新型冠状病毒肺炎疫情下急诊创伤骨科诊疗行为的建议和策略

目的探讨新型冠状病毒肺炎(COVID-19)疫情下急诊创伤骨科诊疗行为的建议和策略。方法回顾性分析2020年1月21日至2月15日期间武汉大学人民医院骨外科收治的128例急诊创伤骨科患者资料,男71例,女57例;年龄为5~88岁,平均48.7岁。门诊处置107例;住院手术21例,其中急诊手术4例,择期手术17例。记录患者和医务人员感染COVID-19的情况,总结疫情暴发以来实施的一些措施和经验。结果107例接受门诊处置的患者中,3例确诊COVID-19,3例疑似COVID-19。4例接受急诊手术的患者中,1例疑似COVID-19;17例接受择期手术的患者中,1例确诊COVID-19,2例疑似COVID-19。医务人员感染COVID-19的情况:2名护士确诊COVID-19,但均为轻症患者;1名医生和1名护士均疑似COVID-19。医务人员感染COVID-19均发生在疫情防控措施执行之前,不排除社区感染的可能。结论各级医疗机构在做好COVID-19防控的同时,保证安全、有效的医疗行为正常运转尤为重要。在COVID-19疫情期间,参与急诊创伤骨科的一线医务人员的接诊过程均面临诸多挑战。通过健全急诊创伤分诊流程、住院患者分类管理、住院病房优化管理、围手术期标准预防、完善落实医护防护制度、患者及陪护宣教配合等措施,可降低院内COVID-19感染发生率,在疫情期间依然可以为急诊创伤骨科患者提供优质、安全的医疗服务。     

新型冠状病毒肺炎疫情期间创伤骨科患者处理要点

新型冠状病毒肺炎疫情严峻,虽一定程度上限制了人员流动,但仍不可避免骨折患者、尤其是低能量损伤老年患者来医院就诊。在此特殊时期,创伤骨科医师应如何在常规的诊疗方式中结合新型冠状病毒肺炎的防控,做好创伤患者围手术期管理,选择合理的术式及麻醉方式,对于患者的预后及疫情的防控至关重要。在做好诊断、治疗、护理、康复等流程的同时,医务人员如何做好自身的防护,避免出现聚集性传播,也是必须要面对的问题。该文从创伤骨科医、护、患三者出发,结合多学科综合干预模式,对当前疫情期间如何做好创伤骨科患者的防治工作进行简要阐述。     

新型冠状病毒肺炎疫情期间急诊创伤骨科患者特点和处理策略

目的探讨新型冠状病毒肺炎(COVID-19)疫情期间急诊创伤患者的损伤特点和处理策略。方法回顾性分析2020年1月20日至2月26日期间南方医科大学南方医院骨科收治的22例创伤急症住院患者资料。男18例,女4例;年龄4~66岁,平均年龄35岁。致伤原因:交通伤11例,锐器切割伤(含菜刀切伤)6例,重物压砸伤1例,机器碾压伤1例,跌倒摔伤2例,机器绞伤1例;损伤类型:高能量损伤13例,低能量损伤9例;损伤部位:上肢7例,下肢15例。医护人员诊疗过程中对于无新型冠状病毒(2019-nCoV)核酸筛查结果的1例患者采用二级防护,其余21例患者采用一级防护。记录患者和医务人员感染2019-nCoV的情况,总结疫情期间创伤急症的处理措施和经验。结果在诊治22例创伤急症患者期间,无一例医务人员和患者确诊COVID-19。紧急入院未做筛查的1例患者按疑似COVID-19病例对待,采用二级防护,术后排除COVID-19。结论COVID-19疫情期间,处理创伤急症的一线医务人员接诊过程均面临较高感染风险。创伤骨科急诊患者主要是交通伤和机器伤,老年患者主要由锐器切割及跌倒引起。通过完善院前筛查、选择合适的麻醉及手术方式、做好围手术期医护人员的防护及合理的术后病房管理和患者心理疏导,可降低院内COVID-19感染发生率。     

新型冠状病毒疫情期间骨科患者手术器械消毒灭菌与管理的流程与策略

2019年12月以来,新型冠状病毒肺炎(COVID-19)已在世界多地暴发。虽然疫情在我国得到控制,随着复工复产的逐步深入,部分COVID-19患者治愈后"复阳",特别是近1个月以来,境外输入病例逐渐增多,因此疫情防控形势仍然严峻,医疗机构在未来一段时间内仍面临巨大压力。基于2016版《医院消毒供应中心清洗消毒及灭菌技术操作规范》、2012版《医疗机构消毒技术规范》、《新型冠状病毒肺炎防控方案(第五版)》及《新型冠状病毒肺炎诊疗方案(试行第六版)》等相关标准,河北医科大学第三医院消毒供应中心制定本科室"新型冠状病毒(2019-nCoV)感染复用器械处理流程、2019-nCoV感染器械回收流程、2019-nCoV感染器械转运车处理流程"等应急预案。为疫情防控期间消毒供应中心(CSSD)各项防控管理措施提供参考。     

Regional trauma patterns during the COVID-19 pandemic

BackgroundThe current pandemic has impacted heavily on health systems, making unprecedented demands on resources, and forcing reconfiguration of services. Trauma and orthopaedic units have cancelled elective surgery, moved to virtual based clinics and have been forced to reconsider the provision of trauma. Our national elective orthopaedic centre has been re-designated as a trauma centre to allow tertiary centres re-direct triaged trauma. Many governments, as part of their COVID-19 management, have significantly restricted activity of the general population. We proposed that trauma patterns would change alongside these changes and maintaining existing standards of treatment would require dedicated planning and structures.MethodsReferrals over a six-week period (March 15th to April 30th) were retrospectively reviewed. Data was collected directly from our referral database and a database populated. Analysis was performed to assess trauma volume, aetiology, and changes in trends.ResultsThere were one hundred and fifty-nine referrals from three individual hospitals within the timeframe. Mean age of patient's referred was 55 (range17–92). Males accounted for 45% of cases. F&A injuries were the most common (32%), followed by H&W (28%), UL (17%), H&F (16%) and K&T (7%). In comparison to the corresponding time-period in 2019, trauma theatre activity reduced by almost one half (45.3%)ConclusionThe majority of trauma referred to our Dublin based centre during COVID-19 related population restrictions appears to be home based and trauma volumes have decreased. Significant reductions are apparent in work and sport related injuries suggestive of compliance with COVID-19 activity guidelines. Maintaining existing standards of treatment requires dedicated planning.     

The impact of COVID-19 on foot and ankle surgery in a major trauma centre

Introduction and aimsCOVID-19 has had a significant impact on orthopaedic surgery globally. This paper aims to evaluate the impact of COVID-19 on foot and ankle trauma in a major trauma centre.MethodsA retrospective observational study of prospectively collected data was performed. All foot and ankle trauma patients over a 33 week period (1st December 2019–16th July 2020) were analysed. All patients with trauma classified by the AO/OTA as occurring at locations 43 and 81–88 were included.ResultsOver the 33 weeks analysed, there was a total of 1661 trauma cases performed; of these, only 230 (13.85%) were foot and ankle trauma cases. As percentage of cases during each period of lockdown, foot and ankle made up 15.20% (147 out of 967) pre-lockdown, 8.81% (17 out of 193) during lockdown and 13.17% (66 out of 501) post lockdown. This difference was statistically significant (p < .001). The most significant change in trauma management was the treatment of malleolar fractures.Further analysis showed that during the lockdown period 29 foot and ankle fractures were treated the same and 13 were treated differently, (i.e. 31% of fractures were treated conservatively, when the consultants preferred practice would have been surgical intervention). Of the 13 patients, 3 have had surgical management since lockdown has been eased.ConclusionIt is evident that the trauma case activity within foot and ankle was significantly reduced during the COVID-19 period. The consequences of change in management were mitigated due to a reduction in case load.     

新型冠状病毒肺炎疫情期间放射科分层防护培训机制的建立与应用

目的探讨新型冠状病毒肺炎疫情期间放射科人员分层防护快速培训机制,以提高防护技能。方法根据放射科六类人员(医生、护士、技师、工勤、保洁、安保人员)不同的工作范畴和职责对新型冠状病毒肺炎的理论知识、防护技能、制度、流程等内容进行培训,采用腾讯课堂网上教学、微信自主理论学习、现场防护技能练习、情景模拟病例演练相结合等方式,进行分层快速培训。结果六类人员经培训考核均合格后上岗。结论分层防护培训可以缩短培训时间,防止交叉感染。     

COVID-19 in spinal cord injury patients at a veterans administration hospital: A case series

ObjectiveTo describe the clinical features and disease course of COVID-19 in veterans with spinal cord injury (SCI).DesignCase series of consecutive veterans with SCI treated at a single center.SettingSCI Unit at an urban Veterans Administration hospital at the epicenter of the COVID-19 pandemic in the US.ParticipantsSeven SCI veterans with confirmed COVID-19 infection by PCR; all veterans were male, mean age was 60.6. Five had cervical level of injury, and five had complete injury (AIS A). Six veterans had a BMI > 22; three had chronic obstructive pulmonary disease; three had chronic kidney disease.InterventionsNone.Outcome MeasuresPresence of co-morbidities, diagnostic values, and clinical findings.ResultsEach case presented differently; the most common presenting sign was fever. In the three individuals with critical and fatal infection, pre-existing comorbidities were more common and inflammatory markers were markedly elevated.ConclusionLevel and completeness of SCI did not appear to correlate with COVID-19 severity, as mild and asymptomatic illness was noted in persons with high grade SCI. As has been shown to be the case in the general population, pre-existing comorbidities are the most reliable predictors of severe SARS-CoV-2 infection currently available for persons with chronic SCI. Contrary to concerns that SCI may mask the cardinal signs of COVID-19, such as fever and cough, by way of compromised thermoregulation and thoracoabdominal musculature, such signs were common in our series. To facilitate early detection, prompt treatment, and minimized viral spread, the implementation of preventive strategies by SCI units is recommended.     

新型冠状病毒肺炎疫情期间乳腺外科运行情况分析

背景与目的:尽管目前国内新型冠状病毒肺炎(COVID-19)疫情得到了有效的控制,但国外病例仍在持续增加,防控形势依然严峻。本研究以陆军军医大学第一附属医院乳腺外科为例,分析总结新型冠状病毒肺炎疫情期间综合性三甲医院乳腺外科运行情况,为疫情期间及后疫情时期安全、高效地开展乳腺外科工作提供有效参考和经验做法。方法:选取自2020年1月31日—2020年2月20日COVID-19流行期间陆军军医大学第一附属医院乳腺甲状腺外科收治的37例乳腺癌患者,对其临床特征、防护手段及治疗效果等病例资料进行回顾性分析。对患者的入院和术前准备、术中防护、术后康复等关键环节,以及医护人员自我防护及心理疏导进行方法总结。对专科治疗及疫情防控的效果进行随访研究。分析在后疫情时期如何提升对潜在传染病风险的认知,结合乳腺外科的诊治特点,从手术指征把握、气溶胶管理和诊室防护等多方面加强疫情防控和职业防护工作。结果:37例乳腺癌患者经排除COVID-19风险后均接受手术治疗,平均手术时间为(152.23±46.19)min,平均术中出血量为(85.23±23.47)mL,无术中输血病例。在37例乳腺癌患者中,有19例患者接受术前6～8周期新辅助治疗,其中7例术后证实为病理学完全缓解。术后2例出现持续发热,经过隔离、监测体温及对症支持治疗后恢复正常,新型冠状病毒核酸检测排除COVID-19感染可能。经跟踪随访,患者及陪护人员均无发热、咳嗽、乏力等COVID-19疑似表现,相关医护人员同样未出现疑似病例,总体防控效果较好。结论:在COVID-19疫情流行期间,在科学防控、竭力避免医患双方感染COVID-19的前提下,可结合当地疫情情况全力为乳腺癌患者提供有效治疗。应继续遵从"科学决策、人文服务"的精神,严格遵循上级下发的各类防控指南和管理规范,并依据实际完成乳腺癌患者的院前排查、术前准备、术中防护、术后康复等必要环节。严格在患者入院前及围手术期各环节遵循疫情防护规范、协调好疫情防控与专科诊治的关系,有利于最大限度地确保乳腺外科手术安全地完成,守护患者及医务人员的健康。     

新型冠状病毒肺炎疫情期间创伤患者急诊救治的护理管理

目的探讨新型冠状病毒肺炎疫情期间创伤患者急诊救治的护理管理策略。方法实施疫情期间创伤患者急诊救治管理,包括改造急诊外科区域、组建疫情防控管理团队、实施基于临床需求的知识培训、改进创伤急诊救治流程、实施患者的安全转运、落实医护人员防护等措施。结果截至2020年3月31日,我院接诊创伤患者644例,其中严重创伤45例,疑似和确诊新型冠状病毒肺炎患者28例,未发生医护人员及患者医院感染。结论重视并科学应对疫情,积极完善制度与流程,狠抓防控措施落实,可确保创伤患者得到及时有效救治,同时有效防范医院感染发生。     

新型冠状病毒感染肺炎背景下泌尿外科诊疗防控工作建议

2019年12月以来,湖北省武汉市发现了多例新型冠状病毒感染的肺炎(NCP)患者,随着疫情的蔓延,我国其他地区及境外也相继发现了相关病例,该病通过基因测序确定为一种新的冠状病毒,世界卫生组织(WHO)将其命名为2019冠状病毒病(Corona Virus Disease 2019,COVID-19)。该病毒传染性极强,主要通过飞沫和密切接触的途径传播,泌尿外科老年患者居多,往往伴有不同程度的基础疾病或免疫功能低下,这些特点导致感染NCP机会明显增加,且易发展为重症患者。本文从泌尿外科日常防控工作出发,结合NCP疫情相关国家政策方案及最新研究进展,制定了泌尿外科诊疗防控工作建议。     

Impact of the COVID-19 pandemic on the management of open fractures in a major trauma centre

IntroductionThe Coronavrius-19 (COVID-19) pandemic has presented the biggest challenge that the National Health Service (NHS) has ever seen. As one of the worst affected regions, Orthopaedic service provision and delivery in London, changed dramatically. Our hypothesis is that these restrictions adversely impacted the care of open fractures in our major trauma unit in London.MethodsThis is a prospective case control study comparing the management of patients presenting pre-COVID, to those presenting during the height of the COVID pandemic in London. The pre-COVID, control cohort presented between the 1st October and the November 30, 2019. The COVID cohort presented between the April 1, 2020 and the May 31, 2020. Data was collected that related to the 11 clinical domains of the British Orthopaedic Association Standards of Trauma (BOAST) 4 guidance, as well as early complications.ResultsOf the 11 domains, 100 % compliance was achieved in 6 components, across both groups where applicable. During pre-COVID times, the timing to initial debridement was within 12 h for High energy trauma in 16/28 (57.1 %), dropping to 7/22 (31.8 %) during COVID, (p = 0.004). Definitive soft tissue closure within 72 h If not achievable at initial debridement dropped from 9/10 (90.0%) to 4/6 (66.7 %), (p = 0.006). There was no significant difference in early complication rates.ConclusionCoronavirus has changed the landscape of healthcare worldwide and impacted open fracture care by increasing time to theatre. This had no effect on early complication rate but longer term effects remain to be seen.     

At the heart of COVID-19

Coronavirus disease (COVID-19) first presented in Wuhan, Hubei province, China in December 2019. Since then, it has rapidly spread across the world, and is now formally considered a pandemic. The disease does not discriminate but increasing age and the presence of comorbidities are associated with severe form of the disease and poor outcomes. Although the prevalence of COVID-19 in patients with cardiovascular disease is under-reported, there is evidence that pre-existing cardiac disease can render individuals vulnerable. It is thought that COVID-19 may have both a direct and indirect effect on the cardiovascular system; however, the primary mechanism of underlying cardiovascular involvement is still uncertain. Of particular interest is the role of angiotensin-converting enzyme 2, which is well known for its cardiovascular effects and is also considered to be important in the pathogenesis of COVID-19. With a range of different drug candidates being suggested, effective anti-virals and vaccines are an area of on-going research. While our knowledge of COVID-19 continues to rapidly expand, this review highlights recent advances in our understanding of the interaction between COVID-19 and the cardiovascular system.     

The effect of COVID-19 epidemic on the sexual function of healthcare professionals

Studies have shown that healthcare professionals struggling with epidemics develop symptoms of post-traumatic stress disorder. The aim of this study is to show how often and severely erectile dysfunction, one of the components of post-traumatic stress disorder, is seen among healthcare professionals during COVID-19 outbreak. The Impact of Event Scale-Revised (IES-R) and the Index of Erectile Function-5 (IIEF-5) were applied to 159 male healthcare professionals working in COVID-19 units and a control group of 200 people. Healthcare professional group was divided into subgroups according to occupation (physician, nurse), age-group (18–25, 26–30, >30), marital status and unit of work (Suspected Patient Area, Diagnosed Patient Area). Both stress disorder and erectile dysfunction were seen at higher rates in healthcare professionals group (p < .001). The median IIEF-5 scores of nurses, married subjects and those working in the Diagnosed Patient Area, were found to be higher (p < .001, p = .014, p = .011 respectively). During the COVID-19 outbreak, healthcare professionals are exposed to psychological trauma and their sexual function may be negatively affected. The measures to be taken are important to estimate which groups are more affected.     

Introduction of a virtual trauma meeting in response to COVID-19

IntroductionThe COVID-19 pandemic has had a huge impact on all our lives, both personally and professionally, and in many ways has been a catalyst for change. Limitations on social gathering have called the wisdom of a conventional trauma meeting into question. We have initiated our virtual trauma meeting and report our early results.Materials and methodsDaily morning trauma meetings are now conducted online. Following instigation, we collated the results of a feedback form completed online to assess the relative merits of a virtual trauma meeting.ResultsThere were 27 responses received to the electronically administered virtual trauma meeting evaluation survey, from a range of trauma and orthopaedic department personnel. There were no concerns regarding patient safety or decision making and, apart from the quality of the audio (63% dissatisfied or very dissatisfied) positive feedback outweighed negative feedback in every category. At 74%, the majority of respondents were satisfied or very satisfied overall with the virtual trauma meeting.ConclusionTrauma meetings can be safely conducted in a virtual environment with high standards of patient care maintained. Virtual trauma meeting offers service enhancements such as early subspecialty input and enhanced cross-site communication and rapid solution development to logistical difficulties. Adapting to conference call etiquette will enhance user experience and opportunity for training opportunities, but adequate investment in high-quality equipment is essential.