You'd think with surgical cases limited to emergencies that there'd be enough anesthesia to cover for pulm but guess not.Originally Posted by ccmdfd
You'd think with surgical cases limited to emergencies that there'd be enough anesthesia to cover for pulm but guess not.
Speaking of anesthesia, a perspective from an anesthesia PGY2 in NYC:
https://www.reddit.com/r/Residency/c...id_icu_in_nyc/
I don't know what the plan is here, but just across the road from our campus are a high school, a middle school, and an elementary school. Schools are empty now, so putting patients there seems better to me than sticking them in parking decks. We have a very small cafeteria.
So has anybody seen survival rates for those who are put on ventilators? The only thing I could find are some Chinese studies with around 200 patients that had 80-90% mortality rates once you were intubated.
It might sound kind of dark, but I’m trying to make some decisions about how much treatment I want if I get sick and end up hospitalized, with nobody relying on my paycheck and nobody to care for me if I come out the other end all fucked up or with cognitive issues due to several weeks of low oxygen this seems like a pertinent question.
I found this 3M face shield in my garage still new in wrapper:
Now every time I go into a COVID-10 room: surgical cap, N95 mask, this thing, gown and gloves.
A buddy has a buddy who is an importer/exporter. He has a supply of KN95 masks coming in. I'm going to buy about 300 to give out to my posse.
So far in AZ, there are 773 cases with 15 deaths. We have not been overwhelmed with COVID-19 cases. No patient in our hospital has died from COVID and most had only mild to moderate symptoms. Right now we are trying to clear out the hospital as much as possible and shore up our supplies. Our Stygian Witches tell us that the COVID meteor will hit us in about 2 weeks.
IIRC across several studies it ends up being about 50/50. Depends on presence of other comorbidities too either pre-existing or secondary to the virus (eg AKI)
if I lived in CA and lost a loved one because there wasn't a ventilator available to try to save them, I might be tempted to go have a personal conversation with Jerry Brown.
Here's a link to a non-paywall version of the story.
If we have to march off into the next world, let us walk there on the bodies of our enemies.
I can, and there is very little that could have been done ahead of the time in this regard.
The material supplies, PPE, maybe vents, that could've and should've been planned ahead if we paid attention to other people's past experiences with SARS, MERS etc.
The ramp-up could've been and should've been done sooner if people on the top weren't in a denial early.
The hospital beds, I presume we could've built huge facilities that would stay idle and used 50% of capacity for the rest of the time and ate loads of money.
The MD workforce, that we cannot plan on the basis of events when a massive surge capacity is required in 2-3 weeks. Nationwide this is a new experience but not unseen before by some of us on a micro-level. Patients in hallways on gurneys, no concept of private rooms except for negative pressure and ICU, rampant infection, shortages, working as a doc, a phlebotomist, a transporter, and a resp therapist in one, not seeing families for 48 hours etc. Been there, done that, nine years at Cook County Hospital do count for something. Except the infection was AIDS and its opportunistic brothers.
My organization is preparing a contractual amendment that will allow them to reallocate us to where we're needed. We're nervous, it's been 15-20 years since most of us managed vents or treated infection but none of us said no. This is the time when country needs us to step out of comfort zones, stay calm in every way we can, and do whatever we can, and we all will.
We will have a different population on the vents so our data will likely be better. @Doc_Glock and I chatted about it today. The MO, at least in our system, is that none gets BIPAP because of aerosolization and risk to caregivers. If they can't maintain sat on N/C, they get the tube even if BIPAP would've been sufficient to keep them afloat. Those who got the tube for spread containment reasons will likely do OK.
Last edited by YVK; 03-28-2020 at 07:53 PM.
Doesn't read posts longer than two paragraphs.
Ahhh, the Cook County folks don't freak out about anything. That hospital is basically on fire about 6 days a week.
In Chicago they're setting up McCormick place, as one of the main field expedient hospitals when it gets really bad here. Hopefully that will hold a few hundred more patients.
A large number of our 'tubed patients are intubated for "source control" so we've seen a few extubations after the patients body recovers. But yeah BiPap and HFNC are a non starter. That seems to make extubation challenging for some, as we get a lot of value from a High Flow Nasal Cannula.
But some of these patients have real shitty activity tolerance post extubation. Most all of the ICU COVID patients I've cared for have the same reason for ICU admit.
"Patient came in ambulatory on room air, and two days later walked 15 feet to the bathroom and started gasping and desaturating to a SpO2 in the 70s on 6L nasal cannula"
Our physical therapy department is at a loss because some of these patients can barely tolerate being in the chair for more than a few minutes before they get tachypneic in the 50s
My sense is that this is a rare bug in that activity is severely exacerbating the underlying problem and the patient likely needs to be on bedrest. But I have no evidence other than anecdata that some fellow nurses and PT staff conjecture.
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