Coronavirus thread

[45dotACP]

We had a few pts ages 40-55 that sated too low on the HFNC, got CPAP for a day or so and last time i worked were on 5-7L nc.

Noticed out sickest non 80+yo pts seemed to have waited atleast 5 days since start of s/s to come in. Had a few false negs. Procal has mostly been up with the sick ones. Liver enzymes up in 1/2, white count slightly below norm. Temps all over the place, some coughing a lot, but not all- not even half actually. Some pts look and sat fine for a day or so and then just drop sats in hrs, you can usually see it coming if you look for it- normally going from 94% to 92% on a normal day BC no one would bat an eye, but now they need to be watched. Ferritin and CRP up in 1/2 of the charts ive been through. 22 bed 1st covid unit. Now they are converting other units, think we have 5 total by now..

Pulm/ID expecting staff to be sick this week, staff expecting pt surge next week


ETA: high d dimers too, occasional BNPs. Would have loved to have a more organized report from the 22 charts per day- just no time.

Godspeed Isaac. We've got two intensivists who caught this already. Both fairly young so I'm praying they'll be alright, but yeah the lab values seem to be fairly consistent. From the ferritin to the CRP to the LFTs and leukopenia.....what a weird fucking bug.

A couple of the docs are more keen on HFNC and I expect we'll get patients on them soon just to reduce vent usage, but BiPap is still mostly taboo here.

Also, we're doing proning on patients that aren't even intubated.

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[Isaac]

The proning has been rec'd here too, and done if needed. Two of my coworkers have it now, both very mild.

[BehindBlueI's]

Good point, but it also shows how we can make tweaks to mitigate the risks while maintaining the larger freedom rather than have my government say "You need to shut down your store now. We only want truly essential businesses like pornography production and marijuana distribution to remain open."

I think that's largely what we are doing. Mitigating risks without going into a full lock down. I don't know if we're doing too much, too little, or just enough but I think the powers that be are largely trying to tread that line of mitigating risk while minimizing the side effects. I'm sure there's fuckery going on with what's "essential" and what's not. Hell, I bought lumber for an entirely optional project. That's not really "essential" so maybe I'm part of the problem, I don't know.

[NEPAKevin]

Hope you don't find yourself on the wrong end of an ADA lawsuit: https://www.marketwatch.com/story/yo...aws-2020-03-27

Anything is possible but our county is one of the first to be included in the Governor's stay at home order and AFAIK the exemption for essential services does not extend to anyone positively exposed to the virus who should have self quarantined.

[5pins]

https://www.medcram.com/courses/COVI...al-ventilation

[Stephanie B]

Like nobody saw this coming:

The captain of a U.S. Navy aircraft carrier facing a growing outbreak of the coronavirus on his ship was fired Thursday by Navy leaders who said he created a panic by sending his memo pleading for help to too many people.

Acting Navy Secretary Thomas Modly said the ship’s commander, Capt. Brett Crozier “demonstrated extremely poor judgment” in the middle of a crisis. He said the captain copied too many people on the memo, which was leaked to a California newspaper and quickly spread to many news outlets.

Thou Shalt Not embarrass Big Navy.

I will raise a glass to Capt. Crozier, who took the courageous path of putting the interests of his crew before the interests of his career. If I ever encounter him, drinks are on me.

[Totem Polar]

Sounds like someone got screwed for trying to do the right thing. I doubt I’ll meet him, but if I do drinks are on me, as well.

In other news, Inslee extended stay at home order until May 4.

Calgon, take me away...

[Borderland]

Sounds like someone got screwed for trying to do the right thing. I doubt I’ll meet him, but if I do drinks are on me, as well.

In other news, Inslee extended stay at home order until May 4.

Calgon, take me away...

it's a good thing I've had 6 years to train for this. I know exactly what to do.

[Nephrology]

Surprise surprise, the USNS Comfort is not being well integrated into city hospital network. This is consistent with what my buddy at FDNY has told me - apparently they are largely taking overflow from the Javits center.

https://www.nytimes.com./2020/04/02/...s-comfort.html

[ccmdfd]

Surprise surprise, the USNS Comfort is not being well integrated into city hospital network. This is consistent with what my buddy at FDNY has told me - apparently they are largely taking as overflow from the Javits center.

https://www.nytimes.com./2020/04/02/...s-comfort.html

Wow.

Just, wow.

cc