Medical Image of the Month: An “Intubation Box” to Protect Healthcare Professionals

Figure 1. A: Intubation box. B: Intubation box in use.

The COVID-19 pandemic has emerged as growing global healthcare crisis. There is evidence of transmission of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARC-CoV-2) from aerosolized spread to personal protective equipment worn by healthcare professionals (1). In an attempt to mitigate hazards to healthcare professionals during the COVID-19 pandemic, particularly those at greater risk to exposure during endotracheal intubation, an Intubation Box has been designed by our Emergency Department (Figure 1A) (2). This is an inexpensive apparatus adjusted to include patients of large body habitus. We illustrate use of the box during endotracheal intubation using video laryngoscopy (Figure 1B). The box protects providers from aerosolized particulate and can be cleaned between each use with anti-viral reagents such as bleach-based or alcohol-based solutions. It is assembled in under one hour using acrylic with acrylic adhesive or equivalent plastic welding adhesive. Information on how to build this box in several easy steps, or how to order boxes, are provided for hospitals around the world at http://www.intubationbox.com.

Lavi Nissim MD¹ and Benjamin Reeser MD²

Departments of ¹Radiology and ²Emergency Medicine

Abrazo Central Campus

Phoenix, AZ USA

References

1. Ong SWX, Tan YK, Chia PY, Lee TH, Ng OT, Wong MSY, Marimuthu K. Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient. JAMA. 2020 Mar 4. [Epub ahead of print] [CrossRef] [PubMed]
2. Cook TM. Personal protective equipment during the coronavirus disease (COVID) 2019 pandemic - a narrative review. Anaesthesia. 2020 Apr 4. [Epub ahead of print] [CrossRef] [PubMed]

Cite as: Nissim L, Reeser B. Medical image of the month: an “intubation box” to protect healthcare professionals. Southwest J Pulm Crit Care. 2020;20(5):173-4. doi: https://doi.org/10.13175/swjpcc030-20 PDF

Medical Image of the Month: Viral Pneumonias

Figure 1. Pulmonary viral infection spectrum on thoracic CT scan in lung windows: A= Coronavirus NL63; B= Adenovirus; C= Influenza AH1 2009; D= COVID-19; E= Coronavirus HKU1; F= Influenza AH1 2009.

Numerous viruses, including the corona, influenza and adenoviruses can cause lower respiratory tract infection in adults (1). Viral pneumonia in adults can be classified into two clinical groups: so-called atypical pneumonia in otherwise healthy hosts and viral pneumonia in immunocompromised hosts. Until the COVID-19 pandemic, influenza virus types A and B caused most cases of viral pneumonia in immunocompetent adults. Immunocompromised hosts are susceptible to pneumonias caused by a wide variety of viruses including cytomegalovirus, herpesviruses, measles virus, and adenovirus. The CT imaging findings consist mainly of patchy or diffuse ground-glass opacity, with or without consolidation, and reticular areas of increased opacity, are variable and overlapping. The imaging findings in COVID-19 pneumonia are generally not distinctive compared to other viral pneumonias, including other coronaviruses such as SARS and MERS (2). A recent study systematically reviewed the longitudinal changes of CT findings in COVID-19 pneumonia. The results suggested that the lung abnormalities increase quickly after the onset of symptoms, peak around 6-11 days, and are followed by persistence of the findings.

Bacterial pneumonias may also take multiple forms and are sometimes difficult to radiographically separate from viral pneumonia (3). However, the presence of ground-glass opacities alone is unusual for a bacterial pulmonary infection. Rather, bacterial infections commonly present as areas of consolidation with air bronchogram formation, centrilobular nodules (often with branching configurations) and airway thickening.

Michael B. Gotway MD

Department of Radiology

Mayo Clinic Arizona

Scottsdale, AZ USA

References

1. Kim EA, Lee KS, Primack SL, et al. Viral pneumonias in adults: radiologic and pathologic findings. Radiographics. 2002 Oct;22 Spec No:S137-49. [CrossRef] [PubMed]
2. Wang Y, Dong C, Hu Y, Li C, Ren Q, Zhang X, Shi H, Zhou M. Temporal Changes of CT Findings in 90 Patients with COVID-19 Pneumonia: A Longitudinal Study. Radiology. 2020 Mar 19:200843. [CrossRef] [PubMed]
3. Panse PM, Jokerst CE, Gotway MB. May 2020 Imaging Case of the Month: Still Another Emerging Cause for Infiltrative Lung Abnormalities. Southwest J Pulm Crit Care. 2020. May 1. (in press). [CrossRef]

Cite as: Gotway MB. Medical image of the month: viral pnuemonias. Southwest J Pulm Crit Care. 2022;20(5):163-4. doi:  https://doi.org/10.13175/swjpcc028-20 PDF