1505 EASiE: ENT and Airway Simulation in Emergencies

Aim A literature review of undergraduate ENT teaching found that most final year medical students and junior doctors did not feel adequately prepared for clinical practice in ENT. Other surveys found junior doctors lack confidence in recognising or initiating management in patients with blocked tracheostomies. To improve this, we ran a simulation session designed to replicate airway emergencies that junior doctors should be able to manage. The aim was to improve confidence in and knowledge of basic management of airway emergencies, including tracheostomies. Method Groups of 4-6 final year medical students participated in 3 scenarios: 2 tracheostomy-related and 1 partially compromised airway. The students had attended a session introducing tracheostomies and the algorithms produced by the National Tracheostomy Safety Project for tracheostomy emergencies. A semi-structured debrief followed each scenario, highlighting key learning points. The students completed a pre- and post-session questionnaire, rating confidence in several domains related to the scenarios. Results Of 24 participants, the percentage of students who felt confident or very confident in the following domains were compared pre- and post-simulation respectively: recognising a potential airway problem (0% vs 71%); identifying an altered airway (0% vs 75%); managing a potentially compromised surgical airway (4% vs 71%); initially managing a compromised airway (8% vs 67%); and identifying when to escalate with a potential airway problem (25% vs 96%). Conclusions Simulation is a valuable tool that can be used to improve both knowledge and confidence in managing potential airway problems in final year medical students. This supports findings from other studies.

Anesthesia-Related Mortality in Children: A Surgeon’s Perspective

Background: Anesthesia-related mortality refers to death resulting from the complications of anesthesia or death due to at least one anesthesia-related complication happening as a cause among the multiple causes of death. The aim of this study was to evaluate the incidence and causes of anesthesia-related mortality in pediatric patients, as experienced by a surgeon. Materials and Methods: This was a retrospective study of children aged 15 years and younger who died at the pediatric surgery unit of Enugu State University Teaching Hospital (ESUTH) Enugu, Nigeria following administration of anesthesia between January 2010 and December 2019. Results: A total of 31,210 pediatric anesthesias/surgeries were performed during the study period; out of which 78 mortalities occurred due to anesthesia. There was male predominance and the median age of the patients was 4 years with a range of 1 week to 12 years. Mortality occurred more in neonates and during emergency surgeries. Airway complications and intussusception were the most common etiology of mortality and pathology in the children respectively. About two-thirds of the deaths occurred in the operating room before commencement of the surgery. Conclusion: Anesthesia-related deaths in children in middle income country like Nigeria are higher than what is obtainable in developed countries. The risk factors for anesthesia-related mortality include male gender, neonates and emergency surgeries. Airway problem is a common cause of mortality.

MicroRNA Levels in Exhaled Breath Condensate of Patients with Esophageal Atresia

MicroRNAs (miRNAs) are noncoding RNAs that play an important role in the regulation of inflammation and have not been evaluated in exhaled breath condensates (EBC) of patients with esophageal atresia and tracheoesophageal fistula (EA–TEF). It is aimed to evaluate the levels of miRNA-21 and miRNA-24 in EBC of patients with EA–TEF. Patients who received surgery for EA–TEF (EA) were assessed for age, sex, types of anomaly, surgical treatments, and respiratory problems. A 500–1000 mL of EBC was obtained from each participant with EcoScreen. The levels of miRNA-21 and miRNA-24 in the EBC were analyzed by real-time polymerase chain reaction and compared between the EA group and the control group consisting of healthy children with no history of respiratory problems (n = 17). The levels of miRNAs in relation to respiratory problems and gastroesophageal reflux (GER) were also assessed. A total of 19 patients were enrolled in the EA group with a mean age of 7.8 ± 3.2 years and a male-to-female ratio of 10:9 EA cases had significantly lower levels of miRNA-21 (P < 0.05) compared to that in control group. The miRNA-24 levels did not differ between groups (P > 0.05). EA patients with positive pH testing for GER (n = 6) and fundoplication (n = 6) had higher levels of miRNA-21 than those with normal pH testing and without fundoplication, respectively (n = 13, P < 0.05). The levels of miRNA-21 and miRNA-24 did not differ between patients with and without proton pump inhibitor treatment (P > 0.05). The lower levels of miRNA-21 in the EBC of EA patients suggest a hyperreactive airway problem, which may be associated with GER and its surgical treatment.

Urticarial manifestation in COVID-19 infection: A case report

Background: The COVID-19 pandemic outbreak causes a worldwide health concern. As the epidemic progressed, several cutaneous manifestations are increasingly noticed; therefore, the authors hope this report will provide additional information that may benefit fellow healthcare professionals. Case report: A 45 years old Javanese female patient complained of fatigue, dry cough, dyspepsia, and reddish pruritic swelling on her face for one day. There was no fever, dyspnea, anosmia, diarrhea, or uvula, tongue, vocal cords, and the airway problem. She had no history of food or drug allergy, urticaria, other comorbidities, or any medicine consumption in the last 15 days. Facial dermatological status showed circumscribed, raised, erythematous areas of edema, slightly pruritic. Normal vital signs. Blood laboratory results: leucocyte 5.760/mL, decreased ALC 818/mL, increased NLR 5.0. Chest X-ray showed an increase in bronchovascular pattern and slight opacity on the peripheral, basal part of both hemithorax. COVID-19 rapid test was positive for IgM, and her PCR of upper-airway secretions revealed positive COVID-19 infection. The diagnoses were COVID-19 infection, dyspepsia, and urticaria. The treatments were levofloxacin, isoprinosine, chloroquine sulfate, omeprazole, fluimucyl, vitamin C, and diphenhydramine. Within three days of treatment, the urticaria started to fade off, and her overall condition improved. Conclusion: The COVID-19 poses a global challenge in the health sector, and one of its various manifestations is cutaneous symptoms. Further research is necessary to elucidate how COVID-19 triggers dermatological symptoms.

Protection of Medical Staff during Tracheotomy: Lessons Learned from the COVID-19 Pandemic

<b><i>Background:</i></b> During the ongoing pandemic of COVID-19, tracheotomy under emergency situation is considered a high-risk procedure that causes probable expose to aerosolized secretion. <b><i>Summary:</i></b> We reviewed our case and previous reports, and summarized a detailed protocol that is needed to protect medical staffs who perform tracheotomy under the COVID-19 pandemic, considering the patient’s condition, experience of medical staff members, and available facilities and equipment. <b><i>Key Messages:</i></b> For efficient protection of medical staff who perform tracheotomy under the COVID-19 pandemic period, we suggest that the following needs to be considered: assessment of patient’s condition (COVID-19 infection and the airway problem), route (safest route to the operating room), experienced surgical team, negative-pressure isolation facility and appliance (personal protective equipment) availability, and safe and appropriate post-tracheotomy care.