A&A practice
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Case Reports
Delayed Diagnosis of Postintubation Tracheal Stenosis due to the Coronavirus Disease 2019 Pandemic: A Case Report.
Tracheal stenosis is an uncommon but severe problem after long-term intubation. Here, we report a patient who came from a containment zone of coronavirus disease 2019 (COVID-19) and presented with complaints of breathlessness and cough. She was suspected to have an infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Later, she developed type 2 respiratory failure and carbon dioxide narcosis because of delay in diagnosis of severe, near-complete postintubation tracheal stenosis due to over suspicion of COVID-19 during the current pandemic.
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Comparative Study
Comparison of the Effectiveness of Different Barrier Enclosure Techniques in Protection of Healthcare Workers During Tracheal Intubation and Extubation.
The coronavirus disease 2019 (COVID-19; SARS-CoV-2) pandemic has created serious challenges to anesthesiologists. As hospitalized patients' respiratory function deteriorates, many will require endotracheal intubation. ⋯ The addition of an enclosure barrier during airway management minimizes the hazard by entrapping the droplets and possibly the aerosols within an enclosed space adding additional protection for health care workers. The aim of this study was to compare the effectiveness of different barrier enclosure techniques during tracheal intubation and extubation.
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A 46-year-old man presented with severe refractory posterior shoulder pain due to a left scapular fracture sustained during a motor vehicle collision. Despite multimodal oral and intravenous analgesics, the patient's pain remained difficult to control. A continuous paravertebral nerve block was performed between the second and third thoracic vertebrae resulting in excellent analgesia of the scapular pain. This case suggests that a continuous thoracic paravertebral block placed between the second and third vertebrae may be considered as part of multimodal analgesia in patients with scapular fractures.
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Approximately 30% of health care workers (HCWs) fail the respirator fit test. Evidence suggests that addressing face leaks in the 3M respirator enhances its fit and improves its efficacy. ⋯ Sixty-eight percent of HCWs who failed the fit test with their first-choice respirator passed with a modified adhesive respirator. To increase the efficacy and safety of 3M respirators, ineffective face seals need substantial improvement in design.
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Some patients infected with the Coronavirus Disease 2019 (COVID-19) require endotracheal intubation, an aerosol-generating procedure that is believed to result in viral transmission to personnel performing the procedure. Additionally, donning and doffing personal protective equipment can be time consuming. ⋯ We describe the Emory Healthcare intubation team approach during the COVID-19 pandemic. This structure resulted in only 1 team member testing positive for COVID-19 despite 253 patient intubations over a 6-week period with 153 anesthesia providers on service.