El objetivo del presente informe fue medir el tiempo de reacción de un operador ante distintos estímulos, y así poder hallar, por medio del análisis estadístico, el tiempo de reacción promedio, como así también la incertidumbre de lo medido (desviación estándar). Para ello fue utilizado un cronómetro, el cual era encendido y apagado a máxima velocidad, y en otro caso medir el periodo de dos intermitencias del faro. Mediante los datos obtenidos, se construyeron histogramas con el fin de analizarlos. Obteniendo el tiempo de reacción del operador y el error del mismo. Además, visualizando en la comparación de los histogramas de la segunda experiencia que la incertidumbre no es influida por el número de mediciones, sino de los resultados variables de la misma, mientras que el error absoluto disminuye cuanto mayor es el número de mediciones.
A 57-year-old man was diagnosed with acute aortic dissection (AAD), but had marked infiltration shadows in his right lung. Intraoperative findings showed that large subadventitial hematomas had spread from the ascending aorta to the right pulmonary artery, which may have caused the infiltration of the lung. Subadventitial hematoma must be considered in rare cases of AAD with pulmonary infiltration.
Orleans Parish in Louisiana is in the midst of an exponentially increasing number of patient admissions with COVID-19 and respiratory symptoms. Patients have been described having CT findings most consistent with an Early stage (< 7 days from symptoms onset) or an Advanced stage (8-14 days from symptoms onset).We describe and illustrate those Early and Advanced stage CT findings from patients with documented COVID-19 who have been admitted to University Medical Center in New Orleans, Louisiana.
Lung ultrasound (LU) has rapidly become a tool for assessment of patients stricken by the novel coronavirus 2019 (COVID-19). Over the past two and a half months (January, February and first half of March 2020) we have used this modality for identification of lung involvement along with pulmonary severity in patients with suspected or documented COVID-19 infection. Use of LU has helped us in clinical decision making and reduced the use of both chest x-rays and computed tomography (CT).
The 2019 novel coronavirus disease (COVID-19) is a highly contagious zoonosis produced by SARS-CoV-2 that is spread human-to-human by respiratory secretions. It was declared by the WHO as a public health emergency. The most susceptible populations, needing mechanical ventilation, are the elderly and people with associated comorbidities.There is an important risk of contagion for anesthetists, dentists, head and neck surgeons, maxillofacial surgeons, ophthalmologists and otolaryngologists. Health workers represent between 3.8% to 20% of the infected population; some 15% will develop severe complaints and among them, many will lose their lives. A large number of patients do not have overt signs and symptoms (fever/respiratory), yet pose a real risk to surgeons (who should know this fact and must therefore apply respiratory protective strategies for all patients they encounter).All interventions that have the potential to aerosolize aerodigestive secretions should be avoided or used only when mandatory. Health workers who are: pregnant, over 55-65 years of age, with a history of chronic diseases (uncontrolled hypertension, diabetes mellitus, chronic obstructive pulmonary diseases and all clinical scenarios where immunosuppression is feasible, including that induced to treat chronic inflammatory conditions and organ transplants) should avoid the clinical attention of a potentially infected patient. Healthcare facilities should prioritize urgent and emergency visits and procedures until the present condition stabilizes; truly elective care should cease and discussed on a case-by-case basis for cancer patients.For those who are working with COVID-19 infected patients’ isolation is compulsory in the following settings: a) unprotected close contact with COVID-19 pneumonia patients: b) onset of fever, cough, shortness of breath and other symptoms (gastrointestinal complaints, anosmia and dysgeusia have been reported in a minority of cases).For any care or intervention in the upper aerodigestive tract region, irrespective of the setting and a confirmed diagnosis (e.g.; rhinoscopy or flexible laryngoscopy in the outpatient setting and tracheostomy or rigid endoscopy under anesthesia) it is strongly recommended that all healthcare personnel wear personal protective equipment (PPE) such as N95, gown, cap, eye protection and gloves.The procedures described are essential in trying to maintain safety of healthcare workers during COVID-19 pandemic. In particular, otolaryngologists, head and neck, and maxillofacial surgeons are per se exposed to the greatest risk of infection while caring for COVID-19 positive subjects, and their protection should be considered a priority in the present circumstances.
Respiratory complications have been well remarked in the novel coronavirus disease (SARS-CoV-2/COVID-19), yet an emerging body of research indicates that cardiac involvement may be implicated in poor outcomes for these patients. This review seeks to gather and distill the existing body of literature that describes the cardiac implications of COVID-19. Notably, COVID-19 patients with pre-existing cardiovascular disease are counted in greater frequency in intensive care unit settings, and ultimately suffer greater rates of mortality. Other studies have noted cardiac presentations for COVID-19, rather than respiratory, such as acute pericarditis and left ventricular dysfunction. In some patients there has been evidence of acute myocardial injury, with correspondingly increased serum troponin I levels. With regard to surgical interventions, there is a dearth of data describing myocardial protection during cardiac surgery for COVID-19 patients. Although some insights have been garnered in the study of cardiovascular diseases for these patients, these insights remain fragmented and have yet to cement clear guidelines for actionable clinical practice. Further studies are imperative for a more cohesive understanding of the cardiac pathophysiology in COVID-19 patients to promote more informed treatment and, ultimately, better clinical outcomes.
Published in Journal of Cardiovascular Electrophysiology. DOI forthcoming.Author list and affiliationNorman C. Wang, MD, MS; Sandeep K. Jain, MD; N.A. Mark Estes III, MD; William W. Barrington, MD; Raveen Bazaz, MD; Aditya Bhonsale, MD, MHS; Krishna Kancharla, MBBS; Alaa A. Shalaby, MD, MSc; Andrew H. Voigt, MD; Samir Saba, MD Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PennsylvaniaAuthor disclosures: Dr. Wang serves as a consultant for Abbott. Dr. Jain serves as a consultant for Medtronic, receives research support from Medtronic, and is a research investigator for Abbott, Boston Scientific, and Medtronic. Dr. Estes serves as a consultant for Abbott, Boston Scientific, and Medtronic. Dr. Saba receives research support from Abbott and Boston Scientific. The remaining authors have nothing to disclose. University of Pittsburgh Medical Center receives institutional cardiac electrophysiology fellowship support from Abbott, Boston Scientific, and Medtronic.Funding: This manuscript did not receive any specific grant(s) from funding agencies in the public, commercial, or not-for-profit sectors.Proposed Tweet: Priority plan for invasive cardiac EP procedures during the COVID-19 pandemic. #EPeeps #COVID19
In December 2019, the world started to face a new pandemic situation, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although COVID-19 clinical manifestations are mainly respiratory, major cardiac complications are being reported. Cardiac manifestations etiology seems to be multifactorial, comprising direct viral myocardial damage, hypoxia, hypotension, enhanced inflammatory status, ACE2-receptors downregulation, drug toxicity, endogenous catecholamine adrenergic status, among others. Studies evaluating COVID-19 patients presenting cardiac injury markers show that it is associated with poorer outcomes, and arrhythmic events are not uncommon. Besides, drugs currently used to treat the COVID-19 are known to prolong the QT interval and can have a proarrhythmic propensity. This review focus on COVID-19 cardiac and arrhythmic manifestations and, in parallel, makes an appraisal of other virus epidemics as SARS-CoV, MERS-CoV, and H1N1 influenza.
The COVID-19 pandemic has placed an extraordinary demand on the United States healthcare system. Many institutions have cancelled elective and non-urgent procedures to conserve resources and limit exposure. While operational definitions of elective and urgent categories exist, there is a degree of surgeon judgment in designation. In the present commentary, we provide a framework for prioritizing head and neck surgery during the pandemic. Unique considerations for the head and neck patient are examined including risk to the oncology patient, outcomes following delay in head and neck cancer therapy, and risk of transmission during otolaryngologic surgery. Our case prioritization criteria consist of four categories: urgent – proceed with surgery, less urgent – consider postpone > 30 days, less urgent – consider postpone 30–90 days, and case-by-case basis. Finally, we discuss our preoperative clinical pathway for transmission mitigation including defining low-risk and high-risk surgery for transmission and role of preoperative COVID-19 testing.