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Травматология и ортопедия России. 2020; 26: 9-14

Травматологическая помощь в условиях пандемии COVID-19

Ситник А. А., Мурзич А. Э., Волотовский П. А., Герасименко М. А.

https://doi.org/10.21823/2311-2905-2020-26-2-9-14

Аннотация

Развивающаяся пандемия COVID-19 является испытанием на прочность для системы травматологической помощи по всему миру. На основании международного опыта в статье приводятся рекомендации по общей организации лечения у пациентов с костно-суставными повреждениями, а также по защите медицинского персонала и пациентов от распространения вируса при оказании медицинской помощи. Рекомендуется полное прекращение плановой госпитализации, ограничение госпитализации пациентов с относительными показаниями к хирургическому лечению переломов. Важным является разделение потоков пациентов на COVID-положительных (или подозрительных) и COVID-отрицательных. При возможности отсрочки перед госпитализацией в стационар пациент должен быть обследован на COVID-19. При неясном COVID-статусе пациента и невозможности отсрочки требуется максимальное соблюдение мер предосторожности: изоляция пациента и использование средств индивидуальной защиты. Для ограничения распространения вируса в коллективе рекомендуется разделение персонала травматологического стационара на 2–3 изолированных друг от друга бригады, каждая из которых работает в течение недели с последующим периодом изоляции в течение 1–2 нед. При хирургическом лечении пациента с COVID-19 наиболее опасными этапами являются интубация/экстубация, а также так называемые аэрозоль-генерирующие манипуляции: использование электрокоагулятора, осциллирующей пилы, промывание раны пульсирующей струей, сверление кости, рассверливание костномозгового канала. Персонал операционной должен иметь защиту соответствующего уровня. Факторами риска заболеваемости медицинского персонала являются переутомление, отсутствие личного обучения использованию средств индивидуальной защиты и пренебрежительное отношение к ним.
Список литературы

1. Vannabouathong Ch., Devji T., Ekhtiari S., Chang Y., Phillips S.A., Zhu M. et al. Novel Coronavirus COVID-19 Current Evidence and Evolving Strategies. J Bone Joint Surg Am. 2020 Apr 1. doi: 10.2106/JBJS.20.00396. [Epub ahead of print].

2. Ashford R.U., Nichols J.S., Mangwani J. Annotation: The COVID-19 pandemic and clinical orthopaedic and trauma surgery. J Clin Orthop Trauma. 2020 Apr 2. doi: 10.1016/j.jcot.2020.04.002. [Epub ahead of print].

3. Yeh H.C., Jones R.K., Muggenburg B.A., Turner R.S. Characterization of aerosols produced during surgical procedures in hospitals. Aerosol Sci Technol. 1995;22(2):151-116. doi: 10.1080/02786829408959736.

4. Stinner D.J., Lebrun C., Hsu J.R., Jahangir A.A., Mir H.R. The Orthopaedic Trauma Service and COVID-19 — Practice Considerations to Optimize Outcomes and Limit Exposure. J Orthop Trauma. 2020 Apr 13. doi: 10.1097/BOT.0000000000001782. [Epub ahead of print].

5. Wen X., Li Y. Anesthesia Procedure of Emergency Operation for Patients with Suspected or Confirmed COVID-19. Surg Infect (Larchmt). 2020;21(3):299. doi: 10.1089/sur.2020.040.

6. Lei S., Jiang F., Su W., Chen C., Chen J., Mei W. et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine. 2020 Apr 5:100331. doi: 10.1016/j.eclinm.2020.100331. [Epub ahead of print] .

7. Ding B.T.K., Soh T., Tan B.Y., Oh J.Y., Mohd Fadhil M.F.B., Rasappan K., Lee K.T. Operating in a Pandemic: Lessons and Strategies from an Orthopaedic Unit at the Epicenter of COVID-19 in Singapore. J Bone Joint Surg Am. 2020 May 6. doi: 10.2106/JBJS.20.00568. [Epub ahead of print].

8. Iannuzzi N., Lack W., Gee A., Chansky H. An Orthopaedic Department’s Response to the COVID-19 Health-Care Crisis. Indirect and Direct Actions with Thoughts for the Future. J Bone Joint Surg Am. 2020 May 5. doi: 10.2106/JBJS.20.00611. [Epub ahead of print].

9. Chang Liang Z., Ye Chong M.S., Sim M.A., Lim J.L., Castañeda P., Green D.W. et al. Surgical Considerations in Patients with COVID-19: What Orthopaedic Surgeons Should Know. J Bone Joint Surg Am. 2020 Apr 24. doi: 10.2106/JBJS.20.00513. [Epub ahead of print].

10. Mi B., Chen L., Xiong Y., Xue H., Zhou W., Liu G. Characteristics and Early Prognosis of COVID-19 Infection in Fracture Patients. J Bone Joint Surg Am. 2020 Apr 1. doi: 10.2106/JBJS.20.00390. [Epub ahead of print].

11. Guo X., Wang J., Hu D., Wu L., Gu L., Wang Y. et al. Survey of COVID-19 Disease Among Orthopaedic Surgeons in Wuhan, People’s Republic of China. J Bone Joint Surg Am. 2020 Apr 8. doi: 10.2106/JBJS.20.00417. [Epub ahead of print].

12. Mi B., Xiong Y., Lin Z., Panayi A., Chen L., Liu G. COVID-19 Orthopaedic Safe Care Toolset. Guidelines for the Diagnosis and Management of Patients with Fracture and COVID-19. J Bone Joint Surg Am. 2020 May 5. doi: 10.2106/JBJS.20.00532. [Epub ahead of print].

13. Schwartz A., Wilson J., Boden S., Moore T., Bradbury T., Fletcher N. Managing resident workforce and education during the COVID-19 pandemic. JBJS Open Access. 2020;5(2):e0045. doi: 10.2106/JBJS.OA.20.00045.

14. Coimbra R., Edwards S., Kurihara H., Bass G.A., Balogh Z.J., Tilsed J. et al. European Society of Trauma and Emergency Surgery (ESTES) recommendations for trauma and emergency surgery preparation during times of COVID-19 infection. Eur J Trauma Emerg Surg. 2020 Apr 17:1–6. doi: 10.1007/s00068-020-01364-7. [Epub ahead of print].

15. Wax R.S., Christian M.D. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anaesth. 2020;67(5):568-576. doi: 10.1007/s12630-020-01591-x.

16. Rodrigues-Pinto R., Sousa R., Oliveira A. Preparing to Perform Trauma and Orthopaedic Surgery on Patients with COVID-19. J Bone Joint Surg Am. 2020 Apr 10. doi: 10.2106/JBJS.20.00454. [Epub ahead of print]

17. Viswanath A., Monga P. Working through the COVID-19 outbreak: Rapid review and recommendations for MSK and allied heath personnel. J Clin Orthop Trauma. 2020 Mar 26. doi: 10.1016/j.jcot.2020.03.014. [Epub ahead of print].

18. Tingbo L. Handbook of Covid-19 Prevention and Treatment. Hangzhou: Zhejiang University School of Medicine; 2020. Available from: https://gmcc.alibabadoctor.com/prevention-manual#prevention_manual

19. COVID 19: Considerations for Optimum Surgeon Protection Before, During, and After Operation. Available from: https://www.facs.org/covid-19/clinical-guidance/surgeon-protection.

Traumatology and Orthopedics of Russia. 2020; 26: 9-14

Trauma Care in COVID-19 Pandemic

Sitnik A. A., Murzich A. E., Volotovski P. A., Gerasimenko M. A.

https://doi.org/10.21823/2311-2905-2020-26-2-9-14

Abstract

The development of COVID-19 pandemic is the serious challenge for trauma care systems across the world. Recommendations on general principles of trauma care in the settings of pandemic, medical stuff protection and prevention of the spread of infection based on the data from international centers are presented in the article. Delay of all elective cases, restriction of surgical treatment of fractures with relative indications for surgery are recommended. The segregation of cases into COVID-19 confirmed or suspected and COVID-19 negative patients is important. When possible before the admission to in-patient department the patient shall be tested on COVID-19. When the COVID-19 status of the patient is unclear all possible protection measures shall be used: patient isolation and medical stuff protection. To prevent the spread of infection it is recommended to split the stuff of the traumacenter into 2 or 3 groups. Each of the groups is working during the week with subsequent period of the self-isolation (remote work) for the period of 1-2 weeks (according to the duration of incubation period of the COVID-19). During the surgical treatment the most dangerous stages of the surgery are endotracheal intubation / extubation and also aerosol-generative procedures: electrocoagulation, pulsed wound lavage, drilling, the use of oscillating saw and medullary reaming. The stuff in the OP-theatre has to be accordingly equipped (personal protection equipment). The risk factors for the medical stuff are fatigue from overwork, the absence of real-time training in infection-prevention measures and non-compliance with PPE.
References

1. Vannabouathong Ch., Devji T., Ekhtiari S., Chang Y., Phillips S.A., Zhu M. et al. Novel Coronavirus COVID-19 Current Evidence and Evolving Strategies. J Bone Joint Surg Am. 2020 Apr 1. doi: 10.2106/JBJS.20.00396. [Epub ahead of print].

2. Ashford R.U., Nichols J.S., Mangwani J. Annotation: The COVID-19 pandemic and clinical orthopaedic and trauma surgery. J Clin Orthop Trauma. 2020 Apr 2. doi: 10.1016/j.jcot.2020.04.002. [Epub ahead of print].

3. Yeh H.C., Jones R.K., Muggenburg B.A., Turner R.S. Characterization of aerosols produced during surgical procedures in hospitals. Aerosol Sci Technol. 1995;22(2):151-116. doi: 10.1080/02786829408959736.

4. Stinner D.J., Lebrun C., Hsu J.R., Jahangir A.A., Mir H.R. The Orthopaedic Trauma Service and COVID-19 — Practice Considerations to Optimize Outcomes and Limit Exposure. J Orthop Trauma. 2020 Apr 13. doi: 10.1097/BOT.0000000000001782. [Epub ahead of print].

5. Wen X., Li Y. Anesthesia Procedure of Emergency Operation for Patients with Suspected or Confirmed COVID-19. Surg Infect (Larchmt). 2020;21(3):299. doi: 10.1089/sur.2020.040.

6. Lei S., Jiang F., Su W., Chen C., Chen J., Mei W. et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine. 2020 Apr 5:100331. doi: 10.1016/j.eclinm.2020.100331. [Epub ahead of print] .

7. Ding B.T.K., Soh T., Tan B.Y., Oh J.Y., Mohd Fadhil M.F.B., Rasappan K., Lee K.T. Operating in a Pandemic: Lessons and Strategies from an Orthopaedic Unit at the Epicenter of COVID-19 in Singapore. J Bone Joint Surg Am. 2020 May 6. doi: 10.2106/JBJS.20.00568. [Epub ahead of print].

8. Iannuzzi N., Lack W., Gee A., Chansky H. An Orthopaedic Department’s Response to the COVID-19 Health-Care Crisis. Indirect and Direct Actions with Thoughts for the Future. J Bone Joint Surg Am. 2020 May 5. doi: 10.2106/JBJS.20.00611. [Epub ahead of print].

9. Chang Liang Z., Ye Chong M.S., Sim M.A., Lim J.L., Castañeda P., Green D.W. et al. Surgical Considerations in Patients with COVID-19: What Orthopaedic Surgeons Should Know. J Bone Joint Surg Am. 2020 Apr 24. doi: 10.2106/JBJS.20.00513. [Epub ahead of print].

10. Mi B., Chen L., Xiong Y., Xue H., Zhou W., Liu G. Characteristics and Early Prognosis of COVID-19 Infection in Fracture Patients. J Bone Joint Surg Am. 2020 Apr 1. doi: 10.2106/JBJS.20.00390. [Epub ahead of print].

11. Guo X., Wang J., Hu D., Wu L., Gu L., Wang Y. et al. Survey of COVID-19 Disease Among Orthopaedic Surgeons in Wuhan, People’s Republic of China. J Bone Joint Surg Am. 2020 Apr 8. doi: 10.2106/JBJS.20.00417. [Epub ahead of print].

12. Mi B., Xiong Y., Lin Z., Panayi A., Chen L., Liu G. COVID-19 Orthopaedic Safe Care Toolset. Guidelines for the Diagnosis and Management of Patients with Fracture and COVID-19. J Bone Joint Surg Am. 2020 May 5. doi: 10.2106/JBJS.20.00532. [Epub ahead of print].

13. Schwartz A., Wilson J., Boden S., Moore T., Bradbury T., Fletcher N. Managing resident workforce and education during the COVID-19 pandemic. JBJS Open Access. 2020;5(2):e0045. doi: 10.2106/JBJS.OA.20.00045.

14. Coimbra R., Edwards S., Kurihara H., Bass G.A., Balogh Z.J., Tilsed J. et al. European Society of Trauma and Emergency Surgery (ESTES) recommendations for trauma and emergency surgery preparation during times of COVID-19 infection. Eur J Trauma Emerg Surg. 2020 Apr 17:1–6. doi: 10.1007/s00068-020-01364-7. [Epub ahead of print].

15. Wax R.S., Christian M.D. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anaesth. 2020;67(5):568-576. doi: 10.1007/s12630-020-01591-x.

16. Rodrigues-Pinto R., Sousa R., Oliveira A. Preparing to Perform Trauma and Orthopaedic Surgery on Patients with COVID-19. J Bone Joint Surg Am. 2020 Apr 10. doi: 10.2106/JBJS.20.00454. [Epub ahead of print]

17. Viswanath A., Monga P. Working through the COVID-19 outbreak: Rapid review and recommendations for MSK and allied heath personnel. J Clin Orthop Trauma. 2020 Mar 26. doi: 10.1016/j.jcot.2020.03.014. [Epub ahead of print].

18. Tingbo L. Handbook of Covid-19 Prevention and Treatment. Hangzhou: Zhejiang University School of Medicine; 2020. Available from: https://gmcc.alibabadoctor.com/prevention-manual#prevention_manual

19. COVID 19: Considerations for Optimum Surgeon Protection Before, During, and After Operation. Available from: https://www.facs.org/covid-19/clinical-guidance/surgeon-protection.

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