AM: Without a respirator, the patient uses improvised ventilation in a health unit – 04/22/2020



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A patient with SARS (Severe Acute Respiratory Syndrome), suspected of having covid-19, a disease caused by the new coronavirus, was treated with a vented plastic bag, improvising a device he was using as a respirator, which was missing during service , in a health unit in Manaus, which is part of the Amazonas government’s public health network.

The photo of the man with the plastic bag, published on the Internet, shows the collapse of the Amazon public health network to meet the great demand for SARS patients. The patient was unconscious and had difficulty breathing when placed on the “kit”.

Brazil registers 2,906 deaths from covid-19 and 45,757 people from the new coronavirus infection. So far, 207 people have died with covid-19 and there are 2,479 infected with the new coronavirus in Amazonas. The data is from the Ministry of Health published today.

In the image, the man appears with his head inside a plastic, with elastic at the edges to try to isolate the air near the patient, which may be contaminated with particles containing coronavirus. Improvisation simulates a “non-invasive ventilation capsule”. It can also be seen that the plastic does not cover the entire upper part of the patient, leaving his right shoulder uncovered and open spaces in the chest region, above the electrodes used for cardioscopy, and the contaminated air may have leaked into the space I was in.

The patient was waiting for a place in the ICU (Intensive Care Unit) of the public network, but the family ended up transferring him to a private hospital. The name of the hospital was not given, nor the name of the patient and his age.

Anesthesiologist Luís Bulhões Calheiros states that improvisation of non-invasive ventilation (which is without intubation), shown in the photo, runs the risk that the plastic does not seal enough and spreads the virus through the environment, contaminating the team and people close to the patient

“It should be noted that, unlike mechanical ventilation, which there is no risk of contamination due to the closed circuit, non-invasive ventilation has the risk of spreading coronavirus particles into the environment. Because of this, it is an option that comes to avoid in these patients, going directly to intubation or placing the patient in insulated capsules in the upper region of the body, to minimize this risk, “says the doctor.

Calheiros explains that non-invasive ventilation is for patients who already have a certain level of respiratory distress, but who can still stay out of mechanical ventilation (without intubation). “At this time of the covid-19 pandemic, when ICU beds and mechanical ventilators are lacking, this mode can help the seriously ill patient remain stable, until a place in the ICU appears and can provide the necessary assistance to that patient. patient, “he explains.

In a note, sent today to Twitter, the Amazonas government reported that “the patient received assistance and, while waiting for the transfer to another unit, the medical team decided, on their own, to use a non-invasive experimental technique to keep him stable, with the family’s authorization.” the patient was transferred to a private unit. “

The report questioned the Amazon government about improvisation with plastic to help patients with respiratory difficulties, but did not get a return until the publication of this text.

The state secretary of health, Simone Papaiz, admitted yesterday at a press conference that the pink rooms, where people with covid-19 or suspected disease are hospitalized, in public hospitals operate with a capacity of 95% to 100% . Yesterday the rate was 100%.

Papaiz said the state is awaiting a promise from the federal government to establish a field hospital in Manaus, which was announced by the Ministry of Health earlier this month. If the promise is kept, the hospital unit will be exclusive to help patients with medium complexity.

“We requested 400 beds from the federal government and the Ministry of Health. We also pointed out the need not only for structure, but also for equipment, supplies and equipment for the implementation of this unit,” Papaiz reported.

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