Läkartidningen
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The new SARS-CoV-2 virus enters cells via angiotensin-converting enzyme 2 (ACE2). ACE2 counteracts ACE and angiotensin II in the renin-angiotensin-aldosterone system (RAAS) and has critical functions in the lung and cardiovascular system. SARS-CoV was found to down-regulate ACE2, leaving angiotensin II unbalanced in affected organs. A similar effect of SARS-CoV-2 could partly explain risk factors and symptoms, and could potentially be treatable.
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Coronavirus Disease 2019 (COVID-19) can cause severe respiratory failure and distressing symptoms including fever, cough, breathlessness and anxiety. Symptomatic (palliative) treatment is of fundamental importance both in conjuncture with life-sustaining interventions and in end of life care. Based on the evidence to date, there are several treatment options to consider for the relief of fever (acetaminophen, NSAID, oral glucocorticoids), cough (morphine), breathlessness (morphine, oxygen, fan), anxiety (benzodiazepines) and pain (NSAID, morphine). Top priorities include precautions to protect staff and people at-risk from infection and planning how to provide adequate treatment for each individual depending on setting, including palliative care.
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This article describes new Swedish guidelines for the care of adult patients having a tracheostomy. A national expert panel of ENT and anaesthesiology specialists appointed by each national specialist association reviewed fatal patient cases involving tracheostomy failure as well as national and international guidelines to produce a "best of practice" document. The main recommendation is that the health care provider has the full responsibility to ensure that the combined surgical competence at the hospital can handle acute airway problems also under difficult anatomical conditions. The distribution of percutaneous and surgical tracheotomy should be weighted to ensure the competence in both.