Sotrovimab

[lymphocyte]

Not an ICU drug but is anybody seeing this used at their institutions? Very promising interim data from the COMET-ICE trial, seems too good to be true. What about casirivimab/imedimimab?

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[chessknt]

we have used tocilizumab and I’ve been highly unimpressed. Started using baricitinib and similarly unimpressed. But then again treating icu covid 19 is a horrible unrewarding slog—maybe these drugs do something but it sure as **** doesn’t feel like it in the day to day work.

ive seen one person so far with the regen cov end up on icu, not sure how many others got it and didn’t end up in icu. Don’t use it in icu as you said.

 

[SurfingDoctor]

Or... ya know... get vaccinated.

Funny enough, I know people who refused the vaccine cause insert reason "X" (experimental, synthetic, etc.) only to get COVID and get injected with monoclonal cocktails. Monoclonal cocktails which come from mouse/myeloma fusion cells synthetically made in the lab as an experiment. Er... yep.

 

[nikolaite]

Or... ya know... get vaccinated.

Funny enough, I know people who refused the vaccine cause insert reason "X" (experimental, synthetic, etc.) only to get COVID and get injected with monoclonal cocktails. Monoclonal cocktails which come from mouse/myeloma fusion cells synthetically made in the lab as an experiment. Er... yep.

Based on my experience watching staff gaining “informed consent”, I highly doubt the folks refusing vaccines but accepting monoclonal therapies knew what they were being given.

 

[SurfingDoctor]

Based on my experience watching staff gaining “informed consent”, I highly doubt the folks refusing vaccines but accepting monoclonal therapies knew what they were being given.

It's almost as if ill-reasoned beliefs don't matter when panic sets in. Who knew?!

 

[Siggy]

we have used tocilizumab and I’ve been highly unimpressed. Started using baricitinib and similarly unimpressed. But then again treating icu covid 19 is a horrible unrewarding slog—maybe these drugs do something but it sure as **** doesn’t feel like it in the day to day work.

ive seen one person so far with the regen cov end up on icu, not sure how many others got it and didn’t end up in icu. Don’t use it in icu as you said.

Reading the Herman Cain Awards and Covid Ate My Face subreddits is a bit of a guilty pleasure. It's amazing how many people were anti-vaxx and thought COVID was a hoax right up until they were hospitalized... and then it's a "OMG, is it too late to get ____" followed by "FYI, X died from COVID... RIP."

 

[Rekt]

Or... ya know... get vaccinated.

Funny enough, I know people who refused the vaccine cause insert reason "X" (experimental, synthetic, etc.) only to get COVID and get injected with monoclonal cocktails. Monoclonal cocktails which come from mouse/myeloma fusion cells synthetically made in the lab as an experiment. Er... yep.

Extremely common on my side (EM). See multiple of these idiots per day. "doc I got the infusion two days ago, why am I not better??" Well, now you're hypoxic and have to be admitted. "You might be a candidate for remdesivir (or other nonsense flavor of the month)" "Is that the vaccine? I don't want that **** at all!".

Mind boggling.

Based on my experience watching staff gaining “informed consent”, I highly doubt the folks refusing vaccines but accepting monoclonal therapies knew what they were being given.

Can confirm. We're a large referral center for monoclonal infusions. Essentially they just get handed a piece of paper that explains everything, up to them to read it, and a number to schedule. Don't have time to counsel the near dozens of patients I see per shift right now for covid. Should have got vaccinated.

 

[nikolaite]

Can confirm. We're a large referral center for monoclonal infusions. Essentially they just get handed a piece of paper that explains everything, up to them to read it, and a number to schedule. Don't have time to counsel the near dozens of patients I see per shift right now for covid. Should have got vaccinated.

Since at least right now data are showing that these infusions are neither here nor there as far as adverse events, you’ll probably stay lucky on that front. But, from a medico-legal POV, you may wish to change your protocols on informed consent. Part of medical service and consultation CYA is getting and recording obvious informed feedback from patients. Signed forms of boilerplate won’t exactly pass muster in front of the board of healing arts in the face of a patient injury complaint even if it fools a medmal jury. While a lot of the informed consent meshuggeneh comes from admin, it’s always valuable to remember that they will trip over themselves to throw you under the bus if it comes to it.

You may not have time to counsel these patients, so the admin need to provide the infrastructure for either yourself or others to do so. Really, it’s time much better spent counseling patients than the 9 - 12 mos. correspondence, anxiety and general time waste being scrutinized by the board of HA.

It is so evident that folks begging for the monoclonal infusions are doing so for the same uninformed reasons that they’re refusing vaccines...and it’s symptomatic of a much larger public health and education problem.

All the best.

 

[chessknt]

Since at least right now data are showing that these infusions are neither here nor there as far as adverse events, you’ll probably stay lucky on that front. But, from a medico-legal POV, you may wish to change your protocols on informed consent. Part of medical service and consultation CYA is getting and recording obvious informed feedback from patients. Signed forms of boilerplate won’t exactly pass muster in front of the board of healing arts in the face of a patient injury complaint even if it fools a medmal jury. While a lot of the informed consent meshuggeneh comes from admin, it’s always valuable to remember that they will trip over themselves to throw you under the bus if it comes to it.

You may not have time to counsel these patients, so the admin need to provide the infrastructure for either yourself or others to do so. Really, it’s time much better spent counseling patients than the 9 - 12 mos. correspondence, anxiety and general time waste being scrutinized by the board of HA.

It is so evident that folks begging for the monoclonal infusions are doing so for the same uninformed reasons that they’re refusing vaccines...and it’s symptomatic of a much larger public health and education problem.

All the best.

Yea right healthcare is collapsing all over the country and you think a medical entity is going to respect some dip**** complaint of injury when they self inflicted this virus on themself and needed treatment? Different standards today than a few years ago. Right now we have clabsi and pressure wounds skyrocketing and nobody cares because we have no nurses for our completely full icu. You think those complaints which are actually justified are going to mean anything?

 

[nikolaite]

Yea right healthcare is collapsing all over the country and you think a medical entity is going to respect some dip**** complaint of injury when they self inflicted this virus on themself and needed treatment? Different standards today than a few years ago. Right now we have clabsi and pressure wounds skyrocketing and nobody cares because we have no nurses for our completely full icu. You think those complaints which are actually justified are going to mean anything?

Of course they will mean something to folks who still buy into concepts like basic human decency, honor of one’s word and the nobility of the medical profession.

The point is not injury complaints after experimental or newly approved COVID treatment. The point I am trying to make is that the Wild West attitude toward informed consent is being magnified here.

 

[chessknt]

Of course they will mean something to folks who still buy into concepts like basic human decency, honor of one’s word and the nobility of the medical profession.

The point is not injury complaints after experimental or newly approved COVID treatment. The point I am trying to make is that the Wild West attitude toward informed consent is being magnified here.

And my point is that when I have people who can’t get the standard of care for problems they had no control over then something as petty as informed consent concerns doesn’t matter at all. Basic human decency died when people refused to get vaccinated or wear masks then showed up and consumed all of the healthcare resources in sight leaving nothing for everyone else. I had a septic pyelo sit in the Er waiting room for 30 hours until she had syncope and needed 3 pressors because the Er is boarding so many icu patients their throughput has dropped to 0. That is 30 hours without antibiotics now in refractory septic shock in a 27 year old.

Yet you think that somehow it is worth our time to sit down and read some drawn out long winded legal document to someone hellbent on contributing to the collapse of healthcare because they might lodge a complaint against us? Or because it is the decent thing to do?

 

[nikolaite]

And my point is that when I have people who can’t get the standard of care for problems they had no control over then something as petty as informed consent concerns doesn’t matter at all. Basic human decency died when people refused to get vaccinated or wear masks then showed up and consumed all of the healthcare resources in sight leaving nothing for everyone else. I had a septic pyelo sit in the Er waiting room for 30 hours until she had syncope and needed 3 pressors because the Er is boarding so many icu patients their throughput has dropped to 0. That is 30 hours without antibiotics now in refractory septic shock in a 27 year old.

Yet you think that somehow it is worth our time to sit down and read some drawn out long winded legal document to someone hellbent on contributing to the collapse of healthcare because they might lodge a complaint against us? Or because it is the decent thing to do?

Yep. And we were seeing the same crazy bs before COVID with people who subsist on solely glucose diets showing up with DKA, etc. You have the duty to the patient regardless…or medical abandonment could be construed as a course of the encounter when your duty is withheld over a personal grudge…and medical battery can be construed if you act on the competent patient’s body without his informed consent. If you’re not going to do your duty by a patient, then you are bound to make other arrangements according to med ethics and the law.

In addition, after slogging through uni, med school, and all the rest, if one’s not capable of breaking down the pertinent information into a 30-second disclosure and a small Q-&-A, then there’re bigger problems.

I highly doubt anyone would find fault with you (other than hospital admin who seem singularly irrational) over rationing your care during the pandemic. But numerous people would find fault with you crowing over the heroics of failure of duty caused by a personal grudge.

If you feel justified and your admin backs your decision, then I definitely support you in continuing to publish your position so it’s clear to the world.

 

[nikolaite]

You’re really decrying hospital policy to prioritize COVID boarding for pts that ought to be sent home once they’re “stabilized”. I agree with you that COVID pts ought not be boarding in ER slots or ICU beds in many cases…but that is not really the class we’re talking about with the monoclonal infusions.

 

[chessknt]

Yep. And we were seeing the same crazy bs before COVID with people who subsist on solely glucose diets showing up with DKA, etc. You have the duty to the patient regardless…or medical abandonment could be construed as a course of the encounter when your duty is withheld over a personal grudge…and medical battery can be construed if you act on the competent patient’s body without his informed consent. If you’re not going to do your duty by a patient, then you are bound to make other arrangements according to med ethics and the law.

In addition, after slogging through uni, med school, and all the rest, if one’s not capable of breaking down the pertinent information into a 30-second disclosure and a small Q-&-A, then there’re bigger problems.

I highly doubt anyone would find fault with you (other than hospital admin who seem singularly irrational) over rationing your care during the pandemic. But numerous people would find fault with you crowing over the heroics of failure of duty caused by a personal grudge.

If you feel justified and your admin backs your decision, then I definitely support you in continuing to publish your position so it’s clear to the world.

I find it disingenuous to say that it is a dereliction of duty/abandonment when you hand a literate person a handout and say read this if you still want to do it the prescription is in the works whereas sitting down and rapidly saying a bunch of words in 30 seconds is not. If someone goes to get an infusion who is conscious that isnt battery come on man.

Do you also get an informed consent witnessed phone call for every line and tube you do on these crashing people who showed up and stayed in the hospital too? You must not have a very big census or you must be very slow…

 

[Siggy]

Do you also get an informed consent witnessed phone call for every line and tube you do on these crashing people who showed up and stayed in the hospital too? You must not have a very big census or you must be very slow…

Yes, or I document "procedure done under implied consent as patient is confused and in extremis due to respiratory failure."

 

[chessknt]

Yes, or I document "procedure done under implied consent as patient is confused and in extremis due to respiratory failure."

Yep--I assume if they are full code they want me to do full code stuff to them. My hospital has a universal consent written in to the initial paperwork basically saying by being in the hospital you agree to necessary and emergent procedures unless you otherwise list them here. It is an astronomical waste of time to do stupid consent for necessary procedures in critically ill patients. It is also a waste of time to do it for medications being written in an overwhelmed ER when a handout can perform the same function. This isn't an organ transplant...

 

[turkeyjerky]

I find it disingenuous to say that it is a dereliction of duty/abandonment when you hand a literate person a handout and say read this if you still want to do it the prescription is in the works whereas sitting down and rapidly saying a bunch of words in 30 seconds is not. If someone goes to get an infusion who is conscious that isnt battery come on man.

Do you also get an informed consent witnessed phone call for every line and tube you do on these crashing people who showed up and stayed in the hospital too? You must not have a very big census or you must be very slow…

He’s not a doctor dude.