Table 1 Summary of AGMPs, Risks, and Appropriate PPE Considerations
Encounter Type | Possible Aerosol Generation | Risk | Patient Mask | Physician PPEa | Special Considerations |
|---|---|---|---|---|---|
History | Minimal | Low | Yes | Surgical Mask, Eye Protectionb | Consider virtual history to minimize in-person time Maintain physical distancing in person |
Physical Exam | Minimal | Low | Yes (if possible) | Surgical Mask, Eye protectionb, Gloves | Time with mask off (of patient) should be minimized where possible |
Transtympanic Injection | Minimal | Low | Yes | Surgical Mask, Eye Protectionb, Gloves | Beware Arnold’s reflex Consider local anesthesia/blocks to reduce coughing for extensive debridement Use of microscope may be hindered by eye protection |
Tympanostomy Tube Placement | Minimal | Low | Yes | ||
Mastoid/EAC Debridement | Minimal | Low | Yes | ||
Cauterization Epistaxis | Minimal | Low | Yes | Surgical Mask, Eye Protection, Gloves, Gownb | Consider chemical cautery over electrocautery |
Rigid Nasal Endoscopy | Moderate | Low | Yes | Avoid powered aerosolized anesthetic sprays Pull mask down to expose nostril or modify mask, keep mouth covered Consider video system over direct visualization to increase distance from patient | |
Flexible Nasopharyngo-laryngoscopy | Moderate | Low | Yes | ||
Tracheotomy/Laryngectomy Patient | High | High | Not applicable | N95 respirator or Surgical Mask Eye Protection, Gloves, Gown | Unable to cover cough Consider N95 mask, particularly if tube being manipulated or suctioning [27] performed |
Rigid Laryngoscopy | No consensus | – | No consensus | No consensus | Consider flexible nasopharyngolaryngoscopy as an alternative |
Aesthetic Procedures | Minimal | Low | Yes (if possible) | Surgical Mask, Eye Protection, Gloves, Gownb | Consider availability of appropriate PPE Dependent on local health authority recommendations |