Coronavirus thread

[Sensei]

This was sent to me by a co-worker who finished his anesthesia residency this past Summer at Columbia in NYC. One of his residency classmates wrote it, and it got published in The Atlantic. Columbia in NYC was the proverbial Second Battle of Fallujah or COP Keating in medical terms last Spring.

https://www.theatlantic.com/ideas/ar...an-get/617302/

While often I’m the first to dismiss The Atlantic as liberal crap, this particular piece comes with the backing of a colleague who was physically present to verify that the author is honest. It also squares as a less intense version of what I’m seeing today.

Basically, there is a sharp divide among the healthcare workers who experience the toll daily, and the portion of the public who use terms like “case endemic.” A similar phenomenon happened with the 2% who fought in the sandbox and the rest of America that went to the mall - the two sides don’t understand each other because their experiences are not aligned.

Here is a screen shot of a text exchange 2 days ago between me and a 45-year old friend from residency who developed severe ARDS in 24 hours. He is an emergency physician, intensivist, and Air Force CCATT veteran:




Keep in mind this guy is a PT stud and physician who literally thought he was going to die alone from drowning as he watched his monitor read a pulse ox of 69% while he was sucking 60 liters on a high-flow nasal cannula. A nurse who he had never met stayed by his bedside, holding his hand while his own partners debated intubating him. That is the reality that those of us who work in America’s ICUs are now seeing daily - people in their 40s and 50s drowning to death...alone...multiple times each day.

[JDD]

...
Keep in mind this guy is a PT stud and physician who literally thought he was going to die alone from drowning as he watched his monitor read a pulse ox of 69% while he was sucking 60 liters on a high-flow nasal cannula. A nurse who he had never met stayed by his bedside, holding his hand while his own partners debated intubating him. That is the reality that those of us who work in America’s ICUs are now seeing daily - people in their 40s and 50s drowning to death...alone...multiple times each day.

I bounce back and forth between thinking dying in panic and confusion would be worse, or dying knowing exactly what is happening and powerless to prevent it would be worse. (the current leading contenders for the two scenarios are some sort of sudden-onset mentally debilitating medical event like like a stroke/cardiac arrest combo; and being surrounded by an overwhelming number of bad-guys and killed after running out of buddies and ammo while accompanying some bright spark on a meaningless trip to somewhere we should not be)

For some reason, this post specifically drove the pandemic home for me in a way that has been mostly academic to me before. Thanks for sharing!

[Nephrology]

This was sent to me by a co-worker who finished his anesthesia residency this past Summer at Columbia in NYC. One of his residency classmates wrote it, and it got published in The Atlantic. Columbia in NYC was the proverbial Second Battle of Fallujah or COP Keating in medical terms last Spring.

https://www.theatlantic.com/ideas/ar...an-get/617302/

While often I’m the first to dismiss The Atlantic as liberal crap, this particular piece comes with the backing of a colleague who was physically present to verify that the author is honest. It also squares as a less intense version of what I’m seeing today.

Basically, there is a sharp divide among the healthcare workers who experience the toll daily, and the portion of the public who use terms like “case endemic.” A similar phenomenon happened with the 2% who fought in the sandbox and the rest of America that went to the mall - the two sides don’t understand each other because their experiences are not aligned.

Here is a screen shot of a text exchange 2 days ago between me and a 45-year old friend from residency who developed severe ARDS in 24 hours. He is an emergency physician, intensivist, and Air Force CCATT veteran:




Keep in mind this guy is a PT stud and physician who literally thought he was going to die alone from drowning as he watched his monitor read a pulse ox of 69% while he was sucking 60 liters on a high-flow nasal cannula. A nurse who he had never met stayed by his bedside, holding his hand while his own partners debated intubating him. That is the reality that those of us who work in America’s ICUs are now seeing daily - people in their 40s and 50s drowning to death...alone...multiple times each day.

That's awful, but I am glad your friend is recovering. Stories like this make me wish I could get the vaccine yesterday.

I obviously haven't seen any COVID patients, but the look of fear I've seen on others with air hunger (COPD exacerbations etc) is pretty impossible to forget.

[Sensei]

That's awful, but I am glad your friend is recovering. Stories like this make me wish I could get the vaccine yesterday.

I obviously haven't seen any COVID patients, but the look of fear I've seen on others with air hunger (COPD exacerbations etc) is pretty impossible to forget.

My personal experience is that the sickest patients with COVID are incredibly hard to sedate, and I think that some of the issue is profound air hunger. We have patients on massive doses of fentanyl, propofol, and versed despite being trach’ed. Some of the attendings have resorted to insane doses of enteral sedation such as 80 of Oxy and 10 of Ativan q6 on top of the traditional IV stuff for some of the ECMO cases. Dropping the Versed or propofol just a hair results in tachycardia, tachypnea, and hypoxia that causes us to chase our tails by going up on ECMO flows, giving volume for the inevitable chugging, and the viscous cycle continues. I know this doesn’t square the the experience at Advocate in Chicago where VV ECMO runs got woken-up, extubated, and mobilized while on the pump. It’s like nothing I’ve ever seen before.

[RoyGBiv]

Not intending to make light of this... not even slightly...
After reading the last few Sensei posts I'm feeling like we're living in another famous Bruce Willis movie.

[Dog Guy]

This was sent to me by a co-worker who finished his anesthesia residency this past Summer at Columbia in NYC. One of his residency classmates wrote it, and it got published in The Atlantic. Columbia in NYC was the proverbial Second Battle of Fallujah or COP Keating in medical terms last Spring.

https://www.theatlantic.com/ideas/ar...an-get/617302/

While often I’m the first to dismiss The Atlantic as liberal crap, this particular piece comes with the backing of a colleague who was physically present to verify that the author is honest. It also squares as a less intense version of what I’m seeing today.

Basically, there is a sharp divide among the healthcare workers who experience the toll daily, and the portion of the public who use terms like “case endemic.” A similar phenomenon happened with the 2% who fought in the sandbox and the rest of America that went to the mall - the two sides don’t understand each other because their experiences are not aligned.

Here is a screen shot of a text exchange 2 days ago between me and a 45-year old friend from residency who developed severe ARDS in 24 hours. He is an emergency physician, intensivist, and Air Force CCATT veteran:




Keep in mind this guy is a PT stud and physician who literally thought he was going to die alone from drowning as he watched his monitor read a pulse ox of 69% while he was sucking 60 liters on a high-flow nasal cannula. A nurse who he had never met stayed by his bedside, holding his hand while his own partners debated intubating him. That is the reality that those of us who work in America’s ICUs are now seeing daily - people in their 40s and 50s drowning to death...alone...multiple times each day.

Pop over to https://pistol-forum.com/showthread....wn-rules/page2 to see that disconnect right here on PF. There's a solid mix of legitimately calling out "leaders" who make shut down orders that aren't based on any real science but hypocritically don't follow their own orders, plus right wing posturing not based on any real science, plus other threads bagging on restrictions on private gatherings (which seem to actually be a serious source of spread), plus bragging about how to fake a mask, plus...

[Baldanders]

Pop over to https://pistol-forum.com/showthread....wn-rules/page2 to see that disconnect right here on PF. There's a solid mix of legitimately calling out "leaders" who make shut down orders that aren't based on any real science but hypocritically don't follow their own orders, plus right wing posturing not based on any real science, plus other threads bagging on restrictions on private gatherings (which seem to actually be a serious source of spread), plus bragging about how to fake a mask, plus...

I'm not sure why anyone thinks postmodernism is a particular vice of the left.

It's a game the whole country can play. Righteous rioters supported by lefties, gun-toting yellers supported by the right. Both valiantly spread death.

"A curious game...."

Too bad there’s not much territory off the chessboard to hide in.

Yes, I know this isn't the politics thread, but how can you possibly separate politics from science and a decent response to this thing at this point? Where mathematical exercises proporting to show "nothing too bad this year" are passed around as possible, right as it is clear that we are moving into a new and terrible phase of this epidemic?

[45dotACP]

My personal experience is that the sickest patients with COVID are incredibly hard to sedate, and I think that some of the issue is profound air hunger. We have patients on massive doses of fentanyl, propofol, and versed despite being trach’ed. Some of the attendings have resorted to insane doses of enteral sedation such as 80 of Oxy and 10 of Ativan q6 on top of the traditional IV stuff for some of the ECMO cases. Dropping the Versed or propofol just a hair results in tachycardia, tachypnea, and hypoxia that causes us to chase our tails by going up on ECMO flows, giving volume for the inevitable chugging, and the viscous cycle continues. I know this doesn’t square the the experience at Advocate in Chicago where VV ECMO runs got woken-up, extubated, and mobilized while on the pump. It’s like nothing I’ve ever seen before.

Your experience squares with mine as a (non CVICU) RN at Advocate.

Our CVTU and ASHU teams have my respect, because doing a sedation vacation with those patients must be a real trip.

I have no idea how they wake those patients up, but yeah early ambulation to a wild degree is a horse they've been on since before the pandemic.

I think some of our older RNs jaws hit the floor when we started walking patients with IABPs

I know they're pretty picky about who they cannulate...usually they're on the younger side. For some of the patients, there is just no point.

Incredibly happy to hear your colleague is feeling better. We've been fortunate not to lose anyone working here. Although one of my colleagues lost her father and many had family members that I personally cared for while we watched their sats tank and talked about starting a BiPap+precedex and...well you know what's after.

A few of our physicians did lose friends and colleagues.

[willie]

I saw some anti vaccination shit on another forum where people were discussing ways to avoid being vaccinated with the covid vaccine. One was bribing a physician to falsify papers.My lgs has a sign posted outside saying that mask rules violated their liberty. I read and write above the 8th grade level, and for the life of me can not figure out some of the reasoning I see in opposition to best medical practices in fighting spread of covid-19 virus. I continue to hear it's no worse than the flu.

Earlier physician posts mentioned covid patients drowning in their own fluid. That reminds me of what I read about the Spanish flu's effect on patients.

[JDD]

Pop over to https://pistol-forum.com/showthread....wn-rules/page2 to see that disconnect right here on PF. There's a solid mix of legitimately calling out "leaders" who make shut down orders that aren't based on any real science but hypocritically don't follow their own orders, plus right wing posturing not based on any real science, plus other threads bagging on restrictions on private gatherings (which seem to actually be a serious source of spread), plus bragging about how to fake a mask, plus...

On a forum in which we spend quite a bit of time and energy thinking about the best and most effective ways to wear, carry, and use protective equipment for personal and group safety, it boggles my mind that there are 2A folks who don't realize how bad the optics are on being anti-mask.

We literally think about the ways to work around the inconvenience and physical limitations of carrying firearms, specifically to protect the people around us - mask wearing and concealed carry are parallels that you can apply all the same arguments to, to a disturbingly high degree. I hate the "sheepdog" analogy... but man, anyone who is full anti-mask has lost any right to call anyone a sheep, or to consider themselves a sheepdog.