Ortho hoods plus N95

[jwk]

We have hundreds of ortho hoods for total joints taking up space in our storerooms. In and of themselves, I don't think they offer any air filtering but clearly provide excellent protection from droplets. Would pairing those with an N95 mask be a reasonable option when taking care of actual or suspected Covid-19 patients?

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[drmwvr]

Addressed in this thread

Eye Protection - COVID19

Currently, we are only provided eye shields and masks with eye shields to protect from particles. If I'm not mistaken, we need a sealed option to protect our mucous membranes from the aerosolized viral particles. What are you guys using? Some of my partners are throwing out ideas, which...

forums.studentdoctor.net

 

[deleted162650]

My concern with the ortho hoods is that the blow air into the hood, and they are not N95 filtered. Thus they are potentially forcing COVID aerosols directly onto your head and eyes.

 

[chocomorsel]

My concern with the ortho hoods is that the blow air into the hood, and they are not N95 filtered. Thus they are potentially forcing COVID aerosols directly onto your head and eyes.

Can that blowing part be turned off? Just have the machine not hooked up. Would that not solve the problem?

 

[deleted162650]

Can that blowing part be turned off? Just have the machine not hooked up. Would that not solve the problem?

if I was gonna wear one I would certainly leave the fan turned off.

 

[IMGASMD]

Can that blowing part be turned off? Just have the machine not hooked up. Would that not solve the problem?

I think then it can get extremely hot, and possible poor circulation.
Passing out while intubation in a positive patient’s room, with limited personnel around you, may not be the best situation to be in.

 

[chocomorsel]

I think then it can get extremely hot, and possible poor circulation.
Passing out while intubation in a positive patient’s room, with limited personnel around you, may not be the best situation to be in.

I don’t think donning all that gear is comfortable and is for sure could get hot. The Chinese docs said it gets hot if I remember correctly.

Hopefully you aren’t in a patients room long enough to pass out.

 

[Mman]

I think with the droplet blasting airflow turned off the mask will probably fog up rather quickly

 

[deleted162650]

Sure it will got hot and foggy eventually, but it’s not like you’re gonna wear it for 3 hours like the surgeons do. It should be tolerable for 15-30 mins.

 

[pjl]

My concern with the ortho hoods is that the blow air into the hood, and they are not N95 filtered. Thus they are potentially forcing COVID aerosols directly onto your head and eyes.

Can the blower be modified to filter?

 

[projectpat]

We have acquired some of these but are limited in supply. When used, we wear an N95 + hood. Without the fan, the screen fogs up and it gets stuffy. The drape attached to the hood provides good protection of the neck. There is no proper protocol for doffing with these items however.

 

[ChiDO]

Sure it will got hot and foggy eventually, but it’s not like you’re gonna wear it for 3 hours like the surgeons do. It should be tolerable for 15-30 mins.

Without the battery and fan turned on, you'll have about 3 mins before it's hot and uncomfortable. The purpose of the hood is to prevent you from getting blood in your face. It doesn't decrease infections in total joints...not sure how much use it is for Corona. Also, they cost $40/each.

 

[jwk]

Without the battery and fan turned on, you'll have about 3 mins before it's hot and uncomfortable. The purpose of the hood is to prevent you from getting blood in your face. It doesn't decrease infections in total joints...not sure how much use it is for Corona. Also, they cost $40/each.

We were debating using these in code situations or intubations with documented Covid-19 positive patients. As many as they use up very non-chalantly turing a total joint case, the cost isn't a consideration. And it's likely a patient billable item to boot.

 

[dchz]

Can that blowing part be turned off?

Usually once the blowing starts I am turned on.

 

[chocomorsel]

Without the battery and fan turned on, you'll have about 3 mins before it's hot and uncomfortable. The purpose of the hood is to prevent you from getting blood in your face. It doesn't decrease infections in total joints...not sure how much use it is for Corona. Also, they cost $40/each.

Wow. I remember when I was a CA1 and I asked the question as to why the ortho surgeons wear these. And someone in the room looked at me and gave me the most crass response about preventing joint infections in Ortho. Basically tried to make me feel like a total idiot for not knowing this.
Jerk!

 

[chocomorsel]

I don’t see this response at all. But not surprising from our SDN comedian.

 

[IMGASMD]

How did I miss that little gem?

 

[chocomorsel]

How did I miss that little gem?

I think he must’ve deleted it immediately. But not before @dchz got to it

 

[dchz]

I don’t see this response at all. But not surprising from our SDN comedian.

How did I miss that little gem?

I think he must’ve deleted it immediately. But not before @dchz got to it

Either that or I fabricated it. Who knows?

I 100% made it up, @SaltyDog didn't say anything

 

[chocomorsel]

Either that or I fabricated it. Who knows?

I 100% made it up, @SaltyDog didn't say anything

I totally need to learn how to do this. I was wondering whether you did that, but because I don’t know how to do that I didn’t dare accuse you.

 

[IMGASMD]

Hahaha. I did suspect it. Went back to the original quote, without seeing it. But I would not have put that statement past saltydog....

 

[Consigliere]

Hahaha. I did suspect it. Went back to the original quote, without seeing it. But I would not have put that statement past saltydog....

Me neither cuz that guy is one....wait for it.....wait for it...

SALTY DOG!

 

[anbuitachi]

the fan is very helpful bc it gets VERY hot, and foggy.
We taped a n95 mask over the vent system to at least filter some of the air..

 

[Wiscoblue]

If you run 10 liters of O2 by nasal cannula hooked up to a long oxygen tube, you could shut off the fan and use an Ortho hood for about 15 minutes, more than enough to do an intubation and maybe even an art or central line.


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[navi86]

We use them without the fan or o2. I like them because they protect my entire head and neck in combination with an n95, surgical gown, and double gloving with surgical gloves. I dress up outside the room while making sure the nurses have everything ready at bedside for intubation. I tell the nurse to push the drugs, then I run in and do the intubation and leave. There's no mask ventilation for covid patients so I don't need to be at bedside before the intubation. Takes me less than 10 minutes. Luckily I have not had any truly difficult intubations yet.

 

[Arch Guillotti]

We use them without the fan or o2. I like them because they protect my entire head and neck in combination with an n95, surgical gown, and double gloving with surgical gloves. I dress up outside the room while making sure the nurses have everything ready at bedside for intubation. I tell the nurse to push the drugs, then I run in and do the intubation and leave. There's no mask ventilation for covid patients so I don't need to be at bedside before the intubation. Takes me less than 10 minutes. Luckily I have not had any truly difficult intubations yet.

This is nuts. What are you so scared of? You have on proper PPE!

 

[StealYourFace]

Someone posted this on one of the Covid Facebook groups:

“I wanted to get opinions on airflow if using a Stryker hood for floor intubations. Some at our hospital have been using the hood without the frame/fan - the hood goes directly on the head, and stays in place by bunching up some of the material in the back and placing a clip. It's then tucked into a surgical gown that is placed over it. In a room filled with aerosol, this seemingly would provide better eye and face coverage (a N95 and second mask with face shield are obviously worn underneath the hood).

But I was wondering about airflow within the hood. In this scenario, room air is coming in both through the hood material itself and from underneath the gown as you breathe. Do you think that room air entering the hood from inhalation is now more static/"trapped" and concentrated around your face, within the hood? Or is it preferable to being exposed to the entire room full of aerosol, without the added barrier of the hood?“

Wasn’t sure if that changes any opinions here?

 

[NewtownD]

We have been using them tucked into a Dupont Tyvek bunnysuit either with the frame and N95 duct taped over intake fan (along with N95 mask on and goggles) or with a bike-helmet style CAPR (also with N95 and goggles).

I've been told the Ortho Hood fan is designed to generate negative pressure within the hood (which makes sense for an arthroplasty) - although to my non-engineer brain both the Ortho Hood frame and the CAPR seem like they are just fans generating airflow inside the hood.

The Ortho Hood is pretty easy to doff, is single use and completely covers my neck and head - this is an advantage over CAPR (lots of hard-to-clean uneven surfaces) or visor (doesn't completely cover head/neck, also annoying to clean). Disadvantages: makes communication more difficult compared to visor-only, and sometimes requires tape in the back to keep it in place.

I tried using the Ortho Hood without the fan or CAPR my first time and will never do it again. I was rebreathing, RR in 30s, sweating through my scrubs. The patient arrested on induction, ROSC with 02, epi and a few chest compressions (not uncommon for our floor intubations) so I was in there for a while. Felt like I was going to pass out. 0/10 do not recommend.

 

[Hoya11]

We use them without the fan or o2. I like them because they protect my entire head and neck in combination with an n95, surgical gown, and double gloving with surgical gloves. I dress up outside the room while making sure the nurses have everything ready at bedside for intubation. I tell the nurse to push the drugs, then I run in and do the intubation and leave. There's no mask ventilation for covid patients so I don't need to be at bedside before the intubation. Takes me less than 10 minutes. Luckily I have not had any truly difficult intubations yet.

I do pretty much the same thing except I am in the room to push the drugs...

You arrive to the ICU, its not even the B team from ICU, its people you have never seen before who have no prior ICU experience, new "ICU" doc, new nurse who used to be working in a nursing home 2 months ago. No one knows anything about airway equipment or room setup for intubation. You have to direct every single step of the way before you enter the room, or youll be inside the room for 20 minutes and have to go in and out 5 times.. One time they were confused as to why I wanted an Ambu bag prior to intubation and where they could find one and what it looked like... not joking..

You get your PPE on, You make sure you they have all the equipment you need and its all ready. THEN you go into the room, they push drugs (they always ask which comes first the sux?) you intubate with glidescope at a distance, leave. My In-room time is 2-4 mins...

My PPE: I use the long face shield AND eye shield (the PAPR I worry about the concerns raised above, plus I like to just throw everything away), a regular mask on top of a N95 mask, long stocking booties, a beard cover, a surgical gown, regular gloves underneath sterile gloves

As soon as Im done I talk to no one. I take off my PPE and put it in a pile on the floor in front of the room ( you guys cant get a garbage can ready?) head right to the sink and wash my hands and face and neck. I used to take a shower after every intubation, but I just couldnt take that many showers at some point, so I just started taking a shower at 3pm and then again at 11pm and then again before I left the hopsital, and then again once I got into my house - good times!

The first times were very nerve racking, now I have become numb to it as Im sure others can relate to. Honestly I cant believe I have done so many intubations, some of which required masking due to emergent nature, and have NOT got sick (knock on wood)

 

[Hoya11]

This is nuts. What are you so scared of? You have on proper PPE!

Its natural to be scared. We all know people who have gotten sick despite proper PPE. Things happen..

 

[Hork Bajir]

I started mixing all of my drugs (prop, sux, phenylephrine, +/- fent +/- esmolol +/- rock) into one 50cc syringe and just asking the nurse to push the whole thing. Makes life easier for everyone (I don’t have to repeatedly for complex instructions to be understood through all of my muffling PPE, less complicated for the floor nurse who has never pushed meds. before, etc). When using sux the patient is usually fasciculating before the nurse is done pushing the giant syringe

The anecdotal name for the drug cocktail in the giant syringe is f***itol

 

[nimbus]

My PPE: I use the long face shield AND eye shield (the PAPR I worry about the concerns raised above, plus I like to just throw everything away), a regular mask on top of a N95 mask, long stocking booties, a beard cover, a surgical gown, regular gloves underneath sterile gloves

Does an N95 work as designed with a beard? Everyone I know shaved their beards when they got fit tested.

 

[Justice4all]

I didn’t tempt it. Most of colleagues with beard failed the 8 minute test for n95 prior to covid. So they are using PAPR.

I rather like the goggles n95 and faceshield.

 

[AdmiralChz]

Does an N95 work as designed with a beard? Everyone I know shaved their beards when they got fit tested.

Basically, no.