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This clinical case shows a patient who was admitted to the Hospital Regional Antofagasta (HRA) due to pneumonia associated with COVID-19, coinfected with Mycobacterium tuberculosis, and who consequently developed Acute Respiratory Distress Syndrome (ARDS) in a Catastrophic condition, which warranted Sequential management that began with airway rescue at the hospital of origin (Barros Luco Trudeau (HBLT)) with mechanical ventilation support, in prone condition with poor results. Upon arrival of the transfer team, Extracorporeal Membrane Cannulation (ECMO) was decided. After his favorable response, he was weaned to the artificial respirator (RA) and supported with Arteriovenous CO2 remover (NovalungR ), a maneuver that lasted 192 hours, achieving improvement from Mechanical Ventilation support, until his final weaning. This is an unprecedented clinical case, due to the combination of catastrophic ARDS, associated with the COVID 19 and TB coinfection, and for this reason it is necessary to document cases, guide behaviors and management, which can be adapted according to the technological and professional development with which count each hospital.
ABSTRACT
Introduction Aeromedical evacuation missions to transport highly infectious critical COVID-19 patients involve multiple factors, therefore planning is essential in their preparation. The management of specialist nurses is cross-cutting, as they participate in the planning, organisation and implementation of aero-evacuation protocols, delivery of care and operational safety procedures throughout the operation, with an integrated aeromedical crew working as a team alongside the air crew. Objective To study the management of nurses specialised in the aero-evacuation of highly infectious critical patients during the COVID-19 pandemic. Design Through a systematic search of the biomedical literature, this study was conducted according to the standards of the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA. The literature search included articles published from 2019 to August 2020 and meta-search engines, yielding a total of 142 articles, and a triangulation of information was performed. A total of 11 articles were eventually included in the review, and the validity of each article was determined according to the guidelines of the Joanna Briggs Institute level of evidence. Results and discussion The systematic review identified 11 studies that use different methodological considerations for conducting an aeromedical evacuation and covering key aspects for a successful operation. Conclusion The management of specialist nurses has a direct impact on the aeromedical evacuation of the critical patient. It covers planning, organisation, and operational safety, applied in the instruction, training, execution and strict monitoring of the work of the aeromedical crew as a solid team. This contributes to the success of the aero-evacuation mission and the infectious patient's high likelihood of survival during the COVID-19 pandemic.
ABSTRACT
INTRODUCTION: Aeromedical evacuation missions to transport highly infectious critical COVID-19 patients involve multiple factors, therefore planning is essential in their preparation. The management of specialist nurses is cross-cutting, as they participate in the planning, organisation and implementation of aero-evacuation protocols, delivery of care and operational safety procedures throughout the operation, with an integrated aeromedical crew working as a team alongside the air crew. OBJECTIVE: To study the management of nurses specialised in the aero-evacuation of highly infectious critical patients during the COVID-19 pandemic. DESIGN: Through a systematic search of the biomedical literature, this study was conducted according to the standards of the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA. The literature search included articles published from 2019 to August 2020 and meta-search engines, yielding a total of 142 articles, and a triangulation of information was performed. A total of 11 articles were eventually included in the review, and the validity of each article was determined according to the guidelines of the Joanna Briggs Institute level of evidence. RESULTS AND DISCUSSION: The systematic review identified 11 studies that use different methodological considerations for conducting an aeromedical evacuation and covering key aspects for a successful operation. CONCLUSION: The management of specialist nurses has a direct impact on the aeromedical evacuation of the critical patient. It covers planning, organisation, and operational safety, applied in the instruction, training, execution and strict monitoring of the work of the aeromedical crew as a solid team. This contributes to the success of the aero-evacuation mission and the infectious patient's high likelihood of survival during the COVID-19 pandemic.
Subject(s)
Air Ambulances , COVID-19 , Communicable Diseases , Nurses , Humans , PandemicsABSTRACT
Objective. To develop a risk model to predict 30-day mortality after emergency department treatment for COVID-19. Methods. Observational retrospective cohort study including 2511 patients with COVID-19 who came to our emergency department between March 1 and April 30, 2020. We analyzed variables with Kaplan Meier survival and Cox regression analyses. Results. All-cause mortality was 8% at 30 days. Independent variables associated with higher risk of mortality were age over 50 years, a Barthel index score less than 90, altered mental status, the ratio of arterial oxygen saturation to the fraction of inspired oxygen (SaO(2)/FIO2), abnormal lung sounds, platelet concentration less than 100000/mm(3), a C-reactive protein concentration of 5 mg/dL or higher, and a glomerular filtration rate less than 45 mL/min. Each independent predictor was assigned 1 point in the score except age, which was assigned 2 points. Risk was distributed in 3 levels: low risk (score of 4 points or less), intermediate risk (5 to 6 points), and high risk (7 points or above). Thirty-day risk of mortality was 1.7% for patients who scored in the low-risk category, 28.2% for patients with an intermediate risk score, and 67.3% for those with a high risk score. Conclusion. This mortality risk stratification tool for patients with COVID-19 could be useful for managing the course of disease and assigning health care resources in the emergency department.
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Sleep disorders are common in the population and are major cause of morbidity. The objective of this review is to assess sleep disturbances in times of emergency and disasters. Throughout history, the biopsychosocial field and sleep have been affected by multiple large-scale events, such as natural disasters, man-caused tragedies, armed conflicts, social crises and pandemics, the experience of which can lead to short, medium and / or long term health problems. In several studies, the negative impact of emergencies and disasters on sleep have been analyzed, emphasizing the importance of the diffusion and promotion of measures that encourage good sleep. The arrival of COVID-19 and consequent home confinement for prolonged periods caused important social consequences. Certain occupational factors and characteristics of disasters are associated with greater comorbidity: a high risk of experiencing physical exhaustion, psychological disorders and insomnia, especially in highly vulnerable groups, such as health professionals, rescuers and first aids-responders. Insomnia is the most frequent sleep disorder in the general population and its worsening in the context of the COVID-19 pandemic, represents a new public health problem. It is essential to promote physical and mental health prevention campaigns, aimed at early screening and management of pathologies in the psychosocial sphere, within socioeconomic possibilities.
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The crisis resulting from the COVID-19 pandemic has generated an adverse situation in which thousands of people dies due to the lack of artificial ventilation devices. In this sense, this work presents a proposal for the robust mechatronic design and control of a low-cost non-invasive ventilator, for which rapid prototyping manufacture strategies such as 3D printing and product design are used. In order to guarantee the reliability of the system operation, in this work, a robust control scheme based on super-twisting sliding modes is proposed, which guarantees the trajectory tracking control corresponding to the breathing profiles required by the patients. Experimental and simulation results validate the effectiveness of the proposed prototype design. Nevertheless, the prototype is waiting to be tested and approved for use in health assistance.