| Autor: |
COURTNEY, JEREMY, ABRAHAM III, GEORGE E., SPURZEM, JOHN R., WILHELM, ANDREW M., ALDRED, L. WESLEY, COILE, CLIFFORD, MOREHEAD, BENJAMIN, HARVEY, JESSIE |
| Předmět: |
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| Zdroj: |
Journal of the Mississippi State Medical Association; Nov/Dec2020, Vol. 61 Issue 11, p388-392, 5p |
| Abstrakt: |
With the arrival of SARS-CoV-2 in Mississippi, procedures were instituted to manage a new disease and a potentially overwhelmed critical care system. Initial strategies emphasized early intubation and empiric use of macrolides and hydroxychloroquine based on anecdotal reports from other countries. Patient exposure was limited to key personnel. As the pandemic has matured, so have our clinical practices. Today, hypoxemic respiratory failure is managed with supplemental oxygen, delaying intubation until we have exhausted noninvasive options. Video laryngoscopy minimizes physician proximity to the oropharynx, coupled with rapid sequence intubation to maximize first-pass success. Management ot acute respiratory distress syndrome (ARDS) includes low tidal volume, low plateau pressure, and weaning PEEP and FiO, as per the ARDSNet protocol. Prone positioning has been utilized and extracorporeal membrane oxygenation (ECMO) offered toaselect few. Similarities between the cytokine storm associated with the SARS-CoV-2 and that of hemophagocytic syndrome led to IL-6 receptor inhibitors in select patients. Direct treatment of the infection has been limited to clinical trials. The coagulopathy of COVID-19 is addressed with an escalating anticoagulation protocol. Discontinuation of isolation follows the Center of Disease Control (CDC) and the Mississippi State Department ot Health guidelines. Tracheostomy is now common. The arrival of COVID-19 to Mississippi has presented challenges. The initial reliance on anecdotes and seemingly unique features of this disease has been mostly replaced with evidence-based treatments and a focus on the similarities to known conditions. While we await new therapeutics and a vaccine, we can serve our patients best by adhering to established practices. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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