COVID Intubation Box Survey |
Date of Code/Intubation? |
What is your clinical role? |
Time of Airway Management event? |
Age of Patient? |
Was the intubation box used for intubation or extubation? |
Minutes from RSI meds to successful intubation? |
Please rate the availability of bringing the intubation box to bedside? |
Please rate ease of use for intubation box? |
Please rate impact of intubation box on safety (GREEN = made safer, YELLOW: no change, RED = more dangerous)? |
Please indicate any other adjunctive protective methods? |
Please indicates devices used for intubation? |
How many intubation attempts? |
Please indicate Mallampati Score? |
Please indicate grade of laryngoscopic view? |
Did patient have criteria for difficult airway (HEAVEN, LEMON, etc.)? |
What was patient BMI? |