HNO
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Experience with an interdisciplinary SOP (standard operating procedure) for tracheostomy (TS) in COVID-19 patients, taking into account the general national and international recommendations, is reported. The operative timing of TS due to prolonged invasive ventilation and frustrating weaning attempts was determined on an interdisciplinary level and involved phases of both high and low disease activity. ⋯ In addition to the standard COVID-19 protective measures for medical staff to avoid nosocomial COVID-19 infection, SOP-supported communication during the TS leads to periprocedural safety for all involved. COVID-19 infections among medical staff in the departments involved are not yet known.
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Since emergence of the new coronavirus in China in December 2019, many countries have been struggling to control skyrocketing numbers of infections, including among healthcare personnel. It has now been clearly demonstrated that SARS-CoV‑2 resides in the upper airways and transmits easily via aerosols and droplets, which significantly increases the risk of infection when performing upper airway procedures. Ventilated COVID-19 patients in a critical condition in the intensive care unit may require tracheotomy for long-term ventilation and to improve weaning. However, the risk of secondary infection of medical personnel performing subsequent tracheostomy care remains unclear. ⋯ Our data, together with the current literature, clearly emphasize that tracheostomy care is associated with a high infection risk and should only be performed by a small group of well-trained, maximally protected healthcare personnel.
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Although vestibular symptoms are amongst the most frequent reasons for seeking emergency medical help, many patients remain undiagnosed. ⋯ BPPV is the most frequent diagnosis seen in the ED; however, physicians need to document nystagmus more precisely and perform diagnostic tests systematically, in order to make an accurate diagnosis. To avoid misdiagnoses, ED physicians and ENT specialists should be able to recognize central signs in patients with an acute vestibular syndrome. Every fourth patient does not receive a definitive diagnosis. Diagnostic ED workup for patients with dizziness needs further improvement.
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Dizziness and vertigo are some of the most common reasons for seeking medical help. Acute dizziness and vertigo require interdisciplinary cooperation. New diagnostic methods (the video head impulse test) and modern algorithms (HINTS: head impulse test/nystagmus [direction changing]/test-of-skew) are increasingly used in case of the acute vestibular syndrome in emergency care. ⋯ In acute vertigo syndromes, the ENT physician has a special role and responsibility in the interdisciplinary workup, since ontological disorders are the most common cause. In any case, an ENT consultation is recommended. In German emergency departments, otorhinolaryngologists use modern diagnostic tools and algorithms such as the video head pulse test and HINTS to objectify peripheral vestibulopathy or identify central causes. Thus, this is a contribution to improving medical care.