Texas surgical volume at this time

[GASPER20]

For those working in Texas, are all/most elective cases cancelled? Are your groups back to earlier COVID days?

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[lane]

Houston... depends on the hospital system. We’re holding off on most same day admissions, but outpatient procedures are good to go. ASCs have been unaffected. Volume ~70ish% of normal for this time of year

 

[DocMcCoy]

West Texas. little bit of squeeze on the electives requiring long admissions/ ICU post op. As in our orthos cancelled their total joints for a couple of days and surgeons working to get non covid players out of the unit as quick as possible. About 90 percent of normal case volume. Running tight but so far enough beds for COVID and all the other stuff that comes in.

 

[deleted697127]

West Texas. little bit of squeeze on the electives requiring long admissions/ ICU post op. As in our orthos cancelled their total joints for a couple of days and surgeons working to get non covid players out of the unit as quick as possible. About 90 percent of normal case volume. Running tight but so far enough beds for COVID and all the other stuff that comes in.

If your total joints are taking up your icu space, you’re doing it wrong.

 

[jwk]

I think they discovered first time around how much money was lost by closing up shop, and are determined not to do it again unless absolutely necessary. All our elective cases require a negative Covid test not more than 3 days prior to their surgery. With that and plenty of PPE, we're full-steam ahead, even with the spike in cases in GA.

 

[DocMcCoy]

If your total joints are taking up your icu space, you’re doing it wrong.

Joints were are a separate issue. Punctuation and sentence structure aside they didn’t want their patients sitting on the floor overnight down the hall from a covid unit

 

[jwk]

Outpatient joints are in. Out the door 4 hrs post-incision.

 

[deleted697127]

Outpatient joints are in. Out the door 4 hrs post-incision.

This is what i was getting at...

 

[victor le cube]

we are at probably 80% normal case loads, contingent on hospital bed availability for covid patients. Outpatient cases proceed, cases that require overnight stay are postponed unless urgent.

 

[nimbus]

Anybody work in RGV?

 

[anbuitachi]

Anybody work in RGV?

View attachment 313782

thats messed up if true

 

[chocomorsel]

Anybody work in RGV?

View attachment 313782

Be there next week. Will let you know all about it. I am sure it’s as bad as NY.

 

[nimbus]

Be there next week. Will let you know all about it. I am sure it’s as bad as NY.

Be safe.

 

[chocomorsel]

Be safe.

Always. Thanks.

 

[dchz]

Anybody work in RGV?

View attachment 313782

Not in RGV at the moment. but those hospitals are notorious for riding the line on resource reserves and staffing, often on the side of unsafe. Not having oxygen in a hospital is pretty ridiculous.

I think the hospital admins have to burden some of the blame, as far as i know, oxygen is not a resource in short supply in Texas. how do you not have adequate reserve of a commodity 5 months into a pandemic???

Be there next week. Will let you know all about it. I am sure it’s as bad as NY.

From what I've seen so far, it's nowhere near as bad as it was when we were both in NY. At least you don't have the nurses union, I've missed Texas nurses.

 

[deleted162650]

I've missed Texas nurses.

I’m sure there’s a country song in there somewhere.

 

[chocomorsel]

It’s depressing as hell. They are all Hispanic. They all mostly have comorbidities. Mostly overweight. And they are all dying. I feel like I am not really helping. I manage symptoms and the bug almost always kills the patient.
Only two have successfully left the ICU so far since this place started getting overwhelmed.

It’s a death sentence still once you are in the ICU. Had a little lady just give up yesterday and died. On HFNC. Hospital for a month. She said she was done.

Even though we wait much later to intubated they are still dying. You get to a point where you just can’t ventilate these patients. Stiff lungs. Or they have an MI. OR PE. Or stroke. Or who the hell knows.

At least we have enough nurses.

 

[nimbus]

It’s depressing as hell. They are all Hispanic. They all mostly have comorbidities. Mostly overweight. And they are all dying. I feel like I am not really helping. I manage symptoms and the bug almost always kills the patient.
Only two have successfully left the ICU so far since this place started getting overwhelmed.

It’s a death sentence still once you are in the ICU. Had a little lady just give up yesterday and died. On HFNC. Hospital for a month. She said she was done.

Even though we wait much later to intubated they are still dying. You get to a point where you just can’t ventilate these patients. Stiff lungs. Or they have an MI. OR PE. Or stroke. Or who the hell knows.

At least we have enough nurses.

Does anything seem to help? Decadron? Convalescent plasma? Remdesivir? Hcq??

 

[IMGASMD]

It’s depressing as hell. They are all Hispanic. They all mostly have comorbidities. Mostly overweight. And they are all dying. I feel like I am not really helping. I manage symptoms and the bug almost always kills the patient.
Only two have successfully left the ICU so far since this place started getting overwhelmed.

It’s a death sentence still once you are in the ICU. Had a little lady just give up yesterday and died. On HFNC. Hospital for a month. She said she was done.

Even though we wait much later to intubated they are still dying. You get to a point where you just can’t ventilate these patients. Stiff lungs. Or they have an MI. OR PE. Or stroke. Or who the hell knows.

At least we have enough nurses.

Sounds like what I’ve heard from my NJ colleagues. Be safe, be careful.

 

[dchz]

OR PE. Or stroke. Or who the hell knows.

Are they not on therapeutic heparin?

At least we have enough nurses.

Not having enough nurses was my #1 challenge in NY. Do y'all have oxygen now?

 

[anbuitachi]

It’s depressing as hell. They are all Hispanic. They all mostly have comorbidities. Mostly overweight. And they are all dying. I feel like I am not really helping. I manage symptoms and the bug almost always kills the patient.
Only two have successfully left the ICU so far since this place started getting overwhelmed.

It’s a death sentence still once you are in the ICU. Had a little lady just give up yesterday and died. On HFNC. Hospital for a month. She said she was done.

Even though we wait much later to intubated they are still dying. You get to a point where you just can’t ventilate these patients. Stiff lungs. Or they have an MI. OR PE. Or stroke. Or who the hell knows.

At least we have enough nurses.

this literally sounds the same as my experience in NY.

But since NY was the first big hit in the US, we didnt have enough staff of any kind. Then nurses came and the issue became that the nurses arent ICU level nurses and vented patients were still dying in high #s. glad thats over

 

[chocomorsel]

Does anything seem to help? Decadron? Convalescent plasma? Remdesivir? Hcq??

Nope. Nope. If they make it to the unit, they most likely are gonna leave in a body bag. Maybe all that stuff helps way way early in the symptoms. They get plasma and steroids and Remdesivir and still die.

 

[chocomorsel]

Are they not on therapeutic heparin?



Not having enough nurses was my #1 challenge in NY. Do y'all have oxygen now?

I am in a well equipped hospital. No lack of drugs or PPE or oxygen.
I can see though when you are trying to prevent intonations and are running plenty of people on on HFNC how you could possibly deplete the oxygen supply.

 

[chocomorsel]

I am in a well equipped hospital. No lack of drugs or PPE or oxygen.
I can see though when you are trying to prevent intonations and are running plenty of people on on HFNC how you could possibly deplete the oxygen supply.

Yes they are on heparin. But some bleed and you hold it.
But things are happening to these patients and then they code. Like crappy crappy crappy but status quo, then boom, code.
Coding them is useless.
Any of y’all ICU trained want to come help, they need it.

 

[vector2]

Nope. Nope. If they make it to the unit, they most likely are gonna leave in a body bag. Maybe all that stuff helps way way early in the symptoms. They get plasma and steroids and Remdesivir and still die.

Thank you for at least anecdotally confirming the point I'm trying to make to people that intubating COVID pts isn't what's causing them to die, so all this hemming and hawing that's going by leaving them on bipap with fio2 100 and Ipap/Epap 30/15 is just making their eventual intubation that much more dangerous for the pt and the anesthesiologist.

 

[IMGASMD]

Yes they are on heparin. But some bleed and you hold it.
But things are happening to these patients and then they code. Like crappy crappy crappy but status quo, then boom, code.
Coding them is useless.
Any of y’all ICU trained want to come help, they need it.

Isn’t Texas board of medicine notoriously difficult to get through? Are they granting any temp licenses?

I offered help in the beginning of May for NJ, three hospitals, no one bit. Was sort of a weird feeling that no one wanted it.

 

[chocomorsel]

Thank you for at least anecdotally confirming the point I'm trying to make to people that intubating COVID pts isn't what's causing them to die, so all this hemming and hawing that's going by leaving them on bipap with fio2 100 and Ipap/Epap 30/15 is just making their eventual intubation that much more dangerous for the pt and the anesthesiologist.

We aren’t intubating till real late. Every day 3-6 die. My 12 bed unit loses two a day or so the past week.
A nurse from Brooklyn said CRRT initiated early on was making a difference towards the end of their pandemic.
Was in a code accidentally yesterday and after four rounds was gonna call it, but the regular ICU docs came in and took over and didn’t want to quit. So I bowed out and went to lunch.

Any bets on whether he lived or died?

It’s very sad what this disease does. We are trying not to intubate early. And hopefully I am not seeing the ones who do well in the other wards. I am sure there are plenty being discharged home. But if you hang around the hospital too long not improving, then it ends badly.
I think we need to put these patients who first come in and only require NC or
Bipap in a large open Negative pressure ward with a bunch of PT and OTs who get them up every few hours and do group physical therapy with them. That would probably make the best difference.

 

[chocomorsel]

Isn’t Texas board of medicine notoriously difficult to get through? Are they granting any temp licenses?

I offered help in the beginning of May for NJ, three hospitals, no one bit. Was sort of a weird feeling that no one wanted it.

Yes. We are in crisis and granting temp licenses.
Otherwise yes, it’s horrible.