RESUMEN
Health care providers (HCP) of ENT and Skull base surgery are highly vulnerable and mostly infected by novel coronavirus as they have to examine and perform procedures directly in oral cavity, oropharynx, nose, nasopharynx, where coronavirus remains in plenty. ENT & Skull base surgeons need to do several aerosol generating procedures (AGP). Most of the endoscopic and microscopic ENT & skull base surgery are AGP; like-mastoid surgery, sinus surgery, surgery of pituitary, tympanomastoid paraganglioma, temporal bone malignancy, tracheostomy etc. All of we know, COVID negative by RT-PCR test is not always COVID negative. In COVID-19 pandemic-routine, even cancer surgeries are avoided or postponed for the sake of safety of HCPs. Moreover, in case of surgical emergency there's no way to refuse a patient for not having a report of COVID test. We thought about neutralizing or destroying the novel coronavirus from it's route of entry zone, as well as preventing aerosol to be transmitted in the air of OT. We designed a novel approach, i.e. 'POLIDON' (POLIDON = Polythene + Povidone Iodine), which can be the solution for these patients as well as surgeons or HCPs of above mentioned specialties. Use of Povidone Iodine as mouthwash and nasal spray or irrigation for both patient and HCPs prior to surgery is proposed. Then, use of simple polythene as barrier drape of patient or operative area for prevention of spread of aerosol in OT during surgery is the other component. With the POLIDON' approach-all these ENT & skull base surgeries can be done with more safety and confidence.
RESUMEN
BACKGROUND: A live foreign body in trachea or bronchus is a very rare as well as life threatening condition. A bigger fish with irregular shape usually impacts at the oropharynx, hypopharynx or inlet of the larynx. But a small or flat, elongated foreign body may cross the glottis and enter into trachea and bronchus. We report a rare type of very long live fish in trachea and bronchus. CASE PRESENTATION: A 16-year-old Bangladeshi boy presented with severe respiratory distress and cyanosis with a history of live fish impaction in the throat. To relieve respiratory distress and secure life an emergency tracheostomy was carried out while a tail fin of a fish was seen through tracheostome directed to the right bronchus which was grasped with an artery forceps and pulled out of the trachea. Respiratory distress was relieved immediately. The fish removed from the trachea was locally known as Guchi Baim Fish (Macrognathus pancalus). It was about 16 cm long and about 2 cm wide at its central region. CONCLUSION: Live fish lodging in the trachea and bronchus is an acute emergency condition. It is very difficult to diagnose and manage because of its presence in critical anatomical location. So a quick short history from accompanying persons especially about the type of fish is crucial to predicting the site of its lodgement in the airway as well as management plan. Avoidance of the tendency of holding the fish between teeth during fishing can prevent this life threatening condition.