COVID-19 a 3-step approach to intubation

During the past week I have had the privilege of working with an esteemed group of peers to draft the manuscript: “Pragmatic Recommendations for Intubating Critically Ill Patients with Suspected COVID-19.”

In the meantime the lead author, Calvin Brown has created an infographic outlining the basic principles. [Also available in PDF format]

Covid 3-step to intubation b
Translation: Cristian Garrido of the Sociedad Chilena de Medicina de Urgencia
Lead authors

Calvin A. Brown III, MD1, Jarrod M. Mosier, MD2,3, J. Adam Law, MD4, Jestin N. Carlson, MD, MS5, Michael A. Gibbs, MD6

  1. Department of Emergency Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
  2. Department of Medicine, Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine. University of Arizona, Tucson, AZ
  3. Department of Emergency Medicine. University of Arizona, Tucson, AZ.
  4. Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia
  5. Department of Emergency Medicine, Allegheny Health Network, Erie, PA
  6. Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC


novel coronavirus of COVID-19

Michael A. Gibbs, MD, FACEP, FAAEM. Professor and Chair, Department of Emergency Medicine at Carolinas Medical Center & Levine Children’s Hospital | EMGuidewire |


  1. Thanks Mike. Is the manuscript available? Any suggestions on limiting exposure during preoxygenation?

  2. Under patient safety I would add using BUHE (Bed Up Head Elevated) to 30 – 45 degrees. If using direct laryngoscopy there is some evidence that it improves glottic visualization. And it might help with the initial oxygenation / ventilation of the bases of the lungs

  3. agree w Iona Vlad. and thank you very much Dr Gibbs, and team.
    as you prob know, Scott Weingart and josh farkas, on EMCrit/pulmcrit have good many brief pods and varied aspects of the CV19 eval and care, all aspects, as does Salim Rezaie on rebelEM, including best way to vent disconnect, avoid bagging, dual venting, more., as well as elsewhere on this site!
    all good work.
    thank you.


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