Is your shop seeing cases?

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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 was predicted, by many. After H1N1 and SARS, at least one of which was a corona virus there were large attempts to create a vaccine. However after the acute phase of the outbreak was contained, they stopped developing the vaccine - for monetary reasons I’m sure. So it never made it through. Not to say it would work for this Coronavirus variant but we may have had at least something in our bag to slow this down significantly.
 
caligas said:
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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Whoever said it would?
Is your point advocating for no ppe/n95 etc? What do you mean?
 
Newtwo said:
Whoever said it would?
Is your point advocating for no ppe/n95 etc? What do you mean?
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I bet he/she means we should be wearing PPE/N95 at all times with all patients in and out of the OR if we are gonna worry abut the best way to minimize contact and aerosolization during intubations..
 
Oh ok. Probably gonna run out of kit in no time then.

Obviously everyone knows this but n95 have to be removed in a very specific timely way. Just randomly walking around the hospital wearing one is less than useless.

Wed probably run out of n95s in a week if that that every time
 
Has anyone addressed the possibility of cyclic re-usage of PPE?

The virus apparently only survives 48hrs on soft surfaces. Instead of discarding masks and gowns, why not collect all of the used ones to quarantine for 3 days then to be re/used?

This is better than attempting to DYI clean the equipment, which could damage the material and cause it to be ineffective.
 
teacher2md said:
Has anyone addressed the possibility of cyclic re-usage of PPE?

The virus apparently only survives 48hrs on soft surfaces. Instead of discarding masks and gowns, why not collect all of the used ones to quarantine for 3 days then to be re/used?

This is better than attempting to DYI clean the equipment, which could damage the material and cause it to be ineffective.
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Eventually we may end up having no choice but to prolong use and re use PPE if this continues to get worse.
 
IlDestriero said:
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.
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Do you have a source/paper? I’m seeing a lot of anecdotes, twitter posts, etc. Would love if JAMA or LANCET could public Italy’s mortality/hospitalization/intubation rates, how they are triaging care.
 
MoMoGesiologist said:
Do you have a source/paper? I’m seeing a lot of anecdotes, twitter posts, etc. Would love if JAMA or LANCET could public Italy’s mortality/hospitalization/intubation rates, how they are triaging care.
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Go to the Covid Thread in the critical care forum. There’s a very interesting podcast there.
 
I'm in the South Puget Sound region in Washington state. A week ago we had 20 people under investigation and 10 PUIs admitted at our major referral center and local community hospital we service, respectively. Had a COVID+ patient on the L&D overnight shift a couple days ago the night before I did OB day. I think we have 1 or 2 of our anesthesiologists who have symptoms and are out. Another person called to intubate someone in the ED today for severe symptoms presumably COVID+. That's just the stuff I've heard of. Our ICU is sectioning off an area now and eventually would become an entire COVID unit.

We are only at the start!
 
We now have 1 confirmed in ICU on vent and 2 other probable on vent awaiting results. The 1 confirmed is improving. Good lung compliance as noted in other thread - has not required proning - has been receiving Plaquenil. He’s approaching 1 week in ICU.
A couple other positives with mild disease.
 
5 confirmed cases, midwest, 800 bed primary referrer center for what seems like everywhere within 120 miles. 1 pt super ded (600 lbs, nec fasc, hot mess express), other 4, young, discharged to self quarantine?

First case today, decort, disclosed to me that she had felt febrile in the past week but never took her temp (had not told anyone else this). Treated like r/o COVID, N95 mask, mcgrath, tried to not let her cough into my mouth. ICU peeps didn't seem concerned, just dropped her off in normal ICU bed?
 
0 admissions here...700 bed system...
 
Our MICU has like 18 ppl intubated (~8ish positive). Buncha tests still pending and it seems like it's taking way too long (60-72h) to come back. We have more beds in the burn unit but theres also a busy SICU and trauma service so those pts who are non COVID are gonna have to be put somewhere else like PACU if burn and SICU have to start taking covid overflow. PPE is being rationed right now. Gowns are running low in ED.

Other hospitals in the area are starting to get really swamped. Rumors of pts on vents in hallways. Anesthesiologists helping in the ICU....
 
vector2 said:
Our MICU has like 18 ppl intubated (~8ish positive). Buncha tests still pending and it seems like it's taking way too long (60-72h) to come back. We have more beds in the burn unit but theres also a busy SICU and trauma service so those pts who are non COVID are gonna have to be put somewhere else like PACU if burn and SICU have to start taking covid overflow. PPE is being rationed right now. Gowns are running low in ED.

Other hospitals in the area are starting to get really swamped. Rumors of pts on vents in hallways. Anesthesiologists helping in the ICU....
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Where is this? Region?
 
vector2 said:
Our MICU has like 18 ppl intubated (~8ish positive). Buncha tests still pending and it seems like it's taking way too long (60-72h) to come back. We have more beds in the burn unit but theres also a busy SICU and trauma service so those pts who are non COVID are gonna have to be put somewhere else like PACU if burn and SICU have to start taking covid overflow. PPE is being rationed right now. Gowns are running low in ED.

Other hospitals in the area are starting to get really swamped. Rumors of pts on vents in hallways. Anesthesiologists helping in the ICU....
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I have no idea how one could run a vent in a hallway. There’s no oxygen.
 
vector2 said:
Gowns are running low in ED.
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I see a lot of people wearing all sorts of body protections but are they very useful? Especially when wearing little surgical masks with gaps on the sides while hovering less that 5ft from other co-workers...
 
Curious as to your thoughts: as we inevitably will be interacting with more covid19 pts in the near future (if we haven’t already), how will you deal with your immediate family? What is your process when you go home- strip down and jump in the shower? Preemptively sleep in separate rooms? Not interact with your kids? What if your wife is pregnant?
 
Lecithin5 said:
Curious as to your thoughts: as we inevitably will be interacting with more covid19 pts in the near future (if we haven’t already), how will you deal with your immediate family? What is your process when you go home- strip down and jump in the shower? Preemptively sleep in separate rooms? Not interact with your kids? What if your wife is pregnant?
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No cases currently at our children's hospital, but my wife is on immunosuppressive therapy for MS, so I am being very cautious. Strip down naked upon entry to home, jump in shower. Currently still at home, but considering subletting a condo downtown with one or more partners as a bolt-hole in case I become symptomatic/quarantined and potentially will move down there anyways if things get really bad and I am in the thick of it managing COVID+ patients.
 
Lecithin5 said:
Curious as to your thoughts: as we inevitably will be interacting with more covid19 pts in the near future (if we haven’t already), how will you deal with your immediate family? What is your process when you go home- strip down and jump in the shower? Preemptively sleep in separate rooms? Not interact with your kids? What if your wife is pregnant?
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I discussed this with my wife. I shower as soon as I get home and am appropriately careful at work.

We decided if she or I get the disease and die, I would rather have spent my last few weeks/months hanging with her and my family. Telling my kids that “Dad was trying to protect you” was the reason they didn’t see me for my last few weeks/months just plain sounds horrible.

That said, I am very low risk of death, and so is she. Short of that, one or both of us being very sick will mean someone else will have to help us with the kids for a bit. Not a big deal.

All this adds up to me washing myself carefully when I get home, but otherwise living a normal life at home (plus home schooling).

I don’t know how a pregnant wife would change this calculation, but I may try to avoid either work, or them shortly before and for a while after delivery. Babies are fragile.
 
I am in a northeastern suburb 1-2 hours from the nearest major city at a community hospital. We are starting to see the surge. Multiple intubations on known or suspected covid patients. We are starting to have discussions about providing backup for the ICU because if things keep going at this rate, they will be overwhelmed soon. We’ve had a few patients shipped out for ECMO. Supplies are dwindling and there is genuine concern and fear. People who said last week that we are overreacting are not saying that anymore.

This feels like the first inning of a generational defining event.
 
First two patients today. One intubated today in MICU. None in OR yet.

The surge is coming.🙁🙁
 
How is the testing process done at your institution? Here, we are required to send out a full viral panel before we can test for covid. It takes several days and is very frustrating.
 
We've got a big private practice (50+ employees , 40 crnas 10 doctors plus 7 partners) and we are now down to about 5 OR cases per day.. for ... weeks?

All of our ASCs are closed and hospital (400 beds) has almost nothing going on, 5-8 cases per day max where we would typically do Hundreds

So I have an important questions and maybe someone can offer input:

Is anyone else furloughing their employees/CRNAs or being furloughed themselves? Is so please PM me because Id appreciate a discussion about the details of the arrangement, thx
 
Hoya11 said:
We've got a big private practice (50+ employees , 40 crnas 10 doctors plus 7 partners) and we are now down to about 5 OR cases per day.. for ... weeks?

All of our ASCs are closed and hospital (400 beds) has almost nothing going on, 5-8 cases per day max where we would typically do Hundreds

So I have an important questions and maybe someone can offer input:

Is anyone else furloughing their employees/CRNAs or being furloughed themselves? Is so please PM me because Id appreciate a discussion about the details of the arrangement, thx
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We are doing rotating CRNA furloughs though it’s looking like all will be furloughed. Looking closely at the senate bill small business loan provision which, if passed may allow us to borrow to keep our CRNAs employed.
Three CRNAs so far have volunteered to work as icu nurses but the hospital so far has declined. Cash on hand plus AR will support the docs for... not sure how long.
 
kmurp said:
We are doing rotating CRNA furloughs though it’s looking like all will be furloughed. Looking closely at the senate bill small business loan provision which, if passed may allow us to borrow to keep our CRNAs employed.
Three CRNAs so far have volunteered to work as icu nurses but the hospital so far has declined. Cash on hand plus AR will support the docs for... not sure how long.
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But even with a small business loan it has to be paid back with no production. That could be in the millions. Is your group willing to take that on? It would put mine out of business. We are at a loss of what to do

As for my shop/state, we have under 20 hospitalizations. None of them on vents. In my opinion this is a MASSIVE overreaction.

I understand NYC and Seattle are in dire straights, but I don’t think this needs to be a one size fits all approach. We need to get back to business as usual ASAP or this is going to crumble everything as we know it. The mortality rate isn’t near what it is in Italy
 
Wkrdoc said:
But even with a small business loan it has to be paid back with no production. That could be in the millions. Is your group willing to take that on? It would put mine out of business. We are at a loss of what to do

As for my shop/state, we have under 20 hospitalizations. None of them on vents. In my opinion this is a MASSIVE overreaction.

I understand NYC and Seattle are in dire straights, but I don’t think this needs to be a one size fits all approach. We need to get back to business as usual ASAP or this is going to crumble everything as we know it. The mortality rate isn’t near what it is in Italy
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*Remind me 9 days
 
Hoya11 said:
We've got a big private practice (50+ employees , 40 crnas 10 doctors plus 7 partners) and we are now down to about 5 OR cases per day.. for ... weeks?

All of our ASCs are closed and hospital (400 beds) has almost nothing going on, 5-8 cases per day max where we would typically do Hundreds

So I have an important questions and maybe someone can offer input:

Is anyone else furloughing their employees/CRNAs or being furloughed themselves? Is so please PM me because Id appreciate a discussion about the details of the arrangement, thx
Click to expand...

Ortho group here, private practice . We have furlowed everyone Starting next week. Everyone is going 50% work and 50% salary. I this way everyone can maintain benefits and also apply for unemployment while keeping their job. I once we get the green light for elective cases, we can go back to full time without having to rehire anyone.

We have separated everyone into two groups, with each working every other week. This way we can hopefully avoid both groups getting infected also.

We have 4 confirmed cases in the county all in self quarantine. None at either hospital (500+300bed). If this keeps up locally, hopefully we're back to mid April cases at our surgery center and private hospital while the hospitals figure out when they restart.
 
Wkrdoc said:
But even with a small business loan it has to be paid back with no production. That could be in the millions. Is your group willing to take that on? It would put mine out of business. We are at a loss of what to do

As for my shop/state, we have under 20 hospitalizations. None of them on vents. In my opinion this is a MASSIVE overreaction.

I understand NYC and Seattle are in dire straights, but I don’t think this needs to be a one size fits all approach. We need to get back to business as usual ASAP or this is going to crumble everything as we know it. The mortality rate isn’t near what it is in Italy
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Every job sectors in the last 40 years have been through a recession or two. Some sectors are stronger than ever and some have withered away. Healthcare Is no different, we aren’t immune to a down cycle. You will be fine through this as will everyone else. Do your part to flatten the curve, stay healthy, live long and prosper.
 
marr65 said:
Every job sectors in the last 40 years have been through a recession or two. Some sectors are stronger than ever and some have withered away. Healthcare Is no different, we aren’t immune to a down cycle. You will be fine through this as will everyone else. Do your part to flatten the curve, stay healthy, live long and prosper.
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Actually, healthcare tends to be recession proof 😉
 
IlDestriero said:
Those are decisions made above my pay grade. They didn't share the reasoning, and I haven't seen any ecmo data.
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Those no real data out there as of now. One paper with 3 patients had a 100% mortality. Most patients seem to recover without getting to ECMO, so it hasn't really required it.

The big problem is it's a limited resource that is very intensive on manpower. More blood transfusions, more complications. When does the calculus shift form it being useful to a hindrance? Furthermore, it makes decision making quite difficult as far as how long you keep somebody on and who gets it.

We haven't been hit hard, but we've ramped up our circuits to 15 and plan on continuing to offer it as a salvage therapy. That's very liable to change however.
 
dabears505 said:
Do you really think a field like ours where 80% of the work is completely elective is recession proof?
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This has been an interesting time to take a hard look at pretty much all medical fields. We don’t really NEED knee replacements, single level fusions, sinus surgery, or ACL repairs. These can improve people’s lives tremendously but you can live without them. Yet this has become the focus of much of the adult world because it’s so lucrative, to the point where many hospitals would close without these procedures. I expect most of these will get done when things start up again but some might decide to put it off, especially if people lose insurance due to unemployment. The ‘needs to happen’ elective cases, like colonoscopies, will surely be running, likely with extended hours.
 
dabears505 said:
Do you really think a field like ours where 80% of the work is completely elective is recession proof?
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80% of the cases at my Children’s Hospital aren’t elective. Many may not be very time sensitive, but the ENT cases, spinal fusions, sports medicine, hernias, strabismus, plastics, GI, etc., etc. will ALL still be there when we start up again. In a few months we will go from famine to feast and make up all of the time and money we lost working to 6 or more every night.
 
IlDestriero said:
80% of the cases at my Children’s Hospital aren’t elective. Many may not be very time sensitive, but the ENT cases, spinal fusions, sports medicine, hernias, strabismus, plastics, GI, etc., etc. will ALL still be there when we start up again. In a few months we will go from famine to feast and make up all of the time and money we lost working to 6 or more every night.
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The lack of insurance will likely hurt quite a bit if there truly are the unemployment rates predicted. That said, I am hopeful the post-quarantine world will pop back pretty quick.
It will be interesting to see society’s altered priorities after all this is over.
 
dabears505 said:
Do you really think a field like ours where 80% of the work is completely elective is recession proof?
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Name the last time a recession impacted your salary? Sure as heck wasn’t 2008
 
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