It’s a delicate procedure that takes skill and a steady hand. Intubation is often necessary when a patient is struggling to breathe. And during the pandemic, it’s all hands on deck.
At a simulation lab at Cook County Health emergency medicine physician Dr. Michelle Sergel has been running drills for hundreds of frontline workers.
A COVID-19 patient’s blood-oxygen level can plummets can in a matter of minutes.
“Their mental status may change. They look visibly air hungry,” Sergel said. “They could start breathing quicker, faster … getting sweaty, explaining they have pain in multiple places.”
The care team must make quick decisions.
The airway is stretched open and a plastic tube is inserted. Then air is manually pumped through the tube.
“Some of the other nuances we have to blend in are the nuances associated with COVID,” Sergel said. “(Like) making sure we’re decreasing the aerosolization, making sure we can do it with all of this equipment on. It’s very hot and hard to breathe. It’s hard to hear each other … feel like we’re yelling at each other.”
When the mechanical ventilator arrives, it’s a split second transition.
Medical workers who don’t typically perform intubations, but may be called to do so during the pandemic, also learn at the simulation lab.
“We need reinforcements because if the frontline gets ill or needs to rest, there needs to be more people that are ready to jump in,” Sergel said.
Cook County Health hospitalist Dr Thomas Sweder is one of the trainees. He takes care of a range of COVID-19 patients but for now relies on a critical care team if a patient needs intubation.
“I learned intubation when I was in med school and the last time I intubated was over 15 years ago,” he said. “One thing that is very clear that I’ve seen is how fast these patients can change sometimes. I’ve seen the pattern that for a couple days a patient needs a little more oxygen, a little more two, three, four liters over the course of a day or two. Then very quickly, over hours, suddenly is in complete respiratory failure and needs to go to the ICU.”
“Not every doctor knows how to intubate,” Sergel said. “Not every doctor knows these emergency procedures or critical care management. So to get those groups ready to jump in and help the frontline – it was very important to train those people.”
The scenarios in the simulation lab vary from simple to more complicated and often perplexing cases. That’s why the drills are critical as healthcare providers are learning on the fly when it comes to COVID-19.
“It’s creating the perfect storm. It’s truly preparing the clinician to land the plane in the proverbial Hudson,” Sergel said. “So it’s really making sure that, God forbid, when you’re faced with that nightmare you’ve got some muscle memory and some recollection of practicing this with your medical team. It’s priceless.”