Urgent cases upper GI, bronch etc

[GaseousClay]

Urgent bronch cases I think PAPR/N95, rsi etc is all necessary but what about urgent ercp/eus/egd? Lots of them done with MAC but a high risk procedure for the GI docs, us and the nurses. Not sure securing the airways for all of those cases would be better or worse. Maybe just giving propofol From a distance and letting the doc deal with a lighter patient who’s is likely to cough and buck more isn’t a great idea either. Thoughts? Any data behind this?

 

[narcotics999]

Did a suspected bronch under Mac, papr, gown, double gloves.

At the beginning, nurse only gave me n95 (you just push meds). Fxxk!

Hopefully he wasn’t and I was adequately protected.

Should I wrap my legs too?


Sent from my iPhone using Tapatalk

 

[deleted171991]

What was the indication for that bronch? Unless he's bleeding, he's not getting a bronch. If it's for cancer, come back in 2 weeks, if Covid doesn't kill you by then.

NEVER bronch a suspicious patient under MAC, especially if you are not in a negative pressure room. You put people at risk.

Don't let dumb people bully you into doing dumb things.

And stop doing non-emergent bronchs or GI cases, especially in non-ICU patients. Just say no, as a group.

 

[deleted171991]

Urgent bronch cases I think PAPR/N95, rsi etc is all necessary but what about urgent ercp/eus/egd? Lots of them done with MAC but a high risk procedure for the GI docs, us and the nurses. Not sure securing the airways for all of those cases would be better or worse. Maybe just giving propofol From a distance and letting the doc deal with a lighter patient who’s is likely to cough and buck more isn’t a great idea either. Thoughts? Any data behind this?

The older the patient, the higher the chance asymptomatic means not infected.

If symptomatic or pertinent history (do a proper preop, including physical exam), either do the case with proper PPE, in a negative pressure room, or postpone if possible.

These people need TB-level isolation; I don't know why everybody is so cavalier with them. They definitely wouldn't be with an active TB patient, despite TB being waaaay less dangerous and mostly curable.

 

[deleted59964]

put a tube, i do for every ercp anyway

if physician wants to bronch through an LMA leave the room while he does it

 

[deleted171991]

put a tube, i do for every ercp anyway

if physician wants to bronch through an LMA leave the room while he does it

Because the viral aerosols will have magically vanished, by the time s/he gets back into the room?

Covid patients should be done paralyzed, after RSI/glide, with deep (or remifentanyl) extubation. Still they will cough at some point during/after wakeup, so PPE, negative pressure room. Put a mask with tight headstrap on them after extubation.

 

[Ronin786]

Did a suspected bronch under Mac, papr, gown, double gloves.

At the beginning, nurse only gave me n95 (you just push meds). Fxxk!

Hopefully he wasn’t and I was adequately protected.

Should I wrap my legs too?


Sent from my iPhone using Tapatalk

Why do you need a PAPR? There's no benefit over an N95 and face shield.

The older the patient, the higher the chance asymptomatic means not infected.

If symptomatic or pertinent history (do a proper preop, including physical exam), either do the case with proper PPE, in a negative pressure room, or postpone if possible.

These people need TB-level isolation; I don't know why everybody is so cavalier with them. They definitely wouldn't be with an active TB patient, despite TB being waaaay less dangerous and mostly curable.

Curious why you think they need TB-level isolation? It's still not transmitted airborne. The risk is from aerosolization during procedures and people in the immediate vicinity. It's still only the same precautions as influenza.

 

[deleted87051]

Because the viral aerosols will have magically vanished, by the time s/he gets back into the room?

Covid patients should be done paralyzed, after RSI/glide, with deep (or remifentanyl) extubation. Still they will cough at some point during/after wakeup, so PPE, negative pressure room. Put a mask with tight headstrap on them after extubation.

Another extubation option is to extubate paralyzed, place a mask tightly, then give sugammadex. I’ve done this a number of times in EP lab where I give opioid free pure gas anesthetic and it works very well with very minimal and often no coughing and they breathe right away.

 

[deleted59964]

Because the viral aerosols will have magically vanished, by the time s/he gets back into the room?

Covid patients should be done paralyzed, after RSI/glide, with deep (or remifentanyl) extubation. Still they will cough at some point during/after wakeup, so PPE, negative pressure room. Put a mask with tight headstrap on them after extubation.

theatre air exchange is pretty rapid, of course you still need ppe when you come back, but no reason to be there for the worst of it

 

[B-Bone]

Any thoughts on ECT? We're down to urgent/emergent cases only, and that apparently includes ECT. I understand that this is important, consequential therapy for a select group of people, but it also seems like a tremendously effective way to spread the virus (masking patients for minutes at a time, lots of drooling/coughing on wakeup, population that more often than not lives in a group home, etc) and potentially take out vital healthcare workers. Do we intubate these patients? Cancel ECT? What are y'all doing?

 

[deleted171991]

Any thoughts on ECT? We're down to urgent/emergent cases only, and that apparently includes ECT. I understand that this is important, consequential therapy for a select group of people, but it also seems like a tremendously effective way to spread the virus (masking patients for minutes at a time, lots of drooling/coughing on wakeup, population that more often than not lives in a group home, etc) and potentially take out vital healthcare workers. Do we intubate these patients? Cancel ECT? What are y'all doing?

These are elective procedures with high contamination risk. I would cancel. These are neither urgent nor emergent usually.

 

[deleted171991]

theatre air exchange is pretty rapid, of course you still need ppe when you come back, but no reason to be there for the worst of it

I worked in places where bronchs were done in an procedure room, not OR, so I am not sure how reliable that ventilation is.

 

[deleted171991]

Why do you need a PAPR? There's no benefit over an N95 and face shield.


Curious why you think they need TB-level isolation? It's still not transmitted airborne. The risk is from aerosolization during procedures and people in the immediate vicinity. It's still only the same precautions as influenza.

N95 fit must be perfect.

Airborne transmission is "unlikely", to quote the CDC. I.e. they don't know. We can't risk contaminating healthcare workers, because they may be hard to replace. I don't think we really know what we're facing.

This is the EU (I trust them more than the CDC, for now):

Healthcare workers in contact with a confirmed case, or a suspected case of COVID-19, should wear PPE for contact, droplet and airborne transmission of pathogens: FFP2 or FFP3 respirator tested for fitting, eye protection (i.e. goggles or face shield), long-sleeved water-resistant gown and gloves[17].

https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-infection-prevention-and-control-healthcare-settings-march-2020.pdf

 

[deleted59964]

Any thoughts on ECT? We're down to urgent/emergent cases only, and that apparently includes ECT. I understand that this is important, consequential therapy for a select group of people, but it also seems like a tremendously effective way to spread the virus (masking patients for minutes at a time, lots of drooling/coughing on wakeup, population that more often than not lives in a group home, etc) and potentially take out vital healthcare workers. Do we intubate these patients? Cancel ECT? What are y'all doing?

cancel if not truly urgent, otherwise RSI and put a tube ... you're giving sux anyway