-Specific Resources

General Surgery Training Program Changes, in effect March 23, 2020

COVID Unit Coverage (March)

Mount Sinai Health System Pre-Surgical COVID-19 Testing. March 25, 2020.

NYC DOH Advisory (Mar 20, 2020) - Controversial advisory to stop testing non-hospitalized and asymptomatic HCWs despite exposure

Mount Sinai Staff Resource Website

Sinai Together - med and grad student volunteers who may be able to help with childcare, pet care, errands, and more.

ACS

American College recommendations to cancel elective surgeries
ACS Resources Page

SAGES

SAGES recommendations on cancelling elective surgeries
SAGES Updates Page

SSO

Society of Surgical Oncology recommendations for how to manage malignancies during COVID-19 pandemic
SSO Resources Page

NHS

British clinical guide for COVID-19 patients

Podcasts:

Behind The Knife:

COVID-19 Essentials for Surgeons

COVID19 Special - Ventilator Management Refresher for Surgeons

 

What if I need to take a suspected, high-risk or COVID-19 positive patient to the OR?

See the paper published from the Department of Anesthesia at the National University of Singapore. Ti et al. What we do when a COVID-19 patient needs an operation: operating room preparation and guidance. Can J Anesth. 2020.

PPE:

  • Almost universally the use of N95 masks is recommended when operating, including patients, this includes on COVID19 high risk, but not confirmed patients (in some instances use of N95 mask is recommended in all instances)

  • N95 and more aggressive PPE* is recommended for any patients under going an aerosolized procedure. It remains unclear if laparoscopic surgery is included.
    (*PAPR are recommended by UMichigan when indicated and Wuhan document recommends Level III (highest level of protection) for all surgical interventions)

  • SAGES currently recommends against laparoscopic surgery if clinically indicated

    *** Note: in general, there is not much information / hard data regarding if laparoscopic surgery causing viral dissemination, but many speculate it is given it is an aerosolized procedure

OR Workflow/Locations:

  • Negative pressure operating rooms should be used

  • No one should leave the room or come in during the case (this includes breaks for nursing and anesthesia staff), required equipment should be delivered by an outsider runner to the room

  • Disinfection protocols for these operating rooms are significantly more stringent than for normal OR cases (some recommend up to 1 hours of cleaning of all surfaces in the room)