Field Notes From the Frontline of a COVID-19 Outbreak: Dyspnea Management for Hospitalized Patients at End-of-Life.

Northern New Jersey was inside one of the worst initial coronavirus disease 2019 pandemic epicenters in the United States. At the peak of the pandemic surge in mid-April 2020, New Jersey saw 8045 hospitalized patients with severe coronavirus disease 2019 symptoms, of which 2002 were in intensive care unit beds (86.3% of statewide capacity), including 1705 requiring mechanical ventilation. Because of the severity of pulmonary dysfunction/hypoxia, the unprecedented numbers of critically ill patients, the national opioid shortage, and transmission prevention measures for standard palliative care treatment protocols in place for refractory and/or end-of-life dyspnea were found to be ineffective in providing adequate symptom relief. The aim of the following Notes From the Field is to provide concise, pragmatic, and experiential reflection by 3 palliative care advanced practice nurses from 3 different hospital systems within the pandemic epicenter. The novel methods and opioid strategies implemented by their respective palliative care teams to ensure continued effective and appropriate treatment for end-of-life dyspnea are described. These accounts include Lessons Learned in order to assist others who may need to quickly implement changes in the future due to pandemic resurgence or second-wave events.

Caring for a laboring woman with amyotrophic lateral sclerosis: a case report.

A case presentation of a pregnant 32-year-old woman with advanced amyotrophic lateral sclerosis who presented in labor at 38+6 weeks gestation is described. Amyotrophic lateral sclerosis is a progressive neuromuscular disease that attacks nerve cells in the brain and spinal cord. It is usually diagnosed after the fourth decade of life, and is more commonly seen in men than women; thus, it is rarely found in the obstetric population. When the perinatal team is confronted with a pregnant woman with ALS,patient management can be a challenge.