TY - JOUR T1 - Swivel-HEPA-ETT (SHE) bougie and HEPA-ETT (HE) methods for safe intubation while managing patients with COVID-19 JF - Emergency Medicine Journal JO - Emerg Med J SP - 256 LP - 257 DO - 10.1136/emermed-2020-209625 VL - 37 IS - 5 AU - Li-Wei Lin AU - Tzu-Yao Hung Y1 - 2020/05/01 UR - http://emj.bmj.com/content/37/5/256.abstract N2 - Dear Editor,At the end of December 2019, a novel strain of coronavirus, SARS-CoV-2, was discovered in Wuhan, China. This virus causes the Coronavirus disease COVID-19 that has spread to multiple countries across the world.1 2 The most severely ill patients have required intubation and ventilation, which will likely be performed by emergency physicians and anaesthesiologists. To reduce the risk of aerosol transmission during the intubation, usage of personal protective equipment (PPE, preferably PAPRs (Powered Air-Purifying Respirators)) and video laryngoscopy (VL) are recommended, along with sedation and paralysis of the patient.1–3 Current intubation recommendations for patients with COVID-19 focus on high-efficiency particulate air (HEPA) filter usage connected between the bag valve and the patient mask during preoxygenation. After intubation, the HEPA filter is then disconnected from the bag valve mask and reconnected to the endotracheal tube (ETT).4 5 However, we suggest using a closed system with the HEPA filter already attached to the ETT via either the HEPA-ETT (‘HE’) or ‘Swivel-HEPA-ETT (SHE)-bougie’ methods. The ETT combination with HEPA filter in advance can potentially reduce aerosolisation of the viral droplets from the larynx and trachea during intubation, and the ventilator can then be connected directly to the HEPA filter after intubation. These two methods can also allow for confirmation of ETT placement without auscultation, … ER -