ABSTRACT
Objective: Numerous national and international publications highlight an increase in enquiries for exposures to disinfectants and antiseptics related to the COVID-19 pandemic. The data published in the literature, however, are limited to analyzing the months corresponding to the first period of confinement, while data relating to the second and third pandemic waves are lacking. Our aim was to analyse these exposures in the months following the wave of the pandemic. Methods: We used descriptive statistics to analyse toxicology consultation volumes to hypochlorite bleaches, disinfectants and antiseptic products for the period 1 February 2020-3 May 2020 (first lockdown), 1 October 2020-31 December 2020 (second lockdown) and we compared these data with that relating to the same periods of 2019 and the period 1 February 2021-3 May 2021. Results: Compared to 2019, accidental exposures to all the products considered in the study showed an increase of 67.9% in the period February-May 2020, an increase of 26.3% in the period October-December 2020 and an increase of 16.9% in the period February-May 2021. (Table 1). During the period February-May 2020 the respective increases compared to the same period of 2019 were: bleaches (+45.7%), antiseptics (+61.7%), disinfectants (+140.2%);for the period October-December 2020 the respective increases compared to the same period of 2019 were: bleaches (+0.3%), antiseptics (+43.2%), disinfectants (+113%). During the period from February to May 2021 compared to 2019 changes were as follows: bleaches (-9.7%), antiseptics (+44.3%), disinfectants (+59%). Respiratory symptoms were present in the majority of cases, followed by gastrointestinal, oropharyngeal, ocular and other routes. Conclusion: The data highlight how the effect of the COVID-19 pandemic on exposures to antiseptic and disinfectant products in Italy did not end with the first wave, but persists, although with smaller numbers, even in the period of the second wave and in early 2021. (Table Presented).
ABSTRACT
Objective: ECMO can provide respiratory (VV) or circulatory (VA) support. During mobilization, specially during transport, nursing care on manoeuvres as proning, decannulation can be one of the worst complication during ECMO support: in relation to aetiology of ECLS, type of configuration, site of decannulation (i.e. drainage or return cannula), specific management has to be done. Methods: Two case reports are presented about ECMO decannulation in VA and in VV support. The patient was undergoing to VA ECMO support due to out of hospital cardiac arrest (OHCA);in the second case VV ECMO was applied due to acute respiratory distress syndrome in Sars-Cov2. A retrospective analysis was done on medical reports to identify what, where and why decannulation was occurred with focus on decision making process and survival outcome. Results: In both, decannulation was on return cannula and patients were survived. In VA case neurological negative outcome was attributable to OHCA damage, while in VV ECMO is currently ongoing. In VA decannulation, displacement occurred before nursing hygiene care, discovering of continuous bleeding: during medication dressing, return cannula was displaced. Perfusionist was present in ICU, clamping circuit, while one nurse compressed the site, one called for help, one increased catecholamines support to manage the acute cardiogenic shock. Return cannula were repositioned into the same vessel. In VV decannulation, in femoral-femoral approach, decannulation occur before a fourth proning cycle. Bleeding was recognized increasing quickly, with discover of integrity lesion on the return cannula: ventilation upgrade, circuit clamping and compression were applied, with replacement of return cannula in right external vein. Conclusions: Decannulation is a teamwork management. Return cannula can product hypovolemic shock in case of VV support, with acute respiratory failure and emergency airways management, especially in case of awaked and extubated patient, while in VA support cardiogenic and hypovolemic shock can occur with increased mortality.