Recomendaciones para la realización de procedimientos quirúrgicos de urgencia, emergencia, trauma y cuidados críticos ante la situación de pandemia por COVID-19

doi:10.25132/raac.v112.n3.1531.es

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Revista argentina de cirugía

versión impresa ISSN 2250-639Xversión On-line ISSN 2250-639X

Rev. argent. cir. vol.112 no.3 Cap. Fed. jun. 2020

http://dx.doi.org/10.25132/raac.v112.n3.1531.es

Articles

Recommendations for the management of emergency surgery, trauma and critical care procedures in the context of the covid-19 pandemic

Comisión de Trauma, Urgencias, Emergencias y Cuidados Críticos, Asociación Argentina de Cirugía

Introduction

Conditions requiring emergency surgery and trauma care are still common in emergency systems and require immediate evaluation and timely resolu tion even during a pandemic as is currently happening with COVID-19, a scenario that threatens to affect their capacity to provide care⁵^,⁸. In these cases, certain mea sures must be taken for the special care of health care workers and their patients, who are often admitted in critical condition and require an immediate surgical in tervention that does not allow for any delay. For this purpose, an algorithm should be developed with re commendations which include a checklist to guide sur geons working in emergency and trauma systems about the issues to consider for the appropriate management and treatment of these conditions and for preparation of perioperative environments during the COVID-19 pandemic. The ultimate goal is to maintain adequa te care with the necessary and required protection in each case⁵^,⁸^,¹¹, raising awareness of the importance of preserving capacity to respond to these conditions that routinely occur in our community⁵.

Figure 1 Algorithm suggested for the management of emergency surgery or trauma in an emergency department during the COVID-19 pandemic²^,³^,⁶^,⁹^,¹⁷^,¹⁸^,²⁰. SX, surgery; PPE, personal protection equipment; RX, radiography; CT-scan, computed tomographic scan; NST, non-surgical treatment; TR, treatment; US, ultrasonography.

Figure 2 Surgical checklist for COVID-19 suspected or positive patients¹⁰^,¹⁵^,¹⁹

Recommendations:

▪▪Evaluate the epidemiological situation in each region and the alert phase of the institution¹^,²^,¹³.

▪▪Provide permanent training in donning and doffing of personal protective equipment (PPE) and use of chec klists by a trained external observer²^,⁷^,¹⁴^,¹³.

▪▪A minimum number of staff with the highest level of training should be available to perform surgical pro cedures²^,³^,⁶^,¹⁸.

▪▪Evaluate the possibility of performing non-surgical treatments or implementing non-invasive conserva tive treatments²^,³^,⁶^,⁹. Ensure that the surgical team enters the operating room after the patient has been intubated and the instrument table has been prepa red. Two scrub persons are needed, one for instru mentation and other for assistance. The surgeons are the last ones to enter the operating room²^,³.

▪▪Computed tomography (CT) scan of the chest, if avai lable, is the imaging test of choice followed by lung ultrasound, while chest X-ray is the third option as screening tool³^,⁶^,¹⁸. The use of bactericidal filters is recommended when performing high-risk aerosol ge nerating procedures² with aspiration of surgical smoke using a suction system connected to a bi-tubular con tainer with sodium hypochlorite solution³^,⁴^,⁶^,¹²^,¹⁶.

▪▪If it is not possible to ensure the correct aspiration and filtering of aerosols during the surgical procedure, evaluate performing conventional surgery to solve the surgical condition³^,⁴^,⁶^,¹²^,¹⁶.

Conclusions

The emergency and trauma care departments have to adapt to the current situation of the COVID-19 pandemic in the same way as the rest of the health sys tem, while providing appropriate care and treatment to patients who require this type of medical care. Howe ver, it is necessary to consider and prioritize certain recommendations during the management of patients with diseases requiring immediate surgery and about how to choose of the most appropriate treatment, while offering the highest protection and safety to the healthcare workers and patients, with the greatest in tention of reducing the risks of viral transmission. The Commission on Trauma, Emergency and Critical Care of Asociación Argentina de Cirugía has prepared this guideline with recommendations to provide surgeons working in the emergency systems with a series of mea sures to deliver adequate care with proper protection.

Referencias bibliográficas /References

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