In the battle to overcome the CoV-2 pandemic, I exist in 3 essential medical/scientific roles. These include lead EMT of the CoV Rapid Response team, Lab research and development and an undergraduate Biochemist, and CoV Anesthesia Unit as an Anesthesia technician. Addressed is the 2 direct medical positions I hold; EMT and Anesthesia technician.
Out on the field as a pre-hospital medical professional, we are directly exposed to both the uncertainty of any contagious disease and the disease itself, and at this time, Covid19. When we respond to a possible Covid case, which is classified under respiratory complications and any inflammatory response particularly fever, we exercise advanced PPE inclusive but not limited to gloves, splash proof goggles, N95 or p100 grade masks, a 0.3 micron procedural mask to protect n95, and hazmat gowns. Each patient is screened on initial assessments which encompasses vitals, pain assessment, lung function and most importantly, events leading up to the 911 call. This helps us gauge whether we need to advise patients to self quarantine, transport to the hospital or advanced life support units.
Now out of the field and into the extreme end of the emergency medical hierarchy; Anesthetic care. This sector will be divided into 3 parts: Emergency anesthesia response, Interventions of the respiratory and cardiovascular systems, and isolation.
Emergency anesthesia responses for CoV patients usually come about under Emergency room critical patients or an on-floor decompensating patient. In the emergency room, The Anesthesia CoV team gets paged to a new patient that arrived with either a critically low lung function, a desaturating blood oxygen level below 80% or 20% below their normal levels, coughing/laryngopharyngeal closing, or all of these. This classifies them as highly critical and requires immediate intervention of the respiratory and cardiovascular system. When these calls come in, the equipment we tag along includes a Covid response kit, PAPR system, general anesthetic agents and RSI medications, the intubation Glidescope and a team minimum of 3 members (usually an Anesthesiologist, a CRNA and an Anesthesia Technician).
After all members suit up with advanced PPE, they make contact with the patient. These PPE are surgical hat, gloves, splash proof goggles, N95 mask or p100 filtered mask, 0.3 micron procedural mask to protect N95, surgical gown under a synthetic splash proof surgical jacket and a Powered Air Purifying Respirator hood (PAPR). When the patient is contacted by the suited-up team, vitals are reassessed and compared with initial assessments by unit persons, and these numbers usually have worsened. Before intubation, the patient is administered a sedative anesthetic agent according to weight. That medication is usually Propofol. With the neuromuscular junctions compromised by use of additional paralytic agents such as succinylcholine, the patient can no longer breathe for themselves, so an endotracheal tube is placed in the airway. To access the trachea, the intubating practitioner uses a camera assisted device called a glidescope. This provides visuals of the throat behind the tongue, exposing the vocal cords and laryngopharyngeal opening. The tube size is chosen based on the size of the patient’s opening. After the tube is placed, high flow oxygen is immediately administered to fully fill the lungs with positive pressure, ultimately reoxygenating the patent’s blood oxygen level and PO2. The high flow serves as a means to keep the lungs open to its full capacity, prevent filling of fluids and prevent the destruction of the alveoli and bronchioles, conditions Covid induces. This essentially triggers the lung’s repair mechanism of fibrogenesis. The connective tissues that regenerate usually are extensive and compromises the placisiticity of the lungs, developing fibrosis. After the respiratory intervention, cardiovascular monitoring assesses arterial pressure through a Radial Arterial Line, and Venous IV through Central lines. An arterial line is a thin catheter inserted into the artery in most common intensive care medical practices including anesthesia. The line allows for a direct monitoring of the arterial blood pressure and can access the blood for blood gas and biochemical analysis at any given time. The central line is mainly for direct IV administration of medications and fluids when needed. Each of these interventions are monitored outside of the isolation room, reducing the exposure of a medical personnel to the CoV patient.
Since an intubated patient receives high flow oxygen therapy, this classifies them as a very high exposure case. The high flow oxygen aerosolized the droplets and it is imperative that these patients are contained in a pressured isolation room. The isolation of these patients consists of monitoring of the respiratory system under general anesthesia, which is administered through the central line access port. The vitals and condition of the patient are read through an EKG monitor and ventilator, each of which is visible from outside of the room.
As a member of multiple levels of care for Covid19 patients, I would always encourage people to use precautions and stay inside. The majority of patients that show up to the ER whispers their last words before being sedated. These include words like “should’ve listened to the warnings” and “I neglected my health for too long”. If you are faced with any symptoms, monitor at home in isolation, and treat symptoms with the instructions of a medical practitioner, whether a general physician or a family doctor. Coming to the ER for mild symptoms triggers a response team that is specialized for very advanced care. This expends resources and should be considered before a decision to show up at a hospital is made. The screening of EMS and emergency teams greatly help the efficiency and control of this pandemic. Please be safe, and do your part in this historical battle, and remember, the healthcare force is only as efficient as the information the public gets and how they use it.