Is your shop seeing cases?

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Multiple cases, including otherwise healthy 40 yo on ECMO and many more on vents

and yet still doing elective cases
 
We have some healthy people also unfortunately that ended up in the ICU, and some on the floor doing ok so far... we are debating whether or not to initiate ECMO on one, supposedly at Udub they are not doing ECMO for covid and we are debating whether or not we should take a similar approach. we just cancelled elective cases today but that may already be too late as we usually run at capacity 100% of the time.
 
Zero in our hospital currently. Had 1 and was discharged.

On a separate note, the hospital brought us "PPE packets" specifically for anesthesia that didn't even have N95 masks. They basically had gloves, plastic gown, and the mask/eye shield thing. No other head cover, no shoe covers. It's seriously a joke.
 
dabears505 said:
Cover 2 hospitals, we have one person on vent at 1 and 2 at the other. Its hard to stay vigilant and worried when the flood of patients coming in is not as much as the measures being taken(which might mean the measures are working).
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This is the dangerous line of thought people keep falling prey to. The virus has a 5 day incubation period + deterioration at day 7-10. That's 12-15 days lag from when these people got infected. The cases you're seeing now in the ICU basically got infected before anything was shut down. These are some of the first people to have gotten infected in the US. If those are the same numbers in two weeks, then maybe I'll breathe a sigh of relief.

As to your question, we have 2 intubated. At least 50 waiting results of their test.
 
thumb_its-the-deep-breath-before-the-plunge-my-feelings-on-49832527.png
 
Several positives, at least 2 intubated in the MICU. Many more pending results I'm sure. Today is the last day of "elective" cases, but we're still starting probably 30-40% of our anesthetizing locations tomorrow, so it's not like it's a weekend type of day where we're doing only urgent/emergent cases. I see several spines and other questionable cases. Even today a few non-urgent cases required escalation of care to ICUs afterwards for various reasons.

Every country and hospital will be looked at on how they handle this disaster and basically get their report card. I fear the U.S. to date has done far too little to mitigate the spread of this.
 
I live in westchester and my kids school is in new Rochelle. It’s extremely tough in NY and it’s just the beginning. My cousin is a RN in the ED where NY pt zero was admitted. (RNs and MDs on self quarantine and some COVID19 diagnoses). We are mirroring northern Italy and unfortunately it’s gonna get worse before it gets better. I’ve been following this pandemic since early January and starting slowly prepping (food, vitamins, cash, etc). My hospital is still doing elective cases but that might change.

I tried telling my group what was to come but it went on deaf ears. We’re sending young healthy pts home from the ED and have cases in the hospital(available beds are dwindling). My cousin at his ED is getting multiple COVID19 admissions daily (2 confirmed cases 4 pending diagnosis just today). I had an emergency intubation in the ED the other night for seizures but who knows. The number of cases in NY increased by 1000 over the last 24 hours.

At this point, I believe mass testing and total shutdown of all national operations is necessary. We’ve passed the point of containment about 4-6 weeks ago. Will lead to deflation and hyperinflation thereafter. But to keep civility, I believe it’s necessary. Protect your wealth and get some Bitcoin. to everyone here


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We've had 1 confirmed positive. Who happened to be visiting from elsewhere. They went home to recover and if they deteriorate, I guess will go to St. Elsewhere.
 
Handful of cases. One code leading to death which was posthumously diagnosed as COVID 19. That person was very sick and older.
 
Had 6 confirmed admits within 4 hours last night (not sure why US results take days to come back?!). We only had 3 admitted in the week leading up to yesterday, so it was a big jump. They're all in a walled-off section of ICU, but I'm not sure how many are actually needing support vs. just quarantined.
 
I can see why people in North America think their outcome/curve will be different from China and maybe Italy. But Germany, France, Spain and Switzerland too?

How are people so stupid/greedy?

A surgeon who obviously has intercourse with canines booked an elective case on my list tomorrow. I cant wait
 
Newtwo said:
I can see why people in North America think their outcome/curve will be different from China and maybe Italy. But Germany, France, Spain and Switzerland too?

How are people so stupid/greedy?

A surgeon who obviously has intercourse with canines booked an elective case on my list tomorrow. I cant wait
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Be glad you have cases. At my shop they have cancelled all the per diems for the foreseeable future...
 
Yes, we have a bunch of cases. Many sent home to quarantine, and a couple in ICU. Masks and PPE of all kinds are being strictly rationed. Elective cases are winding down with strict policy going into place next week. There are daily emails about how we are about to run out of masks. Testing is still difficult to obtain and turnaround time is days.

I have been very unimpressed with the hospital leadership on all of this. Transparency has been a major issue and as a result rumors spread faster than the coronavirus itself. It’s not helpful.

I think there will be a major reckoning for hospitals when this is all over. It is absolutely beyond acceptable that we are being told that supplies are short this early in a pandemic. Maybe it’s a hedge against the potential onslaught a few weeks from now, but it still feels like a lack of preparation to me.
 
Got an email stating that hhs is allowing cross-state practice with any license, pretty much like VA? Is it true?


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GravelRider said:
Yes, we have a bunch of cases. Many sent home to quarantine, and a couple in ICU. Masks and PPE of all kinds are being strictly rationed. Elective cases are winding down with strict policy going into place next week. There are daily emails about how we are about to run out of masks. Testing is still difficult to obtain and turnaround time is days.

I have been very unimpressed with the hospital leadership on all of this. Transparency has been a major issue and as a result rumors spread faster than the coronavirus itself. It’s not helpful.

I think there will be a major reckoning for hospitals when this is all over. It is absolutely beyond acceptable that we are being told that supplies are short this early in a pandemic. Maybe it’s a hedge against the potential onslaught a few weeks from now, but it still feels like a lack of preparation to me.
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Most hospitals are led by incompetent bureaucrats, not clinicians. It shows.
 
GravelRider said:
Yes, we have a bunch of cases. Many sent home to quarantine, and a couple in ICU. Masks and PPE of all kinds are being strictly rationed. Elective cases are winding down with strict policy going into place next week. There are daily emails about how we are about to run out of masks. Testing is still difficult to obtain and turnaround time is days.

I have been very unimpressed with the hospital leadership on all of this. Transparency has been a major issue and as a result rumors spread faster than the coronavirus itself. It’s not helpful.

I think there will be a major reckoning for hospitals when this is all over. It is absolutely beyond acceptable that we are being told that supplies are short this early in a pandemic. Maybe it’s a hedge against the potential onslaught a few weeks from now, but it still feels like a lack of preparation to me.
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Could anyone have predicted this? This is a once in a lifetime event. You can’t really stock up on expensive equipment when the business runs on such thin margins anyway. This is an act of god, Mother Nature, or the Chinese government. Take your pick.
 
dannyboy1 said:
Could anyone have predicted this? This is a once in a lifetime event. You can’t really stock up on expensive equipment when the business runs on such thin margins anyway. This is an act of god, Mother Nature, or the Chinese government. Take your pick.
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This is not a once in a lifetime event. H1N1 was not that long ago. How long ago was the AIDS epidemic? I’m not talking about ventilators, I’m talking about masks. I’m talking about eye shields. Why are we a week or two into this and we are being told we are running out of masks?

Oh but spring is coming and the gardens outside will be nicely mulched soon.
 
dannyboy1 said:
Could anyone have predicted this? This is a once in a lifetime event. You can’t really stock up on expensive equipment when the business runs on such thin margins anyway. This is an act of god, Mother Nature, or the Chinese government. Take your pick.
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Multiple, multiple people predicted (or at least saw the writing on the wall for the US) when China was getting bed and especially when Western Europe was getting bad. We've wasted at least 1.5 months in which production could've been ramped up.
 
For those who are seeing young, healthy patients intubated, has any pattern emerged? Smokers, overweight, etc? Or is this really affecting the fit, 20-40 population ?
 
Money-Moniker said:
For those who are seeing young, healthy patients intubated, has any pattern emerged? Smokers, overweight, etc? Or is this really affecting the fit, 20-40 population ?
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All the younger people we have are fat with comorbidities.


Also @Arch Guillotti and @pgg , can we stop people from making new COVID threads every time a new question pops up? If not there’s going to be a bazillion new posts with information that’s all over the place. We should just be using the clinical thread and economics (politics) thread that already exist.
 
dannyboy1 said:
Could anyone have predicted this? This is a once in a lifetime event. You can’t really stock up on expensive equipment when the business runs on such thin margins anyway. This is an act of god, Mother Nature, or the Chinese government. Take your pick.
Click to expand...

No,the country is super unprepared. We are supposed to have 85million n95 reserve. After h1n1 10+ years ago, only 12m left. No replenishment ever since. We now only have 12m with 5m expired.


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dabears505 said:
This is different than the econ and clinical threads. Those are more macro discussions, this is more personal anecdotes.
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Yea, except first it starts out with you asking if anyone has personally seen cases. And then the next guy (like just a few posts above) asks what are the clinical features of the people you are seeing. And then before you know it you have 2+ competing clinical threads and 10 other threads for each little micro topic that pops up. It's better to just have one COVID clinical megathread to keep all the information in one place.
 
narcotics999 said:
No,the country is super unprepared. We are supposed to have 85million n95 reserve. After h1n1 10+ years ago, only 12m left. No replenishment ever since. We now only have 12m with 5m expired.


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Do the regular surgical masks even help? Cause those are disappearing from my shop. We know this virus is highly contagious and can last on surfaces for days. Clinical syndromes from this virus range from no symptoms to death. Likely some of us on this forum have it and don’t even know it. I’m expecting to get it at some point. Seems useless to get all excited about protective gear when you are just as likely to catch this thing in the docs lounge....
 
dannyboy1 said:
Do the regular surgical masks even help? Cause those are disappearing from my shop. We know this virus is highly contagious and can last on surfaces for days. Clinical syndromes from this virus range from no symptoms to death. Likely some of us on this forum have it and don’t even know it. I’m expecting to get it at some point. Seems useless to get all excited about protective gear when you are just as likely to catch this thing in the docs lounge....
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Yes for fomites and droplets, no for aerosols.
 
I read a group chat exchange between a couple people I know and a friend of theirs (Anesthesia/ICU Physician) in a northern Italy city hospital. It’s really bad. Wartime bad. Worse than the news reports. They could intubate patients in respiratory failure, but they have no vents for them, so they are rationing care, they are reusing PPE because they have none left. Everyone there is C19 positive, patients dying all over. They’re completely overwhelmed. Multiple infected colleagues, and still getting worse. Many of the critically ill and dead were physicians. They try novel therapies, vent strategies, etc. nothing seems to make a difference in the critically ill. They’re frightened and exhausted, the citizens are frightened and exhausted. And it’s coming in a few weeks for us. Hopefully the social distancing and extreme measures will flatten the curve and limit the number of hospital systems that are overwhelmed.
 
It will definitely kill a number of physicians. Working long hours will depress immunity even in the healthiest.

The only way to fix this is to "centralize" the medical system and healthcare resources, forbid any non-essential care, by law, and have the federal government send military (reserve) physicians, healthcare workers and medical resources (such as N95 masks) to the most affected areas. Not the current every state on their own model.

We need national leadership, somebody credible to stand up to and push Trump's buttons in the media, every single day.

We also need anti-speculation laws. Anybody found hoarding and stockpiling N95 or medications, or other essentials, beyond a personal amount, should spend a decade in prison.
 
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dannyboy1 said:
Do the regular surgical masks even help? Cause those are disappearing from my shop. We know this virus is highly contagious and can last on surfaces for days. Clinical syndromes from this virus range from no symptoms to death. Likely some of us on this forum have it and don’t even know it. I’m expecting to get it at some point. Seems useless to get all excited about protective gear when you are just as likely to catch this thing in the docs lounge....
Click to expand...

The problem with this mentality is you may not be considering how viral load may correlate to clinical symptoms. Like you, I am beyond "containment." I fully expect I have or will contract the virus. Our hospital has two patients under investigation (1 ASA4, 1 ASA3). As anesthesiologists, we are right in the line of fire and would potentially receive very high viral loads from performing aerosolizing procedures (intubations) on the patients with the worst disease. Therefore, we must take every precaution imaginable to reduce how much virus gets into our system. Analogous to how our population is attempting to "flatten the curve," we must each individually flatten our own curves and keep our viral exposure below the thresholds of our immune response systems.

Please protect yourself and never intubate anyone without proper PPE (N95 or PAPR/CAPR). If your hospital runs out, don't be a hero.
 
GassmanMD said:
The problem with this mentality is you may not be considering how viral load may correlate to clinical symptoms. Like you, I am beyond "containment." I fully expect I have or will contract the virus. Our hospital has two patients under investigation (1 ASA4, 1 ASA3). As anesthesiologists, we are right in the line of fire and would potentially receive very high viral loads from performing aerosolizing procedures (intubations) on the patients with the worst disease. Therefore, we must take every precaution imaginable to reduce how much virus gets into our system. Analogous to how our population is attempting to "flatten the curve," we must each individually flatten our own curves and keep our viral exposure below the thresholds of our immune response systems.

Please protect yourself and never intubate anyone without proper PPE (N95 or PAPR/CAPR). If your hospital runs out, don't be a hero.
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We should also refuse taking care of patients if not provided with the proper PPE. One cannot be legally expected to do something that puts one's life at risk (we are not in the military). The bean counters won't care until they get on the front pages of newspapers.
 
GassmanMD said:
The problem with this mentality is you may not be considering how viral load may correlate to clinical symptoms. Like you, I am beyond "containment." I fully expect I have or will contract the virus. Our hospital has two patients under investigation (1 ASA4, 1 ASA3). As anesthesiologists, we are right in the line of fire and would potentially receive very high viral loads from performing aerosolizing procedures (intubations) on the patients with the worst disease. Therefore, we must take every precaution imaginable to reduce how much virus gets into our system. Analogous to how our population is attempting to "flatten the curve," we must each individually flatten our own curves and keep our viral exposure below the thresholds of our immune response systems.

Please protect yourself and never intubate anyone without proper PPE (N95 or PAPR/CAPR). If your hospital runs out, don't be a hero.
Click to expand...

There is evidence out of Wuhan that healthcare workers there had more serious course of disease and a higher mortality rate than others of similar age and health status. Likely due to being repeatedly blasted with high viral loads, depressed immune systems from sleep deprivation and overwork, and not resting while symptoms were still mild. I personally don't have to step foot in a hospital until residency starts in July, but I highly doubt this thing will be under any kind of control by then. All I know is the second I start having even mild symptoms I'm staying home and giving my body every chance to fight this off while it's in the early stages. Impressing the boss or coworkers is not worth the risk of death or permanent lung scarring
 
Money-Moniker said:
There is evidence out of Wuhan that healthcare workers there had more serious course of disease and a higher mortality rate than others of similar age and health status. Likely due to being repeatedly blasted with high viral loads, depressed immune systems from sleep deprivation and overwork, and not resting while symptoms were still mild. I personally don't have to step foot in a hospital until residency starts in July, but I highly doubt this thing will be under any kind of control by then. All I know is the second I start having even mild symptoms I'm staying home and giving my body every chance to fight this off while it's in the early stages. Impressing the boss or coworkers is not worth the risk of death or permanent lung scarring
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I heard it can potentially affect the male organ. So if you plan to have kids, .....
 
I still don’t understand how a PROPERLY done RSI with a glidescope would produce more aerosol virus than having a conversion with the infected person.
 
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