ED Muskoka Physicians - Living the Dream

January Virtual Journal Club

January 11, 2021 by Leave a Comment

I’ll post a more “official” article and review later in the month but I came across this article about abscesses and thought it was interesting. Skin abscesses are not the sexiest topic but we treat them frequently so it would be worth considering a practice change if it improved patient comfort and/or outcome.

The SGEM post and podcast (link below) summarizes the article and does a critical appraisal. Original article is posted here: https://onlinelibrary.wiley.com/doi/full/10.1111/acem.14106

Essentially they looked at treatment failure as a primary outcome after treatment of skin abscesses with the loop technique versus standard packing with ribbon gauze. Secondary outcomes were ease of procedure, pain at the time of treatment, ease of care at 36 hours, and pain at 36 hours.

Study conclusion was:

“The LOOP and packing techniques had similar failure rates for treatment of subcutaneous abscesses in adults, but the LOOP technique had significantly fewer failures in children. Overall, pain and patient satisfaction were significantly better in patients treated using the LOOP technique.”

A few thoughts/questions:

What is everyone’s usual practice? Packing vs. no packing vs. leaving a small wick? Has anyone tried this loop technique?

Do we even stock vessel ties in the ER?

Given the questionable evidence regarding packing, wouldn’t it be easier to just not pack at all (ie. no loop or standard packing)?

SGEM#311: Here We Go Loop De Loop to Treat Abscesses
Filed Under: Education, ENT, Great Papers, Physicians Section

Aerosol Generating Procedures

October 22, 2020 by Leave a Comment
https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1111/anae.15292

Journal of anesthesia 

Purpose of the Study  – Quantify the amount of aerosolization during aerosol generating procedures to inform risk assessment

Study Design

-They monitored aerosolization with continuous sampling with an optical particle sizer, which allowed characterisation of aerosol generation within the zone between the patient and anaesthetist

-The extent to which COVID is transmitted as airborne is controversial 

Problems with the study

-Small sample size – used 4 ORs in the UK

-Only 19 intubations and 14 extubations 

-During intubation they use BVM and not RSI

Conclusion

– Tracheal intubation including facemask ventilation produced very low quantities of aerosolized particles – 500x less than a cough (actually state that “this study does not support the designation of elective tracheal intubation as aerosol generating”.

-Extubation, particularly when the patient coughed, produced a detectable aerosol, 15 folds greater than intubation but 35 folds less than a volatile cough .

Questions– They just say “facemask ventilation” – I think they need to be more specific.  What type of facemask did they use, what was the flow rate?

Take away –

(1)If a break in PPE then chance of acquiring COVID is probably minimal during intubation.

(2) patients coughing on us is more risk than intubation, therefore patient’s properly wearing masks can reduce this.

Filed Under: Airway Corner, Critical Care, Education, Infectious Disease, Physicians Section