Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
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Otolaryngol Head Neck Surg · Jul 2020
ReviewA Surgical Safety Checklist for Performing Tracheotomy in Patients with Coronavirus Disease 19.
Performance of tracheotomy is a potential necessary step in the patient with coronavirus disease 19 (COVID-19) and prolonged mechanical ventilation. Due to viral aerosolization, tracheotomy carries a high risk of transmission of COVID-19 to the health care team performing the procedure. We share our institution's surgical safety checklist for performing tracheotomy in patients with COVID-19, including key modifications intended to mitigate risk to the surgical team.
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Otolaryngol Head Neck Surg · Jul 2020
ReviewAirway Management for Endoscopic Laryngotracheal Stenosis Surgery During COVID-19.
The novel coronavirus disease 2019 (COVID-19) pandemic presents unique challenges for surgical management of laryngotracheal stenosis. High viral concentrations in the upper aerodigestive tract, the ability of the virus to be transmitted by asymptomatic carriers and through aerosols, and the need for open airway access during laryngotracheal surgery create a high-risk situation for airway surgeons, anesthesiologists, and operating room personnel. While some surgical cases of laryngotracheal stenosis may be deferred, patients with significant airway obstruction or progressing symptoms often require urgent surgical intervention. We present best practices from our institutional experience for surgical management of laryngotracheal stenosis during this pandemic, including preoperative triage, intraoperative airway management, and personal protective measures.
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Otolaryngol Head Neck Surg · Jul 2020
ReviewAccess to Telemedicine-Are We Doing All That We Can during the COVID-19 Pandemic?
The COVID-19 pandemic has resulted in physicians having to switch from in office visits to telemedicine. Unfortunately, physicians and patients did not have adequate time to anticipate barriers to its implementation. Over the last month, one of the major problems has been patient access to telemedicine. ⋯ This "digital divide" is not fair to our patients in need-especially those with a cancer diagnosis. Patients deserve access to care. We need to implore insurance companies to provide tablets with wireless capabilities to patients in need.
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Otolaryngol Head Neck Surg · Jul 2020
ReviewTelehealth Opportunities for the Otolaryngologist: A Silver Lining During the COVID-19 Pandemic.
The utilization of telemedicine has seen a relatively slow progression over the past 50 years in the US health care system. Technological challenges limiting the ease of use of robust video platforms have been a major factor. Additionally, the perception by many health care providers that telehealth is reserved for only the rural population or that it provides limited value due to the inability to perform in-depth physical examinations contributes to the slow adoption. ⋯ Large health systems are investing millions of dollars and increasing telehealth visit numbers 100-fold to access patients. The "telehealth movement" is here to stay and will undoubtedly be incorporated into providers' daily lives years after the COVID-19 pandemic. By embracing virtual access to health care, otolaryngologists will be able to influence improvements to these systems and broaden access options for patient care well into the future.
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The ongoing coronavirus disease 2019 pandemic has led to unprecedented demands on the modern health care system, and the highly contagious nature of the virus has led to particular concerns of infection among health care workers and transmission within health care facilities. While strong data regarding the transmissibility of the infection are not yet widely available, preliminary information suggests risk of transmission among asymptomatic individuals, including those within health care facilities. We believe that the presence of a tracheostomy or laryngectomy stoma poses a unique risk of droplet and aerosol spread particularly among patients with unsuspected infection. At our institution, guidelines for the care of open airways were developed by a multidisciplinary open airway working group, and here we review those recommendations to provide practical guidance to other institutions.