• Nurse Anesthesiology Is…Science.

    As Michael Hartman, DNP, stepped up to work with COVID-19 patients, he found himself inspired by an unlikely source: A seminar on bioterrorism.

    Hartman, a clinical education coordinator and Certified Registered Nurse Anesthetist (CRNA) at Lehigh Valley Health Network in Pennsylvania, said the information he learned there several years prior to the pandemic expanded his view of anesthesia providers as front-line responders.

    It also foreshadowed our current public health emergency, where CRNAs’ extensive expertise in airway management allows them to apply their scientific clinical knowledge to help treat a disease that has put countless patients on ventilators.

    “Our role as CRNAs changed with COVID. Many, if not all, surgeries were postponed and CRNAs were assigned to COVID airway teams,” Hartman said. “At Lehigh, there were two CRNAs on a COVID airway team that would be available 24 hours. Anyone that needed airway assistance with COVID, we were called to intubate them.”

    The pandemic also piqued Hartman’s analytical curiosity about the transmission of the disease, as well as its lingering effects. Hartman started to research the virus before it surged in the United States and several of his early personal observations about COVID patients were borne out during the pandemic. For example, he saw that gastrointestinal distress among COVID patients increased their morbidity. He also noted a unique characteristic regarding the airways of COVID patients.

    “A COVID airway itself is difficult. With a healthy airway, the tissue is pink and reflects the laryngoscope light, allowing for illumination for placement of the endotracheal tube,” Hartman said. “A COVID airway presented with a dark discoloration, which absorbed the laryngoscope light and added a challenge for intubation.”

    Hartman combined his own learnings with evolving information about COVID to protect other healthcare workers. He assisted in the development of a device to reduce exposure and found other ways to help keep himself and those in the room safe during intubation of a COVID patient.

    “Before COVID, when we prepared a patient for intubation, they would have a mask with pre-oxygen, we would provide medication to relax them and place a breathing tube,” Hartman said. “With COVID, intubation now meant protecting the healthcare staff from aerosolization of the contagion as soon as we opened the airway. Patients were covered with plastic drapes or towels to minimize the aerosolization on intubation and extubation.”

    Hartman’s dedication to patient care — as well as concerns about cognitive side effects, should he be exposed to COVID — led him to record his work on the COVID airway team for future healthcare providers to learn from.

    “During the first wave, there were a lot of unknowns,” Hartman said. “I began to keep a diary as the COVID pandemic emerged in the United States so that if something happened to me, the story would still be told.”

    The diary serves as a memoir of both Hartman’s clinical experience and his emotional connection with the patients living and dying during the most serious health crisis the United States has seen in a century.

    “COVID patients’ last breaths may occur with me, before an intubation,” Hartman said. “We have had moments of prayer, exchanges of last words with family members.”

    For Hartman, being a CRNA means being an advocate for the patient, often when they are incapable of speaking for themselves.

    “We stand up for the patient and protect the patient during surgery,” Hartman said. “This is what makes us leaders in patient care.”


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