 So this is our new world. A world post coronavirus. Hey everyone, welcome back. Thank you so much for watching. So in this episode, I'm going to talk about my life post the coronavirus pandemic spread to the United States and in specific to New York state. So things have changed drastically at hospitals as far as my workflow, what I'm doing, and of course that includes, you know, precautions for taking care of patients who may be presumed positive or patients who are already confirmed positive. As an anesthesiologist, we're intubating patients on a regular basis, so we're considered the airway experts in the hospital. And so if someone presents with COVID related respiratory distress, we are the ones that will be called for that, managing their airway and intubating them, that is. So that is all happening at the hospital. But then what's happening at home with my kids? Well, I might have mentioned this on a previous video. I'm not sure if I did or I didn't. But I used to be a teacher, taught three years of high school biology before I decided to go to medical school. So I have some education background, of course, based on that. But there is nothing on earth that can really prepare you for homeschooling at nine and seven year old. I'm not prepared, I'm not. And I am just taking this day by day. As I usually do when I leave work, I go home for my second job, which is to take care of the kids. And my husband is so instrumental in that part. Unfortunately for him, he is also going to be doing most of the homeschooling because he's off of work as well. So yeah, he's at home and he's dealing with the day to day struggle of both disciplining and educating my kids. So I don't envy him at all. I really pray for him on a daily basis so that we can be able to do it with some type of level of patience. But things are real. So right now in my hospital, we are all on alert. We have implemented our personal protection strategies and safe methods for intubating patients. So yes, my job has been a whole lot harder. I would be responding to any emergencies while I'm here on shift. And that emergency most likely would be someone who needs an emergency intubation for respiratory failure or severe distress. So respiratory failure is when you're not able to exchange oxygen efficiently at all and your oxygen saturation goes down. So respiratory distress is when you have an efficient gas exchange, you have symptoms like chest tightness. So I am on our way down to see patients. This is how we have to see patients now. We wear masks in patients area and this is regular surgical masks not N95s and they are useful to kind of protect us against droplets. So I just finished doing a training session with our respiratory therapist and tomorrow we're going to have a training session with the anesthesiologists so we can learn each other's ventilators. The ventilator is a machine that we're going to be using to help support breathing on patients who are suffering from the severe symptoms of COVID. So respiratory distress when patients are not able to maintain their oxygenation. So if their oxygen levels are dropping and they're having the shortness of breath symptom that is so commonly seen with a severe case, we will have to place a breathing tube in and intubate them. So we're learning each other's ventilators. So this is an anesthesia event and tomorrow we'll be learning about an ICU event. So these very small compact machines are going to be very useful helping us to support the breathing of a lot of patients and it's worthwhile for us to know how to use them and be very comfortable with them if we're going to be doing this on a regular basis going forward or no enact system later on. So the major difference now is that we're learning how to take care of patients with a high risk of being infected or contaminating or infecting others and so we have to take extra precautions beyond those that we usually take. So in the hospital we usually put on our personal protective equipment or PPE. You may be seeing that a lot on the internet PPE such as masks, gloves. So we usually wear gloves whenever we're taking care of any patient and this is a standard precaution that we do every single time. So if we're ever touching a patient taking care of their wounds we always wear gloves. In the OR we always wear masks. So that's standard precaution for us but now we're increasing the requirement of personal protective equipment to include gowns. So we have actual large gowns that we're supposed to put on and these are all recommendations from the Centers for Disease Control. This is our demo gown so we've been using this to show people how to put it on so we're really not trying to waste any supplies or equipment. This is one of them and we're using filters for every patient to ventilate them if we need to but we're trying to reduce the amount of ventilation we're doing and just go straight to intubating or placing the breathing tube in. So this is a breathing tube as many people have not seen before and that's what we're going to be using to support the breathing of someone who's in a respiratory distress or having any respiratory related compromise due to the COVID virus infection. We're also using new techniques to intubate patients as far as like protecting us while we're doing that and that's one of the barrier protection so we're using plastic barriers to cover the patient's face and mouth as we're placing the breathing tube and especially if we're going to be taking it out at some point just so that we prevent any splash of the materials or coughing up the materials into the atmosphere. We'll also be wearing N95 masks which is used to filter out 95% of particulates that are greater than 0.3 microns so definitely undetectable by the eye but can be present in droplets and can be aerosols that might be transmitted on dust particles that are just already suspended in the air and floating throughout the air. So that's why the social distancing is so important you know just staying six feet away at least from patients who are definitely positive or symptomatic or just anyone in general because you never know some people might have the disease and be asymptomatic so we are taking those precautions as well. I don't have mine on right now but let's simulate this would be an eye shield so you should have an eye shield protection so usually in the OR we have a clear shield that we put over the face covers the face and the mouth and we wear our masks and of course hat gown and we wear two pairs of gloves so that we can cover our hands for the intubation and then we take off the outside glove and then use the underlying glove to touch anything right after so that we're not contaminating and we're using hand hygiene between every single step so donning and doffing is where the terminology is donning and doffing is the terminology for putting on your personal protective equipment donning and taking off your personal protective equipment doffing. I definitely want to continue doing your hand hygiene everything that you've been told by multiple people washing your hands multiple times 20 seconds and with hot not hot more but warm water every time your hand is soiled you want to make sure you wash it and then also washing your hands you want to make sure that you get underneath the fingernails and in between the fingers very thoroughly so that's something that we're doing every day in addition to using Purell between every touch of a contact surface right now I have on an N95 and a cervical mask because that is the recommendation for preserving the N95 which is underneath from swelling is to put a surgical mask on top and then every time I'm intubating a patient I'm wearing a N95 mask as the recommendation from American Society of Anesthesiologists so yeah we're doing our best to protect ourselves and also to protect you and help you. So these masks have to be really tight on your face and that makes it kind of hard to breathe so I am in full protective year mode actually I'm going to be wearing goggles soon enough but I find like glasses for now help me to at least avoid touching my eyes um putting my hands on my face so that's why I'm wearing gloves is just to remind myself not to touch my face and that's one of the main modes of transmitting virus that might be on full lights and full lights are inanimate objects or things and stuff that are just like surfaces that people make contact and they touch their eyes so I'm trying to remind myself like that. So also um as I move about the hospital these days I'm wearing gloves just to hold the doors of people like that and then afterwards I'm using hand hygiene so now I'm heading into the procedure my patient is having right now and this patient is going to be intubating something in all the precautions I said before and we're going to make sure that we do everything very safely and very quickly if it's breathing soup inside patients. So just finished the intubation I'm going to see the next patient we're not doing any elective procedures but we are doing no emergency cases and cases that are time sensitive so um you know people break an ankle or a knee, people fracture of a bone, especially if it's open fracture needs to be repaired quickly and the opening closed in a certain hour time if we're infection is a risk so those are the kind of procedures that we're doing these days but nothing elective, nothing that wait until after the quarantine is declared over. So basically things are a lot different now we are doing most of our procedures on an emergent basis only and we are not doing any elective procedures. Most of the offices are closed and we're only seeing patients that emergently need care and so that we can preserve resources and also make sure that there are supplies available for people who have confirmed COVID and need intubation in respiratory distress. We're seeing the patient population across the board fluctuate not just the elderly or being severely affected young people are as well so everyone should be safe and continue to protect themselves with social distancing and hygiene and just you know trying to stay at home if possible you know if you're not doing an essential job please please don't go out and you know get into any situation where you become infected help us protect you by staying home and making sure that you don't take this lightly this is a very serious situation it's evolving by the minute so you know stay tuned to your local news for your local recommendations from your state and you know pay attention to the national news the CDC is always updating their website take a look at that as much as possible so that you can know what's going on but it's very very serious and we are doing our very best to keep people safe but we need your help. So thank you guys so much for watching this COVID update I hope you guys stay safe out there remember just to be safe and try your best to stay on top of all the information that's coming your way it's a lot but it's important to be informed and to act appropriately so all the best to you and until the next video take care