Interesting times …
My heart goes out to all the people ill with coronavirus, and those who have already lost friends and relatives.
My thanks go out to all of you (social distancing really is all we’ve got at the moment), but especially m’colleagues in hospitals around the World (Forza Italia! Viva Espana!) who are showing quite extraordinary dedication in managing cases and organising healthcare to prevent further loss of life.
I wrote a paper several weeks ago on ‘Pragmatic COVID-19 preparedness in older people requiring emergency surgery’. This was just as COVID-19 was declared a pandemic.
Looking at the paper now, it already seems dated, but you may still find bits useful. When it was written, we were mainly fretting about how to intubate and ventilate coronavirus patients, but hadn’t given much thought to how we might manage infected patients who needed emergency surgery.
Thankfully, chains of command and national guidance have improved rapidly, superseding the paper’s message.
Essentially, this guidance advises:
- Get on with it. Aim for prompt (<24 hours) consultant-delivered surgical and anaesthetic care where possible
- Use regional or spinal anaesthesia if possible
- Cemented hemiartroplasty instead of THR for intracapsular fractures, sliding hip screw (DHS) instead of IM nails for trochanteric fractures.
It’s an iterative document, and may well change as new evidence emerges, but it’s the best advice we have, based on the evidence we have right now.