Acute Care Surgery in the Times of COVID-19 Pandemic: Our Experience at a Large Safety Net Hospital
Shrey Modi, Bhuwan Giri
Citation Information :
Modi S, Giri B. Acute Care Surgery in the Times of COVID-19 Pandemic: Our Experience at a Large Safety Net Hospital. Panam J Trauma Crit Care Emerg Surg 2020; 9 (2):142-146.
Background: There is limited experience in managing confirmed or suspected coronavirus disease 2019 (COVID-19) patients who present for emergency general surgery. Differing presentations, diagnostic uncertainty, and lack of guidelines present challenges to surgeons taking care of these patients. Materials and methods: We present a retrospective case series of five patients (age: 20s–50s) with acute surgical emergencies, highly suspected or positive for COVID-19, providing an overview of diagnosis, management, and outcomes. Results: The first two cases were patients with acute cholecystitis and perforated duodenal ulcer with high suspicion for COVID-19 but negative reverse transcription polymerase chain reaction (RT-PCR) results. The third case was a COVID-19 confirmed patient with acute appendicitis managed nonoperatively. The last two cases were COVID-19 positive patients with lower extremity abscess and intussusception. Conclusion: Clinical decisions were made based on the urgency of each case while simultaneously navigating their COVID-19 infection status. Recognizing asymptomatic carriers, maintaining effective communication between different teams, and planning perioperative care were important aspects in achieving favorable outcomes.
COVID-19 Dashboard Johns Hopkins University: Center for Systems and Engineering; 2020 [updated 04-19/2020]. Available from: https://coronavirus.jhu.edu/map.html.
Ross SW, Lauer CW, Miles WS, et al. Maximizing the calm before the storm: tiered surgical response plan for novel coronavirus (COVID-19). J Am Coll Surg 2020;230(6):1080–1091.e3. DOI: 10.1016/j.jamcollsurg.2020.03.019.
COVID-19 testing: the threat of false-negative results. In: West CP, Montori VM, Sampathkumar P, ed. Mayo Clinic Proceedings. Elsevier; 2020.
Zhao J, Yuan Q, Wang H, et al. Antibody responses to SARS-CoV-2 in patients of novel coronavirus disease 2019. Clin Infect Dis 2020. ciaa344. DOI: 10.1093/cid/ciaa344.
Ter Chee VW, Khoo MLC, Lee SF, et al. Infection control measures for operative procedures in severe acute respiratory syndrome-related patients. Anesthesiology 2004;100(6):1394–1398. DOI: 10.1097/00000542-200406000-00010.
Lei S, Jiang F, Su W, et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine. 2020;21:100331. DOI: 10.1016/j.eclinm.2020.100331.
Aminian A, Safari S, Razeghian-Jahromi A, et al. COVID-19 outbreak and surgical Practice: unexpected fatality in perioperative period. Ann Surg 2020;272(1):e27–e29. DOI: 10.1097/SLA.0000000000003925.
Harmer D, Gilbert M, Borman R, et al. Quantitative mRNA expression profiling of ACE 2, a novel homologue of angiotensin converting enzyme. FEBS Lett 2002;532(1-2):107–110. DOI: 10.1016/S0014-5793(02)03640-2.
Cook TM, El-Boghdadly K, McGuire B, et al. Consensus guidelines for managing the airway in patients with COVID-19: guidelines from the difficult airway society, the association of anaesthetists the intensive care society, the faculty of intensive care medicine and the royal college of anaesthetists. Anaesthesia 2020;75(6):785–799. DOI: 10.1111/anae.15054.
Alp E, Bijl D, Bleichrodt R, et al. Surgical smoke and infection control. J Hosp Infect 2006;62(1):1–5. DOI: 10.1016/j.jhin.2005.01.014.
Pryor A. SAGES and EAES recommendations regarding surgical response to COVID-19 crisis SAGES website: SAGES; 2020 [updated 03-30-2020. 03-29-2020]. Available from: https://www.sages.org/recommendations-surgical-response-covid-19/.
