Wearing N95 for whole case?

studentofsdn

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    Starting anesthesia in July and wondering if you guys are keeping N95s on for entire cases or just for intubation/extubation? Sounds silly, but for me the only mask that fits is the 3M 1860s and its soo damn uncomfortable. Wearing it nowadays the whole time wihle prerounding on my pts and even that length of time is almost unbearable.
     

    lovemango

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      Starting anesthesia in July and wondering if you guys are keeping N95s on for entire cases or just for intubation/extubation? Sounds silly, but for me the only mask that fits is the 3M 1860s and its soo damn uncomfortable. Wearing it nowadays the whole time wihle prerounding on my pts and even that length of time is almost unbearable.
      At my hospital we've been wearing them for the entire case for high risk aerosolizing surgeries like bronchs, EGDs, and ENT surgeries. For other surgeries I only wear it for intubation/extubation. We've supposedly moved into a new phase today and returned to "standard precautions" for asymptomatic patients who have tested negative, but given the false negative rate of the tests thus far, I'm going to keep wearing my N95 for intubation/extubation for the time being.
       
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      deleted162650

        Whole case, and I’ve got a regular surgical mask over it.
        Try one that has the exploratory valve on it.

        Taking it on and off is great way to contaminate the hell out of your mask.
         
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        IMGASMD

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          N95 all day every day. Unless I am eating, usually in a place that I wiped down myself.

          You may be in a different age group than me. I have kids at home. I have elderly who live close by. I have older partners and co-workers. If I get any of them sick, I wouldn’t feel great about it.

          You’re in the profession of getting into people’s face. It’s hard for me to imagine in the middle of a true emergencies, you say, wait a second let me put on my n95 before I do something. Do people do it? Sure, just not me.

          Good luck OP in your training.
           
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          marr65

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            Wear an N95 with a mask (ASTM Level 3) over it all day long. It’s uncomfortable but you will learn to deal with it. Also, make sure you wear an eye goggle too. Since you are starting out at a new place, don’t eat in a lounge. Man, people are sitting right next to each other. I can only imagine that it takes one asymptomatic person to infect the whole lounge.
             
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            AdmiralChz

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              Interesting how people do different things around the country. All our patients are tested pre-op, we wear the N95 for intubation/extubation for about 10 minutes around that time along with eye protection. After that you are free to remove if you’d wish (I do). Rest of the room doesn’t wear if they aren’t close to the head of bed during those times.

              If we don’t have a test (typically emergency case), we wear the whole case.

              I personally don’t advocate wearing the entire time for a low-risk case with a negative test. It helps extend the life of the mask, as it is certainly a finite resource.
               
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              Velefunt

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                When I had to wear it, I wore it all day, oftentimes with a mask over it. That was our one mask for the day on top of our repeat-use n95.

                Now all our patients are being rapid tested, so back to regular (1) surgical mask worn all day.
                 

                IMGASMD

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                  When I had to wear it, I wore it all day, oftentimes with a mask over it. That was our one mask for the day on top of our repeat-use n95.

                  Now all our patients are being rapid tested, so back to regular (1) surgical mask worn all day.

                  Rapid test is in and out of stock at my shop. Quest lab has turn around time between 24-96 hours. So as far as I am concerned, useless.
                   
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                  deleted59964

                    i'm fortunate that COVID so far hasnt been a problem here, so I have no expertise.

                    We are being told the aerosols generated by intubation can stay airborne for hours, and that after a doing a suspect case noone should enter the theatre for a period of time (based on airconditioning exchange cycles) after the last aerosol generating proceedure (eg. extubation ) without n95s.

                    seems to me no point wearing it just for intubation / extubation?
                     
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                    chocomorsel

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                      Yes. rightward shift for more erythropoiesis. I wear my N95 for all cases and pt interactions.

                      If you’re a pioneer you’ll toss food in the mask and use it as a feed bag. Great to do between cases when you know you won’t get a lunch.
                      I love it. Grand idea.
                       

                      DrOwnage

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                        I'm sorry but I don't buy the "fact" that intubating is such an aerosolizing procedure. I induce my patients and paralyze them, most of the time I don't mask. They are not breathing. During gentle DL or video laryngoscope the patient doesn't magically shoot air out of the trachea into your face, unless the surgeon performs a diving elbow drop from the top of the scrub table onto the patients chest. In my opinion you're at more risk when you tell your patient to take off their mask to check a malampati score in the preop (and half the time they say "ahhhhh" even though you don't tell them to). I know a lot of people will disagree, but I believe a lot of our protocol is complete bs. You are more at risk walking by your colleagues and chatting with them face to face.
                         
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                        Airway

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                          I'm sorry but I don't buy the "fact" that intubating is such an aerosolizing procedure. I induce my patients and paralyze them, most of the time I don't mask. They are not breathing. During gentle DL or video laryngoscope the patient doesn't magically shoot air out of the trachea into your face, unless the surgeon performs a diving elbow drop from the top of the scrub table onto the patients chest. In my opinion you're at more risk when you tell your patient to take off their mask to check a malampati score in the preop (and half the time they say "ahhhhh" even though you don't tell them to). I know a lot of people will disagree, but I believe a lot of our protocol is complete bs. You are more at risk walking by your colleagues and chatting with them face to face.
                          You might be right. I wear goggles, mask (95 or surgical) and a face shield with interactions with all patients (and maybe more importantly) colleagues.
                           
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                          narcotics999

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                            I use the same N95 off and on for a week or so, by the time mine smells like mints or chocolate I know it’s time for a replacement.
                            One N95 for a week? even now? Every hospital I go I will get one per day. Scrub tech, circulation nurse, anesthesia tech, and surgeons of course get one too.

                            Hospitals should pay to get more.
                             
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                            deleted162650

                              I'm sorry but I don't buy the "fact" that intubating is such an aerosolizing procedure. I induce my patients and paralyze them, most of the time I don't mask. They are not breathing. During gentle DL or video laryngoscope the patient doesn't magically shoot air out of the trachea into your face, unless the surgeon performs a diving elbow drop from the top of the scrub table onto the patients chest. In my opinion you're at more risk when you tell your patient to take off their mask to check a malampati score in the preop (and half the time they say "ahhhhh" even though you don't tell them to). I know a lot of people will disagree, but I believe a lot of our protocol is complete bs. You are more at risk walking by your colleagues and chatting with them face to face.

                              Agreed. Extubation is much higher risk than intubation.
                               
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                              psychbender

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                                One N95 for a week? even now? Every hospital I go I will get one per day. Scrub tech, circulation nurse, anesthesia tech, and surgeons of course get one too.

                                Hospitals should pay to get more.
                                Supply chains are variable. My health system announced that they "cannot" get more N95s or PAPR replacement parts. We've been expected to use the same mask until visibly soiled or broken. I have colleagues who have been wearing the same mask for three or four weeks now. We're working with biomed on the full face snorkel masks with viral filters attached as replacements now. Main OR scrub nurses and techs are told to only use an N95 when working on an actual positive or PUI, but cath lab and endo staff wear them for all cases.

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