Thread by @DrEricLevi

It happened again the other day.

I asked for an N95 mask for my airway operating list. One hospital provided, another said no.

Yes, pre-op swabs are negative, but I spend 3-4 hours in multiple patients’ nose, oral cavity, oropharynx, larynx and trachea in one session.

My sinus cases involve me debriding the nasal mucosa, removing polyps and dissecting the nasopharyngeal mucosa.

My throat cases involve me dissecting the oral mucosa, tonsils, palate, tongue.

I’m always inches from patients noses and mouths.

My airway cases mean I’m 30cm away from a patient’s mouth with positive airway blowing into the patient and released on to my face. The airway is not secured or sealed. It’s an open ventilation with air returning on to my face and neck. Diagram below. medicine.uiowa.edu/iowaprotocols/…

Knowing that the nasopharyngeal mucosa & tracheal secretions contain high concentration of viral materials and that there is a known rate of false negative tests, I would have thought that an N95 mask would be appropriate. Low risk patient but high risk AGP procedure.

But I confess, this pandemic is exhausting for me. I’ve pleaded. Wrote people. Suggested. Smiled. Listened. Etc.

Then told to tone it down.

Too tired to fight battles all the time.

I took the surgical mask and did my work.

Feeling unprotected by the protocol-writers.

ENT, maxillofacial, dental surgeons are spending hours each day face to face with patients. Inches away. Everything we do is aerosol generating.

I would love for protocol writers to join us in a clinic or operating theatre and see how much saliva and snot splatter they catch.

I will, as I have always done, wake up each day and do the job required of me despite the high community prevalence and with whatever protection given to me. Most times the foot soldiers don’t get much of a say in the command boardrooms.

Stay safe everyone!