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Why is there an anesthesiologist on President Trump’s Walter Reed medical team? Why would the president need an anesthesiologist?
This morning Dr. Sean Conley, the White House Physician, introduced President Trump’s medical team of seven doctors. Dr. Conley spoke to the nation from the approach to Walter Reed National Military Medical Center in Bethesda, Maryland. He introduced the team behind him with these words:
“Behind me are some of the members of the president’s medical team, whom I’d like to introduce. Dr. Sean Dooley, pulmonary critical care doctor. Brian Garibaldi, pulmonary critical care. Dr. Robert Browning, pulmonary critical care. Dr. Jason Blaylock, infectious disease. Dr. Wes Campbell, infectious disease. Dr. John Hodgson, anesthesia. Major Kurt Klein, Army Nurse. Commander Megan Nasworthy, Navy Nurse. Lieutenant Julianna Lavopa, Navy Nurse. Lieutenant Commander John Shea, clinical pharmacist. And not present with us are Lieutenant Beth Carter, Lt.. Maureen Meehan, both Navy nurses and Dr. Jesse Schonau, director Executive Medicine Program.”
The tally of these seven doctors reads:
3 Pulmonary and Critical Care doctors
2 Infectious Disease doctors
1 Emergency Room doctor, (this is Dr. Conley, a doctor of osteopathic medicine, or D.O.)
Why an anesthesiologist? President Trump is diagnosed with COVIE-19. Details of his illness are few. We were told that as of today, Saturday, October 3rd 2020, President Trump has no fever, no trouble breathing, is not currently on oxygen therapy, and has an oxygen saturation of 96% (normal = 90-100%).
COVID-19 is an infectious disease, so it makes sense that two infectious disease doctors are attending to him.
COVID-19 most commonly causes serious illness by lung infection, so it makes sense that two pulmonary and critical care doctors are attending to him.
But why does President Trump need an anesthesiologist on his medical team at Walter Reed Medical Center?
The answer: Airway Management.
If a patient with COVID-19 becomes acutely ill and his respiratory status declines so much that he cannot keep a safe oxygenation level merely by breathing oxygen through a supplementary mask or an oxygen tent, then that patient needs to be placed on a ventilator.
Ventilators pump oxygen in and out of a patient’s lungs via a breathing tube placed in the patient’s windpipe (trachea). This is called an endotracheal tube, and every anesthesiologist places hundreds of these tubes each year. The placement of an endotracheal tube into a COVID-19 patient who is gasping for breath is an acute procedure which requires an expert. A general anesthetic drug and a paralytic drug would be injected into the patient’s intravenous line, and then an anesthesiologist (wearing a space suit of extensive personal protective gear) would use a device called a laryngoscope to place the tube into the trachea under direct vision of the patient’s voice box.
If you’re a patient and you begin gasping for breath because of respiratory failure secondary to COVID-19, you don’t want your anesthesiologist to be far away. That’s why there’s an anesthesiologist on President Trump’s current medical team. The next few days will be telling. The president may remain stable and have only minimal or mild illness, but there is a nonzero chance that he will decompensate and become acutely ill.
Placing an endotracheal tube into Donald Trump would probably be an uneventful task for an expert, but the president is overweight and he does have a thick neck. Patients whose airway looks like his can prove difficult for an anesthesiologist to intubate the trachea. The attending anesthesiologist would most likely use a video laryngoscope, which has a camera on the tip of the scope that is inserted into the patient’s throat. This technology allows the anesthesiologist to “see around the corner” into the patient’s larynx or voice box. The image of the patient’s airway appears on a video screen.
Regarding President Trump’s treatment to date: he has already been treated with Remdesivir, an antiviral therapy which is administered via an intravenous line. There is data that Remdesivir is effective in animals for COVID viral prophylaxis or immediately following viral inoculation.
It appears he also received an antibody cocktail yesterday, REGN-COV2, developed by Regeneron. The development of this cocktail was described in the journal Science in August.
No one knows how President Trump’s medical course will proceed. As a medical doctor, I can only wish him the best of health, the best of medical care, and the best medical outcome that is possible. I hope no anesthesiologist has to place a breathing tube.
Stay tuned in these interesting and difficult times.
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