COVID-19: Clinical Resources

Multisystem Inflammatory Syndrome in Children

Published October 15, 2020; originally published May 15, 2020
A multisystem inflammatory syndrome may cause critical illness in children and young adults up to 2-4 weeks following a SARS-CoV-2 infection. Learn about the clinical presentation, diagnostic criteria, and commonly used treatments.

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Shock in Critically Ill Patients

Published August 24, 2020
Shock is common in critically ill patients. Learn about the different types of shock, the associated clinical findings and physiology, and treatments for each type.

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COVID-19 Neurocritical Care

Published August 10, 2020
COVID-19 may lead to a wide spectrum of neurological complications. Learn about the associated clinical findings, phases, diagnostic considerations, and outcomes.

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"Cytokine Storm" and COVID-19

Published August 5, 2020
CHEST offers information on the the potential role of cytokine storm in the pathogenesis and severity of COVID-19 disease.

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Personnel During Code Blue in the COVID-19 Pandemic

Published August 5, 2020
The COVID-19 pandemic poses unique issues for resuscitation in the event of a code blue. Specifically, it is important to manage the code blue with an eye to the safety of care providers. CHEST proposes an algorithm for managing resuscitation work and personnel flow to simultaneously provide optimum support for patients and optimum protection for caregivers. This workflow was proposed by Michael Waxman, MD, of Kansas City, MO, in accordance with American Heart Association guidelines.

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Management of Patients with COVID-19 Infection

Updated July 28, 2020; originally published March 11, 2020
In this brief article, Ryan C. Maves, MD, FCCP, and Vikram Mukherjee, MD, describe known factors related to the transmission of COVID-19, its epidemiologic and clinical factors, and guidance on patient management and the protection of health-care workers.

COVID-19: ICU for the Non-Intensivist

Published May 6, 2020
CHEST offers critical care procedures for non-intensivists being tasked to take care of ICU patients during the COVID-19 pandemic.

What is Acute Respiratory Distress Syndrome (ARDS)?

Published May 1, 2020
CHEST offers a clinical overview of Acute Respiratory Distress Syndrome (ARDS) including diagnostic criteria.

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COVID-19 Clinical Summary

Published April 3, 2020
Access this evidence-based overview of current patient management strategies and factors.

Communication in Crisis

Published October 16, 2020
During the COVID-19 pandemic, clear communication between members of the health-care team is crucial. Follow these tips for how to effectively communicate in times of crisis.

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Updated Recommendations for COVID-19 PPE

Updated October 13, 2020; originally published March 30, 2020
This handy infographic displays updated PPE recommendations for usage with patients who test positive or are suspected positive for COVID-19.

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How Simulation Can Effectively Prepare Staff for Optimal Patient Care and Minimal Viral Spread During COVID-19

Published August 26, 2020
Simulation exercises can provide a reliable way to optimize patient care and minimize viral exposure, while accommodating the needs of learners and clinicians. Sanjana Mathur, MD, explains how some institutions have utilized simulation during the COVID-19 pandemic.

Indicators and Triggers for Potential Movement to Crisis Care

Updated July 17, 2020; originally published March 19, 2020
John L. Hick, MD; and Dan Hanfling, MD provide a refresher on transition to crisis care standards of care, often necessitated in pandemics, and offers strategies to employ in particular situations.

Surge Priority Planning COVID-19: Critical Care Staffing and Nursing Considerations

Published March 19, 2020
This article by Anne Marie Martland, MS, ACNP-BC, Meredith Huffines, MS, BA, RN, and Kiersten Henry, DNP, ACNP-BC, addresses nursing leadership and administrative considerations, strategies for optimizing staffing resources, and maintaining staff safety and resilience.

Bronchoscopy in the Era of COVID-19

Published October 20, 2020
CHEST's Bronchoscopy Domain Task Force has created an infographic with key information on how to provide timely care while minimizing exposures during bronchoscopy in the era of COVID-19. Get information on indications, recommendations for testing, and tips for performing bronchoscopy in suspected or COVID-19-positive patients as well as COVID-19-negative patients.

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The Intensivists’ Dilemma: Extra-Step or No-Step for Extracorporeal Support in Patients With COVID-19

Published September 1, 2020
COVID-19 has magnified ethical and clinical dilemmas in the ICU. Determining whether it is appropriate to cannulate a patient and start extracorporeal membrane oxygenation (ECMO) needs to be carefully weighed against the availability of resources, team support, and the patient’s goals of care.

Pleural Drainage During COVID-19

Published June 18, 2020
Learn how to create a closed pleural drainage system using stocked items with these step-by-step instructions from Swedish Medical Center in Seattle, WA.

Focused Lung and Cardiac Ultrasound Exams in COVID-19 Patients

Published May 5, 2020
A daily lung and cardiac ultrasound exam is performed on COVID-19 patients. Four lung zones that roughly correspond with the upper, middle (or lingula), and lower lobes are examined on the anterior, lateral, and posterior chest walls, respectively. The lung findings are coded with the highest number in each zone as normal (0), discrete B-lines (1), fused B-lines (2), subpleural consolidations (3), or lobar consolidation (4). At least one cardiac view, usually the parasternal long-axis view, is obtained daily to assess left ventricular systolic function. Any suspected abnormal findings warrant obtaining additional cardiac views for further investigation. The summary of findings sheet (page 2) can be laminated, placed in the patient’s room, and updated daily. The daily exam tracking sheet (page 3) is for clinicians to keep track of their patients’ findings while rounding.

Ultrasound Cleaning Protocol

Published May 4, 2020
View general procedures for the cleaning and disinfection of ultrasound equipment.

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Airway Management

Published April 9, 2020
All three documents provide consensus expert opinion from the CHEST Difficult Airway Management faculty members for teams conducting emergency airway management (endotracheal intubation) for suspected or confirmed COVID-19 patients. These documents are adapted from the Difficult Airway Management course materials, highlighting considerations in balancing effectiveness and safety of the procedure for patients and the health-care team.

CHEST Emergent Airway Management for Suspected or Confirmed COVID-19 Patients: Provides equipment, personnel, and planning considerations for ICU and airway team leaders who are planning for or engaged in airway management of COVID-19 patients.

CHEST APPROACH to Airway Management- COVID-19 Highlights: Adapts the CHEST APPROACH framework for difficult airway management with key considerations for procedural safety in the COVID-19 setting. Airway teams can use the APPROACH framework to create a shared mental model of the procedure.

CHEST Airway Checklist with APPROACH with COVID-19 Highlights: A companion checklist for the CHEST APPROACH framework for difficult airway management. A team member positioned outside of the room can manage the checklist to support the team's ability to be prepared and maintain situational awareness.

COVID-19 Precautions During Airway Management

Published March 31, 2020
Download this helpful guide for clinicians on COVID-19 precautions during airway management.

Essential Institutional Supply Chain Management in the Setting of COVID-19

Published March 19, 2020
As the COVID-19 pandemic evolves, supply chain disruptions for medical supplies and medications are anticipated. Pritish K. Tosh, MD; and Lisa Burry, PharmD, discuss how health-care facilities can examine and optimize their supply chain management in order to detect and respond to supply chain disruptions.

Currently Available and Emerging Therapies for COVID-19

Updated August 14, 2020; originally published March 30, 2020
Authors Kelly M. Pennington, MD; and Eva M. Carmona, MD, write about therapies and medications currently in use or under trial for the treatment of patients with COVID-19.