ABSTRACT
Severe acute respiratory syndrome-coronavirus 2 has spread rapidly worldwide infecting >= 4 million people including >= 2.9 million deaths and overwhelming health-care systems globally. It has prompted governments to open field medical facilities to decongest hospitals and triage patients. Governments are preparing for a stage 3 surge in cases leading to a situation of "severe shortage" of mechanical ventilators due to an overwhelming number of cases. Health authorities are looking into measures for mass production of ventilators with locally available materials. However, when deploying these devices on patients, it is imperative to ascertain if they are safe and do not perpetuate a vicious circle of worsening lung injury and death. The Association for the Advancement of Medical Instrumentation and the Medicines and Healthcare Products Regulatory Agency have brought out guidelines that emergency ventilators manufactured for the current epidemic need to satisfy.
ABSTRACT
The outbreak of novel coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has led to a global pandemic of unprecedented proportions. Management of patients infected with COVID-19 has led to a great risk of hospital-based transmission of infection to health-care professionals (HCPs). The HCPs at various levels in a multispecialty health-care setup are at risk of contracting the virus. Those who are involved with performing or assisting in aerosol-generating procedures (AGPs) have a potentially higher risk of developing the infection. The AGPs involve a wide range of procedures such as pulmonary function testing, high-flow oxygen administration, endotracheal intubation, nebulization, application of ventilators, weaning and extubation, bronchoscopy, tracheostomy, and cardiopulmonary resuscitation. Hence, understanding the overall nature of the disease is of vital importance to develop preventive strategies to reduce transmission of the virus through aerosols. This review article intends to elucidate the port of entry associated with SARS-CoV-2 infection and its spread through the AGPs. We also intend to focus on methods to prevent aerosol-related transmission of infection to HCPs by illustrating clinically practiced evidence-based protocol followed in our multispecialty health-care setup.
ABSTRACT
Introduction: COVID-19 causes various cardiopulmonary manifestations. Bedside point of care ultrasound helps in the rapid diagnosis of these manifestations. Vscan Extend (GE, Wauwatosa, WI, US) is a handheld ultrasound device with a dual probe and an artificial intelligence application to detect ejection fraction. It can help in reducing the time for diagnosis, duration, and number of HCW exposed to COVID-19. Objectives: This is a prospective observational study comparing the cardiorespiratory parameters assessed by Vscan Extend with the conventional ultrasound machine. This evaluates the safety and accuracy of Vscan Extend and its utility in reducing the time duration for diagnosis. Materials and methods: Paired observations were made in 96 COVID-19 patients admitted to the intensive care unit by two intensivists. Intensivist A used the Vscan Extend device to assess the cardiac function, lung fields, diaphragm, deep veins, and abdomen. Intensivist B used routine investigation tools like clinical examination, X-ray chest, ECG, and conventional echocardiogram. The agreement between the findings and the time duration required in both the methods was compared. Results: The median duration of examination using handheld ultrasound was 9 (8.0-11.0) minutes, compared to 20(17-22) minutes with the conventional method (P < 0.001). The Cohen Kappa Coefficient was 1.0 for LV systolic function, most of the lung fields and diaphragmatic movement. Discussions: The use of handheld ultrasound has significantly decreased the time required for bedside examination of patients than the conventional method. The agreement was perfect between both the methods for systolic function, lung fields, and diaphragmatic movement. Conclusion: Vscan Extend handheld device helps in the rapid identification and diagnosis of cardiopulmonary manifestations in COVID-19 patients. The agreement between the handheld device and the conventional method proves its efficacy and safety.
ABSTRACT
The Spanish influenza pandemic of 1918 globally claimed between 50 and 100 million lives. In India, it was referred to as The Bombay Fever and accounted for a fifth of the global death toll. The current outbreak of the novel coronavirus (2019-nCoV), a new human-infecting β-coronavirus, has clearly demonstrated that the size of an organism does not reflect on its ability to affect an entire human population. 2019-nCOV, first detected in December 2019 in Wuhan, China, spread rapidly globally. Disease in humans ranged from flulike symptoms to severe acute hypoxic respiratory failure. The virus appears closely related to two bat-derived severe acute respiratory syndromes (SARS) coronaviruses. Although bats were likely the original host, animals sold at the Huanan seafood market in Wuhan might have been the intermediate host that enabled the emergence of the virus in humans. Under the electron microscope, the SARS-CoV-2 virus grips its receptor tighter than the virus behind the SARS outbreak in 2003 to 2004. The viral particle docks onto the angiotensin-converting enzyme 2 (ACE2) receptor and initiates viral entry. This review discusses the various aspects of the SARS-CoV-2 virus, its structure, pathophysiology, mechanism of interaction with human cells, virulence factors, and drugs involved in the treatment of the disease.
ABSTRACT
The creation of intelligent software or system, machine learning, and deep learning technologies are the integral components of artificial intelligence. Point-of-care ultrasound involves the bedside use of ultrasound to answer specific diagnostic questions and to assess real-time physiologic responses to treatment. This article provides insight into the pearls and pitfalls of artificial intelligence in point-of-care ultrasound for the coronavirus disease 2019 pandemic.
ABSTRACT
The coronavirus pandemic has become a challenge to all the healthcare systems in the world. Urgent creation of an intensive care unit (ICU) for the same is the need of the hour. The ideal ICU for COVID -19 should be isolated, fully equipped with invasive and noninvasive monitoring, with 24/7 trained medical personnel, nursing staff and laboratory support. As the coronavirus infection is transmitted by droplets and is highly contagious, protection of healthcare workers is crucial. Personnel working inside the ICU should get personal protective equipment (PPE). Strict guidelines for donning and doffing of PPE should be followed to prevent cross-contamination. Respiratory failure being the commonest complication of COVID-19, knowing the ventilator management for the same is essential. It is of great importance to meticulously manage all the resources to combat this contagion.
ABSTRACT
The new coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Patients with COVID-19 can progress from asymptomatic or mild illness to hypoxemic respiratory failure to multisystem organ dysfunction and death. Healthcare workers, particularly anesthesiologists, are at increased risk since their airway management expertise is required in situations where suspected or confirmed cases of COVID-19 require surgical procedures and in critical care settings. Such patients undergoing surgery have a higher perioperative morbidity and mortality. Additionally, aerosol-generating procedures place the operating room staff at high risk of contracting the COVID-19 infection. Here, we present a review of COVID-19 management, particularly in the perioperative setting. In addition, this article highlights specific concerns with the use of transesophageal echocardiography and the precautions to be taken during cardiopulmonary resuscitation. This review article is based on this institutional protocol supported by literature from recent publications and guidelines from major health organizations on COVID-19.
ABSTRACT
When caring for patients with suspected or confirmed COVID-19 (coronavirus disease 2019), especially when involved in procedures that generate aerosol, personal protective equipment (PPE) with full-body coverage is recommended. The Centers for Disease Control and Prevention emphasizes and recommends the following principles with regard to donning and doffing of PPE: (1) training and education (rigorous and repeated training of the health care workers [HCWs]), (2) all HCWs must exhibit competency in the PPE donning and doffing, and (3) PPE doffing should be done in a manner that prevents self-contamination or self-inoculation with contaminated PPE or hands (remove the most contaminated PPE items first, perform hand hygiene at each stage of doffing, and discard disposable items in containers for biomedical waste).
ABSTRACT
The Spanish influenza pandemic of 1918 globally claimed death between 50 and 100 million lives. In India, it was referred to as The Bombay Fever, and accounted for a fifth of the global death toll at that time. The current outbreak of the novel coronavirus disease 2019 (COVID-19), a new human-infecting beta coronavirus, has demonstrated that the size of an organism does not reflect on its ability to affect almost an entire human population. COVID-19, first detected in December 2019 in Wuhan, China, that spread rapidly worldwide. In humans, this disease ranged from flu-like symptoms to severe acute hypoxic respiratory failure. By appearance, this virus closely related to two bat-derived severe acute respiratory syndrome (SARS) coronaviruses. Although bats were likely the original host, animals sold at the Huanan seafood market in Wuhan might have been the intermediate host that enabled the emergence of the virus in humans. Under the electron microscope, the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus grips its receptor tighter than the virus behind the SARS outbreak in 2003 to 2004. The viral particle docks onto the angiotensin-converting enzyme 2 (ACE2) receptor and initiates viral entry. This review discusses the various aspects of the SARS-CoV-2 virus, its structure, pathophysiology, mechanism of interaction with human cells, virulence factors, and drug involved in the treatment of the disease.