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The Official CORONAVIRUS oh *&^! thread. Time to start stocking up on food?

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Hmm, looks like I wasn't far off after all with my previous pic posting.  This pic is out of Paris where they converted a snorkel mask into a ventilator.

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Edited by GetMeOuttaThisMess

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Just saw my first PPE related death....there should be a public service announcement about when to wear a mask and when not to....older guy, all the typical risk factors , decides to mow his lawn. At home. Alone. Wearing an N-95....big stemi, not revived when he coded. Likely not Covid related, but medics didn't want to do compressions until they got an adv airway...and it took a while....asystole despite lengthy resuscitation attempt. Damn.

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What the hell is wrong with your EMS crews? I hope whoever their medical director is puts a stop to that nonsense. 

Waiting to perform compressions until after an advanced airway is in place matches no guidelines or recommendations from any society that I'm aware of. 

If they are running around with no PPE then that's a failure on another level, but if the patient had a frigging N95 on that's pretty good. There are suggestions to throw a NRB or surgical mask on the dead guys face, or at least maintain a good deal with a BVM. 

I find that scenario pretty frustrating, sorry man.

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Don't want to detract too much from the purpose of this thread, but here is the latest AHA update for cardiac arrests in the land of Covidania. Nothing earth shattering but...

Major changes I noted:
- It's ok to pause for intubation. I'm assuming this is due to the high risk of aerosolizing particles with compressions. Keep your distance as best you can (this goes for non-infectious patients as well, distance improves view), if you can't toss the tube in then place an LMA/EGD/SGD whatever acronym you want to use.
- Place an oxygen mask over the patient's face while performing compressions with oxygen flowing, this will assist in preventing particulate spread, a simple mask will assist as well
- Mechanical CPR devices are recommended to reduce to number of rescuers needed on scene/in the room during the resus
- If you have a HEPA/Viral filter USE IT and minimize disconnections

- Also suggestions about using the ventilator for in-house arrests rather than a BVM, there are instructions in there, not sure I completely agree about using a pressure-control mode for delivering the breaths but whatevs.

Article is attached. Rationale at the beginning, algorithms/figures around page 13
 

CIRCULATIONAHA.120.047463.pdf

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Right now is not a great time in the world to need to give birth either - alone without partner or family using skype or FaceTime to "share" the moment.

Nor is it a good time to be a heroin injector who gets SBE and sepsis going into NON COVID resp distress and needing ventilation - my latest find......................... Now needs 6 weeks of somewhere to stay with a PICC line and BID abx. No SNFs want these folks.

Our world is a messed up place right now.

 

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1 hour ago, Cideous said:

It's a bad time to have an MI in this country....

I'm not sure I would say it's ever a good time...but yeah, bad time for pretty much anything to occur that is a medical emergency.

 

7 minutes ago, Reality Check 2 said:

Right now is not a great time in the world to need to give birth either - alone without partner or family using skype or FaceTime to "share" the moment.

wife 6 weeks out from due date on Monday...sucks big time...I'll be there with her, but all the wonderful moments of our 1.5yo meeting her sister the day she is born, parents and in-laws visiting to meet their granddaughter, having to plan what to do with our 1.5yo daughter because we can't bring her with us but don't want my wife delivering alone...the list goes on and on...

My personality, I relatively take it in stride because it's 100% out of our control and no amount of planning or anything would have made a difference on our part.  But it's definitely affecting my wife, and then of course she's scared to even go to the hospital...it's a literal nightmare.

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The best and the worst of every walk comes out in times like these.

The whole combo sucks - Jaguar, PA, Florida - staff saw it being loaded......

Come on folks...................... 

Hoarding toilet paper is bad enough.

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5 hours ago, EMEDPA said:

just had another nstemi sign out ama....

And the right-wing nutjobs are complaining that people are dying "with" Covid-19 and not "of" Covid-19 to inflate the count.  How 'bout that excess mortality because people are too scared to go to the hospital that's equipped to help them, because they're afraid to get Covid-19?

Sigh.

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Virtual visits,: I have a patient with chronic hep C, cirrhosis, and a previously undiagnosed murmur with bradycardia and bilat dependent LE edema who has been waiting 3 months to get into cards and his appointment next week was canceled. He called yesterday with what sounded like possible DVT... unilateral LE swelling and he even described a palpable cord on the back of his calf. I advised him to go to the ED.

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.... and we've now passed 500k confirmed US cases, with an instantaneous CFR of just under 4%, and 6% recovered.  Stupidity on Facebook abounds, with the Antivaxxers now pushing a 5G conspiracy theory, and plenty of others (well, the two groups probably overlap) pushing various woo as a cure.

Probably the most dangerous graph I've seen isn't the exponential growth--I could have accurately drawn those out from the data available in late January, for the most part--but the difference in "Taking Covid-19 seriously" between the left and right.  The preexisting lack of intra-party trust in the U.S. may doom us all: the left sees this as an opportunity to advance their agenda, at least according to those on the right who don't think this is an outright hoax.  The right will be screaming "fake news!" and undermining quarantine until all of us die, at least according to the left.  Democratic-controlled states are trying to close gun shops as nonessential, while Republican-controlled states are trying to classify abortion as an elective service and halt it.  Both sides favored open borders for different reasons, which is why the political will was never present to close the borders in time to make any sort of a difference.

Half of the economy halted, and the other half has whiplash.  Money is being printed like TP, which is going to lead to rampant inflation and long-term economic woes.  We can't just "hibernate" the travel and restaurant industries, because the people who USED to work there need to eat. Every armchair economist has a solution, which usually involves bailing out the things THEY perceive as important... but the economy is too complex to be modeled by one human mind.

We are never going back to the way things were.  I'm wondering what the aftermath will actually look like when the dust settles.

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And the right-wing nutjobs are complaining that people are dying "with" Covid-19 and not "of" Covid-19 to inflate the count.  How 'bout that excess mortality because people are too scared to go to the hospital that's equipped to help them, because they're afraid to get Covid-19?
Sigh.
I know. I was in the military and you wouldn't hear this from the Marines. We go to war with the resources we have, not what we want. We chose a job of being a public servant. We shouldn't be premadonnas. Buy yourself a respirator and a facemask and go to work. Wash your hands and your body.

Sent from my SM-N975U using Tapatalk

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5 hours ago, Mayamom said:

I still don't get why are they going to sign out AMA?  Stay home already.  

FAMILY calls 911 when grandma gets CP or stroke sx. they get ED workup then don't want to be there....

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54 minutes ago, Marinejiujitsu said:

I know. I was in the military and you wouldn't hear this from the Marines. We go to war with the resources we have, not what we want. We chose a job of being a public servant. We shouldn't be primmadonnas. Buy yourself a respirator and a facemask and go to work. Wash your hands and your body.

Sent from my SM-N975U using Tapatalk
 

yup, this is what we signed up for.

"What, I have to see sick patients?" Yes, yes you do. It's your job. you have been very well paid for years for taking care of BS, now it's time to step up and earn your keep buttercup. I understand older providers and folks with bad comorbidities taking a pass on this one, but for everyone else this is the job. Sick spouse or babies at home? Stay away from them until this is over. We can't have everyone take a pass because they know someone sick or there would be no providers left.

I feel bad for paramedics in big cities who are getting sick at high rates despite spraying themselves down with Lysol after every patient contact. They have a legit beef. most of us do not.

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Well, seems like the ER is back to normal. Shoulder dislocation, FB in rectum, stroke requiring TPA, psych pts coming out of the rafters, and a drunk who will require a full workup to prove they are just drunk....

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