Challenges Faced by Healthcare Professionals during the COVID-19 Pandemic: A Review

Introduction: On March 11, 2020, the WHO formally declared the new coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks a pandemic by publishing public health guidelines to guide pandemic response. Serious illnesses may necessitate hospitalization and ventilatory assistance. The pandemic of coronavirus disease 2019 (COVID-19) has posed new concerns for healthcare workers around the world. However, in many developing nations, including India, information is scarce concerning these issues. Healthcare facilities are one-of-a-kind and difficult to understand. The Indian healthcare system consists of both governmental and private healthcare facilities. Healthcare practitioners face a variety of obstacles daily. The unexpected appearance of COVID-19 created a new threat to an already overburdened healthcare system. The pandemic altered the healthcare dilemma by introducing new employment and societal obstacles to healthcare workers. The goal of this review research is to uncover the causes of the workplace and societal issues that healthcare workers encounter.

COVID-19 cohort on children with cancer: delay in treatment and increased frequency of deaths

Objectives: to describe epidemiological characteristics and deaths in children with cancer and COVID-19 at a reference hospital in Recife, Brazil. Methods: cohort involving children under the age of 19 underwent cancer treatment during April to July 2020. During the pandemic, real-time reverse transcriptase polymerase chain reaction assay (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS -CoV-2) in nasal / oropharyngeal swab were collected in symptomatic patients or before hospitalization. Those with detectable results were included in this cohort study. The outcomes were delayed on cancer treatment and death. Descriptive analysis was performed and presented in preliminary results. Results: 48 children participated in the cohort, mostly with hematological neoplasms (66.6%.),69% were male, median age was 5.5 years. The most frequent symptoms were fever (58.3%) and coughing (27.7%);72.9% required hospitalization, 20% had support in ICU and 10.5% on invasive ventilatory assistance.66.6% of the patients had their oncological treatment postponed, 16.6% died within 60 days after confirmation of SARS-CoV-2 infection. Conclusions: COVID-19 led a delay in the oncological treatment for children with cancer and a higher mortality frequency when compared to the historical series of the service. It would be important to analyze the risk factors to determine the survival impact.

Primeiro caso de COVID-19 em uma unidade de Cuidados Paliativos oncológicos: relato de experiência

Objetivo: Relatar a experiência da assistência de Enfermagem à primeira paciente em Cuidados Paliativos oncológicos com COVID-19, no Rio de Janeiro. Método: Trata-se de estudo descritivo do tipo relato de experiência acerca da assistência de Enfermagem à paciente com COVID-19 em instituição de referência. Resultados: Durante o levantamento de dados, constatou-se que a assistência de Enfermagem é fragmentada e sem sistematização em registros e prontuário, consistindo em: vigilância do estado geral da paciente, assistência ventilatória e risco de queda. Incluíram-se medidas para aliviar o medo frente aos sintomas físicos mais expressivos. O uso da tecnologia por videochamada foi o recurso utilizado para amenizar a ansiedade. Conclusão: A abordagem da equipe de enfermagem à paciente com doença avançada e com COVID-19 se torna peculiar pela rápida evolução desta doença, tornando a assistência de enfermagem múltipla, complexa, com cuidados biopsicossocioculturais. O rápido agravamento da doença, isolamento, ausência de cuidador/familiar e risco de contaminação da equipe frente à adequação do serviço de internação hospitalar no contexto da pandemia fizeram com que a assistência de enfermagem fosse mais específica e cuidadosa. Em meio ao caos, à mistura de sentimentos e ao medo, vivenciou-se a verdadeira essência do Cuidado Paliativo.Descritores: COVID-19; Cuidado Paliativo; Enfermagem.FIRST CASE OF COVID-19 IN AN ONCOLOGICAL PALLIATIVE CARE UNIT: EXPERIENCE REPORTObjective: To report the experience of nursing care to the first patient in palliative care oncology with COVID-19, in Rio de Janeiro. Method: This is a descriptive study of an experience report about nursing care for patients with COVID-19 in a reference institution. Results: During data collection, it was found that nursing care is fragmented and without systematization in records and medical records, consisting of: surveillance of the general condition of the patient, ventilatory assistance and risk of falling. Measures to alleviate fear in the face of the most expressive physical symptoms were included. The use of technology by video call was the resource used to alleviate anxiety. Conclusion: The nursing team's approach to patients with advanced disease and with COVID-19 becomes peculiar due to the rapid evolution of this disease, making nursing care multiple, complex, with biopsychosociocultural care. The rapid worsening of the disease, isolation, absence of caregiver / family and risk of contamination of the team in view of the adequacy of the hospitalization service in the context of the pandemic made nursing care more specific and careful. In the midst of chaos, mixed feelings and fear, the true essence of Palliative Care was experienced.Descriptors: COVID-19; Palliative Care; Nursing.PRIMER CASO DE COVID-19 EN UNA UNIDAD DE CUIDADOS PALIATIVOS ONCOLÓGICOS: INFORME DE EXPERIÊNCIAObjetivo: informar la experiencia de la atención de enfermería al primer paciente en oncología de cuidados paliativos con COVID-19, en Río de Janeiro. Método: Este es un estudio descriptivo de un informe de experiencia sobre cuidados de enfermería para pacientes con COVID-19 en una institución de referencia. Resultados: Durante la recolección de datos, se encontró que la atención de enfermería está fragmentada y sin sistematización en los registros y registros médicos, que consiste en: vigilancia del estado general del paciente, asistencia respiratoria y riesgo de caídas. Se incluyeron medidas para aliviar el miedo frente a los síntomas físicos más expresivos. El uso de la tecnología por videollamada fue el recurso utilizado para aliviar la ansiedad. Conclusión: El enfoque del equipo de enfermería para pacientes con enfermedad avanzada y con COVID-19 se vuelve peculiar debido a la rápida evolución de esta enfermedad, lo que hace que la atención de enfermería sea múltiple, compleja y con atención biopsicosociocultural. El rápido empeoramiento de la enfermedad, el aislamiento, la ausencia del cuidador / familia y el riesgo de contaminación del equipo en vista de la idoneidad del servicio de hospitalización en el contexto de la pandemia hicieron que la atención de enfermería fuera más específica y cuidadosa. En medio del caos, sentimientos encontrados y miedo, se experimentó la verdadera esencia de los cuidados paliativos.Descriptores: COVID-19; Cuidados paliativos; Enfermería.

Contrast Induced Nephropathy- A Single Centre Observational Study

Background: CIN is an important cause of morbidity and mortality post cardiac procedures. Renal derangement and diabetes being the most important risk factors. Multifactorial causation of the disorder led us to study the risk factors associated with CIN. Methods: All patients who underwent cardiac procedures between March 2019 and March 2020 were screened for CIN and included in the study. Out of the 3192 patients screened 99 patients were diagnosed with CIN. Parameters such as diabetes mellitus, hypertension, CKD, anemia, duration of hospital stay, cardiogenic shock, number of stents, amount and type of contrast, Ejection Fraction, creatinine clearance before and after the procedure, concomitant nephrotoxic drugs were also recorded. Results: Ninety-nine patients developed CIN amounting to 3% of the total procedures, 11% expired, 18% required dialysis, average creatinine clearance before the procedure was 53.15 ml/min/1.73 m2 and post procedure it was 29.16 ml/min/1.73 m2, 51.5% of cases had creatinine clearance prior to procedure <60 ml/min/1.73 m2, 60.6% were diabetic, 81.8% were hypertensive, 30.3% were anaemic, 15% had heart failure, 33% required ventilatory assistance, average haemoglobin level was 11.83 mg/dl, 33% received iso-osmolar contrast and 45% had EF of 35% or less. Conclusions: CIN has a multifactorial causation most common being prior renal derangement and diabetes mellitus. This is one of a kind study in this part of country among cardiac patients. Newer biomarkers of kidney injury could also be studied in future.

Tracheostomy in the coronavirus disease 2019 patient: evaluating feasibility, challenges and early outcomes of the 14-day guidance

ObjectivesTo report feasibility, early outcomes and challenges of implementing a 14-day threshold for undertaking surgical tracheostomy in the critically ill coronavirus disease 2019 patient.MethodsTwenty-eight coronavirus disease 2019 patients underwent tracheostomy. Demographics, risk factors, ventilatory assistance, organ support and logistics were assessed.ResultsThe mean time from intubation to tracheostomy formation was 17.0 days (standard deviation = 4.4, range 8–26 days). Mean time to decannulation was 15.8 days (standard deviation = 9.4) and mean time to intensive care unit stepdown to a ward was 19.2 days (standard deviation = 6.8). The time from intubation to tracheostomy was strongly positively correlated with: duration of mechanical ventilation (r(23) = 0.66; p < 0.001), time from intubation to decannulation (r(23) = 0.66; p < 0.001) and time from intubation to intensive care unit discharge (r(23) = 0.71; p < 0.001).ConclusionPerforming a tracheostomy in coronavirus disease 2019 positive patients at 8–14 days following intubation is compatible with favourable outcomes. Multidisciplinary team input is crucial to patient selection.

Total Injectable Anesthesia of Dogs and Cats for Remote Location Veterinary Sterilization Clinic

Background : Sterilization clinics often occur in remote places where anesthesia machines and compressed oxygen are unavailable. This study describes the use of total injectable anesthesia in dogs and cats presented for sterilization in a remote location. Results: A total of 100 animals were sterilized; 26 female cats (CF), 22 male cats (CM), 28 female dogs (DF), and 24 male dogs (DM). CF were anesthetized with dexmedetomidine (20 mcg/kg), ketamine (8 mg/kg) and hydromorphone (0.1 mg/kg) IM. CM were anesthetized with dexmedetomidine (15 mcg/kg), ketamine (5 mg/kg) and hydromorphone (0.1 mg/kg) IM. Insufficient anesthesia in cats was treated with alfaxalone (1mg/kg) IM. All cats were administered meloxicam at 0.3mg/kg SQ. DF were anesthetized with dexmedetomidine (15 mcg/kg), ketamine (7-10 mg/kg) and hydromorphone (0.1 mg/kg) IM. DM were anesthetized with dexmedetomidine (15 mcg/kg), ketamine (5 mg/kg) and hydromorphone (0.1 mg/kg) IM. All dogs had IV catheter and endotracheal tube placed. If SpO 2 <90<91%, dogs had assisted ventilation via Ambu bag. Insufficient anesthesia in dogs was treated with alfaxalone (1 mg/kg) IV. All dogs were administered meloxicam at 0.2 mg/kg SQ. Following surgery, atipamezole (0.05-0.1mg/kg) IM was administered to any patient that did not have voluntary movement. All patients survived and were discharged. Less than 25% of cats and male dogs required supplemental anesthesia. Fifty seven percent of female dogs required supplemental anesthesia. More than 89% of patients (in any group) required atipamezole administration. One cat recovered with agitation and hyperthermia (41.1C/ 106F). Some dogs required ventilatory assistance to remain normoxemic while anesthetized. Conclusion: Total injectable anesthesia can be accomplished for remote location sterilization clinics with minimal morbidity.

Cross mapping between clinical indicators for assistance in intensive care and nursing interventions

ABSTRACT Objective: Identify the main clinical indicators for assistance in the Intensive Care Unit (ICU) and map them in the nursing interventions described by the Nursing Interventions Classification (NIC). Methods: Integrative literature review study, followed by cross-mapping between clinical indicators for assistance in the ICU care and NIC nursing interventions and activities. Results: 36 articles were identified, which resulted in 285 clinical indicators for ICU care, with mechanical ventilatory assistance, pain, sedation, psychomotor agitation, delirium, anxiety, altered heart rate, diet by naso tube / oroenteral and diarrhea the clinical indicators for assistance in the ICU the most prevalent. These were mapped in 12 Nursing Interventions Classification interventions and 130 nursing activities. Final considerations: It is concluded that the clinical indicators for ICU care associated with Nursing Interventions Classification are concrete data that assist intensive care nurses in their clinical practice.

Total Injectable Anesthesia of Dogs and Cats for Remote Island Veterinary Sterilization Clinic

Background: Sterilization clinics may occur in remote places where anesthesia machines and compressed oxygen are unavailable. This study evaluated the efficacy of total injectable anesthesia in dogs and cats presented for sterilization on Isabela Island, Galápagos, Ecuador. Results: A total of 100 animals were sterilized; 26 female cats (FC), 22 male cats (MC), 28 female dogs (FD), and 24 male dogs (MD). FC were anesthetized with dexmedetomidine (20 mcg/kg), ketamine (8 mg/kg) and hydromorphone (0.1 mg/kg) IM. MC were anesthetized with dexmedetomidine (15 mcg/kg), ketamine (5 mg/kg) and hydromorphone (0.1 mg/kg) IM. Inadequate anesthesia in cats was treated with alfaxalone (1mg/kg) IM. All cats were administered meloxicam at 0.3mg/kg SQ. FD were anesthetized with dexmedetomidine (15 mcg/kg), ketamine (7-10 mg/kg) and hydromorphone (0.1 mg/kg) IM. MD were anesthetized with dexmedetomidine (15mcg/kg), ketamine (5 mg/kg) and hydromorphone (0.1 mg/kg) IM. All dogs had IV catheter and endotracheal tube placed. If SpO2<90%, dogs had assisted ventilation via Ambu bag. Inadequate anesthesia in dogs was treated with alfaxalone (1mg/kg) IV. All dogs were administered meloxicam at 0.2 mg/kg SQ. Following surgery, atipamezole (0.05-0.1mg/kg) IM was administered to any patient that did not have voluntary movement. All patients survived and were discharged. Less than 25% of cats and male dogs required supplemental anesthesia. Fifty seven percent of female dogs required supplemental anesthesia. More than 89% of patients (in any group) required atipamezole administration. One cat recovered with agitation and hyperthermia (41.1C/ 106F). Some dogs required ventilatory assistance to remain normoxemic while anesthetized. Conclusion: Total injectable anesthesia can be accomplished for remote location sterilization clinics with minimal morbidity.

DOZ047.86: Open tracheostomy vs percutaneous tracheostomy in pediatrics

Introduction Tracheostomy is one of the most frequent surgical procedures in chronically ill pediatric patients and mechanical ventilatory assistance. The most widely used technique is open; however, the percutaneous technique guided by endoscopy is becoming increasingly common. Due to the current controversy, this study presents our experience in both techniques. Methodology Retrospective and descriptive analysis was carried out of 100 patients selected between 2010 and 2017. They were divided into two groups: open tracheostomy (TA) and percutaneous tracheostomy (PT), with 50 patients each according to the technique used. The age, diagnosis, indication of tracheostomy, days of intubation, endoscopic findings, cannula size, surgical time, intraoperative complications, and definitive decannulation were analyzed. A bibliographic review was also carried out. Results and Discussion The main indication for tracheostomy in both groups was prolonged orotracheal intubation (TA group 78% and TP group 82%). Children who underwent percutaneous tracheostomy were older in age (median age of 9 years for TA group and 2.5 years for PT group). There were no significant differences regarding the days of previous intubation: 19 days for the TA group and 13 days for the TP group. Weaning was achieved before mechanical ventilation for the TP group (7 days in the TP group and 19 days in the TA group). The surgical time was almost 50% less for the TP group (TA group 80 minutes and TP group 45 minutes). There were no intraoperative complications in any group. Distant complications were more frequent in the TA group (34%). Definitive decannulation was achieved in 17 patients in the TA group (34%) and in 19 patients in the TP group (38%). The long-term follow-up was performed for 8 months by the TA group (r: 1–36 m) and 9 months by the TP group (r: 1–48 m). Conclusions Percutaneous tracheostomy is feasible in children. Simultaneous endoscopic vision is recommended for the control of complications during the procedure. At the same time it allows us to diagnose preexisting injuries. The size of the tracheostomy kit should be adjusted to the age of the patient and the size of the tracheostomy cannula to perform a safe tracheostomy.