MT2PA Posted March 24, 2020 Share Posted March 24, 2020 (edited) 5 hours ago, Reality Check 2 said: * Our dentist sent us texts about urgent only - no routine cleanings for at least the next month * Specialty clinics in my area are not seeing new referrals unless said limb is hanging by a thread or one needs a stent * No elective radiology - meaning 10 yrs of back pain does not get an MRI right now; not sure on mammograms * A local pain clinic tried to charge my VA contracted patient $65 for a phone visit to refill his meds - our contract dept quickly kiboshed that nonsense showing them on contract that video/telephone visits are covered * No new eye exams right now. No new hearing tests right now * All elective surgeries canceled in all local hospitals * No PT right now - sorry if that hurts, sir, google some youtube exercise videos * No labs unless you really need them * Slightly elevated PSA came back this morning on a guy - added Free ratio and repeat PSA in 3 months - asymptomatic * No elective vaccines right now - stay out of the clinic Working on my umpteenth phone call, video services not working at this time. Right this minute, I cannot tell you why I don't drink........................... This is essentially what my system is doing. Only urgent ambulatory visits (chemo must go on....) but clinics are sparse. It's not perfect and we're learning as we go but they are at least taking this seriously. Seems like chaos from the inside but compared to these other stories...I feel like I should be bragging. Edited March 24, 2020 by MT2PA Quote Link to comment Share on other sites More sharing options...
PbagJones Posted March 24, 2020 Share Posted March 24, 2020 (edited) This is getting really bad here in NYC, I work in critical care for a major city hospital system. We’re are on the brink of running out of ventilators, the RT told me we only hav 2 left in the whole hospital, until we have to start using the ones in the ORs. We are also running very low on PPE, we are getting just one N95 to use the entire shift. The patients that progress to intubation are not doing well. Many are on high FI02 and PEEP and needing to be proned. Also many of them are going into AKI requiring HD. Our 20 bed unit is filled with all intubated covid patients. Very soon people who need ventilators and ICU beds will not be able to get them if things keep up at the pace they are going. Edited March 24, 2020 by PbagJones 1 Quote Link to comment Share on other sites More sharing options...
Moderator True Anomaly Posted March 24, 2020 Moderator Share Posted March 24, 2020 Finally had my first true positive covid case yesterday Manning the tent at my place of practice- 29 y/o comes in, no med hx, states he was traveling to NYC for the past two months, and a coworker tested + for covid last week. Sx’s of cough and fever for the past week, but last two days notices that his breathing is just wrong. Guy is ambulatory, afebrile, mildly tachycardic, but also having conversational dyspnea and looks uncomfortable. Got him a room for further evaluation- checked this AM and sure enough, tested positive. Even though, like y’all, I’m reading as much as possible about how this disease looks in patients who are presenting, but the more first-hand look you get at it when patients like this guy are borderline- you can definitely see that had this guy not come in, another day and the chances of him having respiratory failure were very high 2 Quote Link to comment Share on other sites More sharing options...
Cideous Posted March 24, 2020 Author Share Posted March 24, 2020 2 hours ago, True Anomaly said: Finally had my first true positive covid case yesterday Manning the tent at my place of practice- 29 y/o comes in, no med hx, states he was traveling to NYC for the past two months, and a coworker tested + for covid last week. Sx’s of cough and fever for the past week, but last two days notices that his breathing is just wrong. Guy is ambulatory, afebrile, mildly tachycardic, but also having conversational dyspnea and looks uncomfortable. Got him a room for further evaluation- checked this AM and sure enough, tested positive. Even though, like y’all, I’m reading as much as possible about how this disease looks in patients who are presenting, but the more first-hand look you get at it when patients like this guy are borderline- you can definitely see that had this guy not come in, another day and the chances of him having respiratory failure were very high Just curious, but what did you do to abate respiratory failure? He get admitted? Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 24, 2020 Moderator Share Posted March 24, 2020 our admission criteria at this point is an oxygen requirement. If you are well enough to drive yourself in, you are probably going home. 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 24, 2020 Moderator Share Posted March 24, 2020 I was just asked to come up with an MD calc like algorithm for admission criteria. Will base on comorbidities, age, and sao2. 1 Quote Link to comment Share on other sites More sharing options...
Reality Check 2 Posted March 24, 2020 Share Posted March 24, 2020 Just got approved for two weeks of home telework - until the Washington state shelter order is over - then assess the situation again for risks/benefits. I am grateful for this. Everyone be safe!!! 3 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 24, 2020 Moderator Share Posted March 24, 2020 1 hour ago, EMEDPA said: I was just asked to come up with an MD calc like algorithm for admission criteria. Will base on comorbidities, age, and sao2. Here it is. This is for adults. I would consult peds for anyone under 13. Covid Admit criteria.docx 2 Quote Link to comment Share on other sites More sharing options...
EMSGuy1982 Posted March 24, 2020 Share Posted March 24, 2020 42 minutes ago, Reality Check 2 said: Just got approved for two weeks of home telework - until the Washington state shelter order is over - then assess the situation again for risks/benefits. I am grateful for this. Everyone be safe!!! Stay safe! The “stay home, stay safe” order here in Washington pretty much has no teeth to it. Business as usual here in WA. If you take a look at the list of “essential“ services they released there is a grey area for anyone to operate. Pretty sure coffee stands and dog groomers aren’t part of the essential infrastructure. Maybe Washingtonians will change their tune when people start dropping like they are in Italy. Not sure where they get the magical number of 2 weeks but I sure hope things settle down. We run our UC with 4 providers including myself and we all are a little toasty after the last few weeks.. provider burn out is going to get bad if this drags on. I did see some TP at our corner store. Pretty sure it’s 1/4 ply paper if anyone is desperate. Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted March 24, 2020 Share Posted March 24, 2020 (edited) NADA for this "old" man at Wallyworld this morning at 6a. Didn't even ask for ID. I have spent the day isolating self with wife by swapping out my dash on my Jeep and taking the hard top off. I'm going to hook up the power washer and put the soap nozzle on it and see if it substitutes for a bidet. I have a foam cannon for my vehicles so I guess I can soap as well as rinse. Just found facial tissue at Costco website so ordered some since we're about out during allergy season. Edited March 24, 2020 by GetMeOuttaThisMess 1 Quote Link to comment Share on other sites More sharing options...
mgriffiths Posted March 24, 2020 Share Posted March 24, 2020 In Michigan, our "stay at home" executive order went into effect at midnight Monday night. I woke up this morning to a roofing company tearing off to replace my neighbor's very functional roof (simply at the end of its life, but not leaking or anything). I yelled at them and told them I would call the police if they didn't leave. They had 8 employees, all arrived in 2 cars (violation of social distancing order) and all huddled together working on the same area of roof. I had to go to the grocery store for diapers and wipes and told them they had until I returned. They weren't gone, but finishing patching up the areas they had torn off but thankfully left shortly thereafter. Then, I get an email from our HOA that lawncare for HOA property would continue as normal because the lawncare company was considered "essential infrastructure." I called immediately, but thankfully one of the multiple police officers in my neighborhood had already called and put a the kibosh on that. Amazing the level of stupidity. Maybe there is a reason the world is shutting down... 3 1 Quote Link to comment Share on other sites More sharing options...
Reality Check 2 Posted March 24, 2020 Share Posted March 24, 2020 I have a letter that shows I am an essential federal employee if I have to go in to our physical building. Not sure anyone would ask. Our local law enforcement said they weren't giving out tickets for violations but "encouraging" compliance. Husband is off work from school district - no one working right now. They actually observe the governor's advice. Not sure how many people have to die before some knuckleheads grasp this concept. We are fine at home. We have enough toilet paper for now for our group. Full freezer and pantry. Have dog food and cat food - more essential as they outnumber me...... Hubby in the garage building and doing stuff. I am so grateful we have some acres and enough room to spread out and get away from each other sometimes. Weather sort of cooperating for now. Bless Netflix and Amazon Prime. Have to keep my husband off amazon and Craigslist..... No video work for now because the equipment is not working properly. I will do phone appts and Skype with my nurses and team. Just have to keep the cat off my keyboard - he sends interesting emails. I will save a ton on hairspray and makeup for now..... working in sweats..... Supposed to recheck the situation at the two week mark. One day at a time, folks, one day at a time. 1 Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted March 24, 2020 Share Posted March 24, 2020 20 minutes ago, Reality Check 2 said: Bless Netflix and Amazon Prime. Have to keep my husband off amazon and Craigslist..... Bite your tongue girl! Bought new tennis shoes and new smaller jeans yesterday at Amazon and Penney's. Awaiting new watchband from overseas. Also waiting on new auto transmission and transfer case knobs for my Jeep. Oh....I guess I DO see your point. 3 Quote Link to comment Share on other sites More sharing options...
mgriffiths Posted March 24, 2020 Share Posted March 24, 2020 22 minutes ago, Reality Check 2 said: Have dog food and cat food - more essential as they outnumber me..... Too true...too true... 2 Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted March 24, 2020 Administrator Share Posted March 24, 2020 1 hour ago, mgriffiths said: Then, I get an email from our HOA that lawncare for HOA property would continue as normal because the lawncare company was considered "essential infrastructure." Here in Washington State, marijuana dispensaries are essential services. Sheesh. 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 24, 2020 Moderator Share Posted March 24, 2020 11 minutes ago, rev ronin said: Here in Washington State, marijuana dispensaries are essential services. Sheesh. yup, they have lines around the block. Overheard recently: what kind of weird world is this in which it is easier to get weed than toilet paper? 1 Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted March 24, 2020 Administrator Share Posted March 24, 2020 Just now, EMEDPA said: Overheard recently: what kind of weird world is this in which it is easier to get weed than toilet paper? Or guns, for that matter, as gun shops were not considered essential services, while the pot shops are... Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted March 24, 2020 Share Posted March 24, 2020 (edited) Watching ABC World News and NYC video shows folks tripping all over themselves. No wonder they’re a medical disaster. We have to be smarter than this. They even interviewed a “Physician’s Assistant”. They didn’t say an assistant to who. Edited March 24, 2020 by GetMeOuttaThisMess Quote Link to comment Share on other sites More sharing options...
ohiovolffemtp Posted March 25, 2020 Share Posted March 25, 2020 EMED., Looked over your admission guidelines. It looks like a 66 y/o COPD'r who sats 90% at baseline would point into admission no matter what. Rev, In KY, gun stores are considered essential infrastructure and are staying open as long as they follow social distancing. One of the country's largest online and retail stores is based in KY and is letting in "limited numbers of customers" but has closed their ranges. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 25, 2020 Moderator Share Posted March 25, 2020 Just now, ohiovolffemtp said: EMED., Looked over your admission guidelines. It looks like a 66 y/o COPD'r who sats 90% at baseline would point into admission no matter what. Rev, In KY, gun stores are considered essential infrastructure and are staying open as long as they follow social distancing. One of the country's largest online and retail stores is based in KY and is letting in "limited numbers of customers" but has closed their ranges. astute observation. one of our caveats was in folks not requiring o2 at baseline. If they were 90%, 66 yrs old, and had copd without home o2 then yes, they would come in unless they looked great. like anything, it is just a guideline. Quote Link to comment Share on other sites More sharing options...
Reality Check 2 Posted March 25, 2020 Share Posted March 25, 2020 Has anyone followed patients after positive test and recovery? Read an Article about a community north of NYC where folks are repeatedly testing positive 20-30 days after first test but are asymptomatic and feel fine but remain on quarantine. The state dept of health policy is not letting them out until negative. Lots of debate - why aren’t they negative, wasting tests, others have gone negative, are they still capable of transmission? I don’t think we know exactly what to expect yet. Leaves a huge future unknown. Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 25, 2020 Moderator Share Posted March 25, 2020 8 minutes ago, Reality Check 2 said: Has anyone followed patients after positive test and recovery? just Tom Hanks 3 1 Quote Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 25, 2020 Moderator Share Posted March 25, 2020 46 minutes ago, ohiovolffemtp said: EMED., Looked over your admission guidelines. It looks like a 66 y/o COPD'r who sats 90% at baseline would point into admission no matter what. Rev, In KY, gun stores are considered essential infrastructure and are staying open as long as they follow social distancing. One of the country's largest online and retail stores is based in KY and is letting in "limited numbers of customers" but has closed their ranges. https://www.cnn.com/2020/03/24/us/los-angeles-gun-store-close-coronavirus-trnd/index.html L.A. County closed all their gun shops. Quote Link to comment Share on other sites More sharing options...
mgriffiths Posted March 25, 2020 Share Posted March 25, 2020 7 hours ago, EMEDPA said: https://www.cnn.com/2020/03/24/us/los-angeles-gun-store-close-coronavirus-trnd/index.html L.A. County closed all their gun shops. I think I'm more surprised that a gun shop is able to survive in LA. 1 1 Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted March 25, 2020 Share Posted March 25, 2020 Has anyone followed patients after positive test and recovery? Read an Article about a community north of NYC where folks are repeatedly testing positive 20-30 days after first test but are asymptomatic and feel fine but remain on quarantine. The state dept of health policy is not letting them out until negative. Lots of debate - why aren’t they negative, wasting tests, others have gone negative, are they still capable of transmission? I don’t think we know exactly what to expect yet. Leaves a huge future unknown.RST will remain positive for up to two weeks post infection, so I was told by Quintel when I called company a couple of years ago. Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You can post now and register later. If you have an account, sign in now to post with your account.