Objective During the COVID-19 pandemic, healthcare workers (HCWs) have had the highest risk of infection among essential workers. Although personal protective equipment (PPE) use is associated with lower infection rates, appropriate use of PPE has been variable among HCWs, even in settings with COVID-19 patients. We aimed to evaluate the patterns of PPE adherence during emergency department resuscitations that included an aerosol generating procedure (AGP). Methods We conducted a retrospective, video-based review of pediatric resuscitations involving one or more AGPs during the first three months of the COVID-19 pandemic in the United States (March-June 2020). Recommended adherence (complete, inadequate, absent) with five PPE items (headwear, eyewear, masks, gowns, gloves) and the duration of potential exposure were evaluated for individuals in the room after AGP initiation. Results Among the 345 HCWs observed during 19 resuscitations, 306 (88.7%) were nonadherent (inadequate or absent) with recommended use of at least one PPE type at some time during the resuscitation, 23 (6.7%) of whom had no PPE. One hundred and forty HCWs (40.6%) altered or removed at least one type of PPE during the event. The aggregate time in the resuscitation room for HCWs across all events was 118.7 hours. During this time, providers had either absent or inadequate eyewear for 46.4 hours (39.1%) and masks for 35.2 hours (29.7%). Conclusions Full adherence with recommended PPE use was limited in a setting at increased risk for SARS-CoV-2 virus aerosolization. In addition to ensuring appropriate donning, approaches are needed for ensuring ongoing adherence with PPE during exposure.
Although rare, total hip arthroplasty (THA) may be indicated in pediatric patients with degenerative changes of the hip joint after previous trauma. To illustrate management principles in this patient population, this study describes the case of a 15-year-old female who sustained bilateral femoral neck fractures after a generalized tonic-clonic seizure, an atypical, low-energy mechanism for this injury. These fractures were not diagnosed until 14 weeks after the seizure episode, at which point they had progressed to nonunion on the left side, malunion on the right side, and degenerative hip joint changes were developing bilaterally. Bilateral THA was ultimately performed, and the patient had favorable outcomes at 1 year postoperatively. In determining the optimal management strategy for such patients, a multidisciplinary approach should be used, with input from the patient's family, pediatrician, pediatric endocrinologist, pediatric orthopaedic surgeon, and adult reconstruction surgeon. From a surgical standpoint, this report highlights the importance of selecting the appropriate bearing surfaces, broaching technique, mode of implant fixation, and implant features when performing THA in the active pediatric patient.
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