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joemate
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  #2456099 6-Apr-2020 17:37
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Face shields are OK, just received some feedback from different departments of the local hospital.

 

Those facemask prints are 0, they don't provide any seal between the face and the print. If one feels safe while wearing it, go for it.

 

The other interesting thing is this box, for anesthetists during intubation and extubation, because that's the moment when aerosol-generating events (AGEs) happen.

 

An article in the New England Journal of Medicine here.


 
 
 

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gchiu

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DR

  #2456437 7-Apr-2020 13:04
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That is interesting.  I wonder if a vacuum device just above the patient can capture enough of the spray to stop it reaching the guy doing the intubation.  It's difficult enough trying to intubate someone with nothing in your way.


afe66
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  #2456450 7-Apr-2020 13:36
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joemate:

 

Face shields are OK, just received some feedback from different departments of the local hospital.

 

Those facemask prints are 0, they don't provide any seal between the face and the print. If one feels safe while wearing it, go for it.

 

The other interesting thing is this box, for anesthetists during intubation and extubation, because that's the moment when aerosol-generating events (AGEs) happen.

 

An article in the New England Journal of Medicine here.

 

 

 

 

No.

 

We have tried them. They are too difficult in practice in a theatre environment

 

The key thing is to intubate people as fast and efficiently as possible and that involves within reason doing what you do well/normally. Be very careful about changing things for the sake of changing for what seem to be good ideas. In a crisis you need to be able to get at the patient from more than on angle which involves needing to take the box off. (how do you suddenly place a suction device or gain front of neck access)

 

The specific problem with this is you cant use a bougie as part of your failed away drill they are 50cm long. Also these patients may desaturate fast and its not the time for trying a technique you are not familiar with vrs one you have been using for many many years

 

In addition the box wont be easy to extubate people with in place. Patients often cough and some are aggitated on awakening ie move, sit up. this will knock the box onto the floor.

 

 

 

Our department is using clear plastic sheets as used by singapore. (we bought several hundred meters of it. Each case uses 1.5 meters and is disposed of afterwards)

 

The anaesthetist works with their hands under the sheet and looks though at the patient. Similar to the cataract dressings. The patient can see you though it and you can talk to them as you preoxygenate and reassure them

 

Your clean assistant can manipulate the patient through the plastic sheet from above if needed to. ie cricoid presure. If airway crisis the sheet can be removed. As the patient by this point will be full paralyzed its "safer" in that the patient cant cough

 

One the airway is secured the anaesthetist removes their hands from beneath the sheet removes gloves and is relatively clean for the case.

 

 

 

For extubation the patient is extubated by the anaesthetist with hands under the sheet. Coughing after extubation is common at the best of times as is much worse with reactive airways. So having the first couple of coughs under the sheet minimises aerosoling particles as they are caught under the sheet. You can also see the patient and them you as you talk to them to reassure as they awake. Once airway is sorted an N95 mask is placed on the patient and the plastic sheet carefully removed and disposed of.

 

 

 

Everyone should be reassured that a lot of simulations are being done to ensure practice and a lot of emails are flying around the country between various ICU/Anaesthetic department with copying of sensible ideas.




MikeAqua
7724 posts

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  #2456463 7-Apr-2020 13:59
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A local firm here is making lightweight face shields with a fabric headband. 

 

Not for medical use at all, but we are using them for people working in wet environments, to protect their mask from external wetting and to reduce the amount of time they spend wiping splashes off their face.  They are washable and you can trim the underside to size with scissors.

 

Also used as a secondary layer for 1st Aid - in addition to disposable gloves, disposable apron and mask.





Mike


gchiu

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DR

  #2456474 7-Apr-2020 14:12
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Ideally intubation/extubation should be done in a negative pressure room but this is practically impossible in this crisis.

 

I've seen high flow vacuum devices placed near patients to try and suck up all the virus they're aerosolizing but ...


afe66
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  #2456549 7-Apr-2020 16:25
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gchiu:

 

Ideally intubation/extubation should be done in a negative pressure room but this is practically impossible in this crisis.

 

I've seen high flow vacuum devices placed near patients to try and suck up all the virus they're aerosolizing but ...

 

 

 

 

Operating theatres are positive pressure by design.

 

No role for them to be capable of negative preasure.


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