COVID-19 and Digestive Surgical Emergencies: Experience of the General Surgery Department of Tangier University Hospital.

On March 11, 2020, the WHO declared that the epidemic of COVID-19 had become a pandemic, and this disrupted all the regulated operative programs. On the other hand and by its urgent nature, the emergency surgery was maintained with particularity in some situations, an association with infection by COVID-19. The circumstances of diagnosis of the association of infection by COVID-19 and surgical emergency are based on clinical, radiological, and biological criteria. In this work we report the experience of the University Hospital of Tangier concerning the management of three patients with the particularity of associating a covid infection and a digestive surgical emergency, we will discuss through these cases, the necessary protective measures in intraoperative and the impact of the covid infection on the morbi-mortality Concerning the impact of covid infection on postoperative morbidity and mortality, there are generally two situations: When the covid infection is benign, the prognosis depends on the severity of the surgical emergency and in this situation the prognosis is the same as for patients not infected by covid, this is the case of the first and third cases. The second situation; when the covid infection is severe, it has a great impact on the prognosis and the postoperative care in intensive care. With this publication, we are trying to provide information to help surgeons better manage this category of patients, especially in view of the panic caused by the pandemic, and the difficulty of adapting to the new patient circuit, but more studies recruiting more cases are needed to confirm our findings.

Acute Shortage Ventilator (Preprint)

UNSTRUCTURED We have implemented an Acute Shortage Ventilator (ASV) motivated by the COVID-19 pandemic and the possibility of severe ventilator shortages in the near future. The unit cost per ventilator is less than $400 US excluding the patient circuit parts. The ASV mechanically compresses a self-inflating bag resuscitator, uses a modified patient circuit, and is commanded by a microcontroller and an optional laptop. It operates in both Volume-Controlled Assist-Control mode and a Pressure-Controlled Assist-Control mode. It has been tested using an artificial lung against the EURS guidelines. The key design goals were to develop a simple device with high performance for short-term use, made primarily from common hospital parts and generally-available non-medical components, and at low cost and ease in manufacturing.

Acute Shortage Ventilator

We have implemented an “Acute Shortage Ventilator” (ASV) motivated by the COVID-19 pandemic and the possibility of severe ventilator shortages in the near future. The unit cost per ventilator is less than $400 US excluding the patient circuit parts. The ASV mechanically compresses a self-inflating bag resuscitator, uses a modified patient circuit, and is commanded by a microcontroller and an optional laptop. It operates in both Volume-Controlled Assist-Control mode and a Pressure-Controlled Assist-Control mode. It has been tested using an artificial lung against the EURS guidelines. The key design goals were to develop a simple device with high performance for short-term use, made primarily from common hospital parts and generally-available non-medical components, and at low cost and ease in manufacturing.

Application of a physical science model in the analysis of patient flow in a hospital

One of the most relevant aspects in hospital management relies on how to properly control and predict the patient flow, that is, the paths and the time sequence a whole set of patients run in their journey inside the hospital, as they look for treatment. This issue is of the utmost importance since it interferes in the quality of the healthcare delivered to a person and also has a huge impact on both the costs for the patient and the operational costs for the hospital. This work intends to collaborate with the comprehension of the patient flow analysis and to offer a mathematical model analogous to a physical model capable of, qualitatively at first sight, describing the main variables and properties of this flow. We also present the logical elements that allow the manager to develop quantitative flow evaluations adaptable to a specific institution, based on local measurements of the variables described here. This theoretical formulation can directly be applied to practical situations concerning the management of patient flow. The relevant variables and their mathematical relations can be used by the manager in order to quantify each relevant patient circuit in a hospital. This way, it is expected that recurring problems derived from the unwanted variations in the patient flow can be anticipated and corrected by the manager.

Spinal Cord Injury (SCI) Rehabilitator

The proposed device is a rehabilitation aid for the prevention of secondary diseases usually associated with Spinal Cord Injury. In such patients the calf muscles are degenerated and there is abnormality in systemic blood circulation. Thus there is a high risk of the patient being subjected to death. For faster recovery in such a patient, it is medically recommended that he or she is given continuous passive motion for a longer duration. This is done by a physiotherapist using his manual power. The movements usually given are: adduction and abduction, flexion and extension, plantar-flexion and dorsi-flexion. The outcome of such a process will be very limited as it is a laborious task. Thus the main objective behind this project is to provide continuous movement so as to improve the patient’s joint mobility and muscle flexibility thereby enhancing the blood circulation and neuro muscular activity in a low-cost technique. The device automatizes all the movements provided by a physiotherapist. Three different motors are used to control each of the movements listed. Basically, it is a mechanical model in which speed, torque, angle and time of each of the movements can be adjusted. The device is battery-powered and provides complete patient-circuit isolation and is inclusive of all patient safety parameters.

The Capnograph: Applications and Limitations —An Analysis of 2000 Incident Reports

The first 2000 incidents reported to the Australian Incident Monitoring Study were analysed with respect to the role of the capnograph. One hundred and fifty-seven (8%) were first detected by a capnograph and there were a further 18 (1%) in which capnography was contributory. Of the 1256 incidents which occurred in association with general anaesthesia 48% were “human detected” and 52% “monitor detected”. The capnograph was ranked second and detected 24% of these monitor detected incidents; this figure would have been nearly 30% if a correctly checked, calibrated capnograph had always been used. The capnograph is a “front-line” monitor for oesophageal intubation, failure of ventilation, anaesthetic circuit faults, gas embolism, sudden circulatory collapse and malignant hyperthermia. It is a valuable “back-up” monitor when other monitors (e.g. low pressure alarm, pulse oximeter) are not in use, are being used incorrectly or fail. Such situations, in order of frequency of detection were: circuit-leak, overpressure of the breathing circuit, bronchospasm, leak of ventilator-driving-gas into the patient circuit, aspiration and/or regurgitation and hypoventilation. There were 20 reports of “failure”, over two-thirds of which would not have occurred with appropriate checking and calibration. Seven were due to gas sampling problems and 6 to apnoea alarm failure. Two circuit leaks and 2 faulty unidirectional valves were not detected; on 3 occasions problems occurred due to power failure, calibration problems, or misinterpretation of an alarm. In a theoretical analysis of the 1256 general anaesthesia incidents it was considered that the capnograph, used on its own, would have detected 55% of these incidents, had they been allowed to evolve (43% before any potential for organ damage). It is highly recommended that a suitable, correctly checked, calibrated capnograph be used on all intubated and/or ventilated patients from the moment of intubation until extubation; capnography is also useful in the “apnoea” detection mode for patients breathing spontaneously on a mask.