American journal of otolaryngology
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The novel coronavirus (SARS-CoV-2 or COVID-19) pandemic has impacted nearly every aspect of otolaryngologic practice. The transition from office-based evaluation to telemedicine and the number of postponed elective surgical cases is unprecedented. ⋯ As practices begin to move towards resuming elective and same day ambulatory surgery, safety of both the patient and healthcare team is of paramount importance. Usage of total intravenous anesthesia (propofol and remifentanil) over volatile gas anesthesia (e.g., sevoflurane) may increase the number of patients able to safely receive care by reducing potential spread of the virus through reduction in coughing and significantly decreasing the time spent in the recovery room.
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The coronavirus SARS-CoV-2 (COVID19) pandemic has pushed health workers to find creative solutions to a global shortage of personal protection equipment (PPE). 3D-printing technology is having an essential role during the pandemic providing solutions for this problem, for instance, modifying full-face snorkel masks or creating low-cost face shields to use as PPE (Ishack and Lipner, 2020 [1]). Otolaryngologists are at increased occupational risk to COVID19 infection due to the exposure to respiratory droplets and aerosols, especially during the routine nose and mouth examinations where coughing and sneezing happen regularly (Rna et al., 2017 [2]; Tysome and Bhutta, 2020 [3]). The use of a headlight is essential during these examinations. ⋯ The face shield with the headlight has been found very useful for treating epistaxis, changing tracheostomy cannulas and during routine nasal and oral examinations. The headlight face shield adapter was designed to solve a specific problem among the ENT community; however other specialist can find it useful as well. Nonetheless, manufacturers should take care of specifics problems like this and provide commercially available products to protect the ENT workforce in this new era.
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To determine if rapid implementation of simulation training for anticipated COVID-19 tracheostomy procedures can increase physician confidence regarding procedure competency and use of enhanced personal protective equipment (PPE). ⋯ Adoption of standardized COVID-19 tracheostomy simulation training at centers treating COVID-19 patients may result in improved physician safety and enhanced confidence in anticipation of performing these procedures in real-life scenarios.
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SARS CoV 2 is very much homologous in structure to SARS CoV. Review of literature suggests the in-vitro virucidal action of povidone iodine in SARS CoV and MERS. The oropharynx and nasopharynx are target sites of SARS CoV 2. A significant proportion of COVID 19 sufferers are asymptomatic, but shedding these viral particles, PVP-I has been shown to be a safe therapy when used as a mouthwash or taken nasally or used during ophthalmic surgeries.
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COVID-19 has become a pandemic with significant consequences worldwide. About 3.2% of patients with COVID-19 will require intubation and invasive ventilation. Moreover, there will be an increase in the number of critically ill patients, hospitalized and intubated due to unrelated acute pathology, who will present underlying asymptomatic or mild forms of COVID-19. Tracheostomy is one of the procedures associated with an increased production of aerosols and higher risk of transmission of the virus to the health personnel. The aim of this paper is to describe indications and recommended technique of tracheostomy in COVID-19 patients, emphasizing the safety of the patient but also the medical team involved. ⋯ A safe approach to performing percutaneous dilational bedside tracheostomy with bronchoscopic guidance is feasible in COVID-19 patients of appropriate security measures are taken and a strict protocol is followed. Instruction of all the health care personnel involves is key to ensure their safety and the patient's favorable recovery.