Professional Documents
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Orthopedic Surgeons in The Era of COVID-19
Orthopedic Surgeons in The Era of COVID-19
• In a country such as Spain , which has the highest number for HCW affection
( 14% , 15000 doctors and nurses are affected) .
• A HCW is more likey to experience a severe form of disease due to high viral loads exposure and
the subsequent cytokine storm
• 139 doctors have passed away so far in Italy due to this disease.
When you operate not knowing
the patient has the disease !!!!
Would you operate on a Covid-
19 case?
• The problem for medical professionals is often portrayed as simply one of sourcing extra masks,
goggles and plastic gowns — or personal protective equipment (PPE). But this is only part of it.
• First, the issue isn't only PPE shortages, it’s that the kind of equipment that’s used commonly
isn’t appropriate for all medical practitioners, such as many surgeons.
• Second, the absence of adequate testing, including routine checks of patients, increases the
chance that doctors will fall ill.
• And third, it seems that, when exposed, some doctors are at greater risk of being among those
who get the most serious form of the disease, like those unfortunate names on the Italian list.
Alister Hart, chair of orthopaedics at
University College London and a surgeon
at one of Britain’s largest orthopaedic
hospitals:
• “ Nearly all orthopedic surgery requires power tools, hammers and
other implements. Not to get too graphic, but lots of material gets
spread around, which could facilitate the virus’s transmission. Though
blood and gore may not be its favored route, research into airborne
transmission(such as SARS and MERS) supports the idea that Covid-19
is an opportunistic invader. Blood donors are now screened for the
virus in Wuhan.”
He continues:
• “the combination of power tools, high-velocity blood splatter and
ventilation systems , operating rooms will soon be like
Face masks (single layer and double layer) have little proven effect for
protection
• For that we need to understand this virus better and take a look
around at what other countries are doing.
Proper OR for a COVID-19
patient : AIIR
Some tips all over the world
Droplet precautions : keep your PPE on the entire time , frequent hand washing and deal
with every surface as contaminated.
Aerosol precautions ( for us mainly when a case gets intubated) do not be present in the
OR unless necessary and wear a respirator during surgery on such a case that is intubated.
When using cautery , use the minimum current( monopolar better than bipolar), vigorous
suctioning of aerosols from cautery.
Drilling and power tools are regarded as aerosol generating procedures same as
intubation and oxygenation.
From UK , ROYAL COLLEGE OF
SURGEONS
The impact of Covid-19 on the
orthopedic department
• On patients (consultations, follow-ups, electives)
Healthcare institutions and systems may make hotel accommodations available for
healthcare workers who cannot or prefer not to go home following patient care activities.
Be alert to the fact that viral contamination of surfaces is a known means of transmission of
infection.
Keep hand sanitizer and/or disposable gloves for use of ATM, vending machines, gasoline
pumps, and transfer of items at the time of purchases.
Clean your cell phone frequently before, during, and after patient care activities. Cell phones
may be kept in a Ziploc bag during work activities. The phone can be used while in the bag.
At home,
Consider removing clothes and washing them upon arrival home.