ABSTRACT
Anaesthetists play an important role in the evaluation and treatment of patients with signs of thoracic trauma. Anaesthesia involvement can provide valuable input using both advanced diagnostic and therapeutic interventions. Commonly performed interventions may be complicated in this setting including airway management, damage control resuscitation, and acute pain management. Anaesthetists must consider additional factors including airway injuries, vascular injuries, and coagulopathy when treating this population. This evidence-based review discusses traumatic thoracic injuries with a focus on new interventions and modern anaesthesia techniques. This review further serves to support the early involvement of anaesthetists in the emergency department and other areas where they can provide value to the trauma care pathway.
ABSTRACT
The SARS-CoV-2 coronavirus pandemic has spread around the world including the United States. New York State has been hardest hit by the virus with over 380 000 citizens with confirmed COVID-19, the illness associated with the SARS-CoV-2 virus. At our institution, the medical physics and dosimetry group developed a pandemic preparedness plan to ensure continued operation of our service. Actions taken included launching remote access to clinical systems for all dosimetrists and physicists, establishing lines of communication among staff members, and altering coverage schedules to limit on-site presence and decrease risk of infection. The preparedness plan was activated March 23, 2020, and data were collected on treatment planning and chart checking efficiency for 6 weeks. External beam patient load decreased by 25% during the COVID-19 crisis, and special procedures were almost entirely eliminated excepting urgent stereotactic radiosurgery or brachytherapy. Efficiency of treatment planning and chart checking was slightly better than a comparable 6-week interval in 2019. This is most likely due to decreased patient load: Fewer plans to generate and more physicists available for checking without special procedure coverage. Physicists and dosimetrists completed a survey about their experience during the crisis and responded positively about the preparedness plan and their altered work arrangements, though technical problems and connectivity issues made the transition to remote work difficult. Overall, the medical physics and dosimetry group successfully maintained high-quality, efficient care while minimizing risk to the staff by minimizing on-site presence. Currently, the number of COVID-19 cases in our area is decreasing, but the preparedness plan has demonstrated efficacy, and we will be ready to activate the plan should COVID-19 return or an unknown virus manifest in the future.