No abstract

In December 2019, a novel coronavirus (now named COVID-19) was identified as a causative agent for a cluster of pneumonia cases in Wuhan, China.1 Till March 2020, India was one among 50 countries which identified patients tested positive for COVID-19.2 One day curfew was imposed in the country on March 22, 2020 to forewarn the people about the danger the country was going to face. The government of India announced a nationwide lockdown for 21 days from March 25, 2020 with subsequent second, third and fourth lockdowns. This was done to reduce the transmission of disease and flatten the curve. The preparations to manage COVID-19 pandemic crisis began in Jawaharlal Nehru Medical College Hospital Aligarh, a tertiary care centre in western Uttar Pradesh by 15th of March 2020. In April 2020, it was declared as Level 2 COVID care hospital to deal with complicated and critical cases. The establishment of flu clinic, exclusive COVID-19 isolation ward, teleconsultation and widespread screening of patients by Reverse transcriptase polymerase chain reaction (RT PCR) were some measures undertaken to deal with the crisis. The increased burden of patients presenting with bronchopneumonia necessitated augmentation of the existent infrastructure and better utilization of resources. Emergency and trauma centre, JNMCH, AMU Aligarh was also no exception and reorganising emergency trauma ICU as COVID-19 suspect ICU made the functioning of the entire hospital a lot smoother during this unsustainable crisis situation. However, there were several challenges to overcome while designating an emergency and trauma ICU as COVID-19 suspect ICU. There is ample amount of literature available discussing the strategies for preparing a dedicated COVID ICU, however there is relative scarcity of literature on the challenges in managing an emergency and trauma ICU (ETC – ICU) during the pandemic. In this review, we discuss the strategies and planning for converting an emergency and trauma ICU into a COVID suspect ICU in a tertiary care centre in western Uttar Pradesh (India) during the pandemic and the challenges faced. Bangladesh Journal of Medical Science Vol.20(5) 2021 p.26-31

Background Pneumothorax associated with a steep head-down position in vaginal hysterectomy surgery is rare but can cause life-threatening complications. Case presentation We report a case of a female patient with no obvious lung pathology who suffered intraoperative pneumothorax associated with prolonged steep Trendelenburg position. To the best of our knowledge, this is the first well-documented case of this association. A 53-year-old female, diagnosed as a case of recurrent umbilical hernia with cystocele and rectocele was planned for vaginal hysterectomy with anterior perineorrhaphy and posterior colpoperineorrhaphy along with open mesh repair for umbilical hernia under general anaesthesia. Approximately 90 min after the steep Trendelenburg position, the peak inspiratory pressure increased, while the oxygen saturation decreased. The airway pressures remained continuously on the higher side whole throughout the surgery despite an interrupted propped-up position in between. The patient could not be extubated and shifted to the intensive care unit (ICU) where ultrasonography (USG) of the lung and chest x-ray showed signs of pneumothorax. Intercostal tube drainage (ICTD) was placed, and the patient improved dramatically. It was suspected that a steep head-down position for a prolonged period led to persistently raised airway pressures and the subsequent development of pneumothorax. Conclusions Pneumothorax can develop in rare circumstances even if airway pressures are under the safety range. So, careful monitoring and immediate treatment are necessary to prevent the condition from worsening and anaesthesiologists must be aware of such potential danger.