Medical aspects of COVID19
April 7, 2020 at 3:50 pm #145407
My goal for this post and those to follow is for MEDICAL personnel to post what information they are working with, i.e what info your respective hospitals and companies (ie contract) are providing you. I am already sharing as much info as I can with my colleagues (on the forum) but am obviously missing those who may be lurking. Our limitation in patient care is finding this virus’s weakness.
April 7, 2020 at 3:55 pm #145409
From 2 of our ED docs (and yes, I have their permission to share)
April 7, 2020 at 4:04 pm #145410
Working with Joe to get the limitation fixed.
April 7, 2020 at 4:52 pm #145415AndrewParticipant
Basically in the ER, on call ins, they are telling people to self isolate, and no you cannot come in to get tested.
For us, on the truck, face mask and gloves for sure. Then if the Pt answers the questions about fever, out of the country last 14 days, contact with someone with probable, or confirmed, CV-19, etc. it’s mask, gloves, gown, and bootties. Only 1 EMT will make the initial contact for the questions while maintaining the 6′ distance.
Asytole does not get worked. VTAC/VFIB, AFib, will get worked but with a very limited crew. Limited in the sense that the old normal for a potential heart attack was 2 trucks. Also limited in the sense that very little time will be spent on scene and it will be an expedited load and go to the ER. O2, cannula only at 2 lpm, under a mask. no NRB or BVM. Anyone remotely positive gets a mask on them before we get near them. I’m sure I’m leaving something(s) out, but I just got off of a 48 this morning, and that’ the gist of it.
- This reply was modified 1 month, 3 weeks ago by Andrew.
April 7, 2020 at 6:59 pm #145427
April 7, 2020 at 6:59 pm #145438
April 7, 2020 at 7:03 pm #145449
April 7, 2020 at 11:11 pm #145475First SergeantModerator
Thanks for this.
Signal Out, Can You Identify
Je ne regrette rien
In Orbe Terrum Non Visi
April 9, 2020 at 8:33 am #145535idahocajunParticipant
@wheelsee, thanks for sharing man. I can give two perspectives, EMS (as medical director) and from the ED (Dept. Chairman-but I work full time ;):
1. EMS: our county implemented department wide PPE on all calls weeks ago. With the high rate of asymptomatic shedders as well as atypical symptoms, we decided early to maximize PPE: N-95, gown, eye pro, gloves, etc. on all calls. To date, we’ve had results and knock on wood despite high rates of known exposures…our folks are staying healthy. We also limiting aerosolizing procedures and increases screening to maximize our risk mitigation. We have a full surge protocol in place if we get to NYC level craziness.
2. ED: man, this has been crazy, as my group staffs 5 ER’s for the health system. We crafted an intubation good for critical patients, cohort area of new negative pressure rooms in the department, separate triage area and advanced screening. To date, our volumes are down, but acuity is up. Positive pressure ventilation and high PEEP seem to be key in managing this thing…ARDS.net has been a great resource as well. PEEP, prone, and time.
Our mortalities are highly associated with age (>65) and significant comorbidities.
For intubation, we’ve shifted to 100% videoscope under our “hood” to reduce risk of aerosolization. We wanted to switch over to only MDI’s for breathing treatments…but just don’t have enough.
PPE: moving target based on supply. Eye pro, gloves, gown and surgical mask on all suspected patients. N-95 or PAPR for aerosolized procedure. I personally wear N-95 all shift under a surgical mask. In my mind…every patient has it, only way to reduce my risk is to treat everyone as if they are carrying it. The hospital has been awesome and provides us all with scrubs every shift. So I show up in shorts, change, work, drop off, and head home without bringing home “contaminated” scrubs.
At home, I have a separate entrance to the house where I fully decon. Shoes (dedicates work) never come in. I fully change and throw stuff in laundry. Wipe down keys, phone, etc. Full shower before joining the family in common area. Nothing is perfect, but better than most.
Happy to share protocols we’ve drafted if it helps. Just trying to stay ahead of this thing in our AO, which to date seems to be working. Stay safe!
April 9, 2020 at 8:39 am #145537
April 9, 2020 at 8:55 am #145541
Coronavirus May ‘Reactivate’ in Cured Patients, Korean CDC Says
With all respect, please limit this to 1st (or 2nd) hand medical sources. There are other threads that this would be appropriate in.
April 9, 2020 at 9:19 am #145548
…please limit this to 1st (or 2nd) hand medical sources.
No one should take this as discouraging discussion, just as Wheelsee noted 1st & 2nd hand experiences or specific questions regarding information presented in this particular thread.
We are fortunate to have some SME’s as members and can benefit greatly from it.
April 11, 2020 at 12:07 pm #145628
Update from my company
April 11, 2020 at 3:08 pm #145632
April 15, 2020 at 2:48 pm #145796
Interesting article on the different phenotypes of COVID19, their respective pneumonia’s and observations on how to treat. While this is an editorial, it is written by ICU specialists in Italy. It was published in the journal “Intensive Care Medicine”
April 20, 2020 at 6:58 pm #146006
From the Journal of Thrombosis and Haemostasis (published Mar 25)
Discusses the use of anti-coagulants in COVID19 patients.
May 14, 2020 at 1:52 pm #147238
From Dr Amal Mattu, an Emergency medicine cardiology guru who teaches at Univ of Maryland School of Medicine.
Disclaimer – he puts out an internet weekly EKG class that I subscribe to. Also, my medical director was a Fellow of Dr Mattu’s at Maryland.
This is NOT designed to open a discussion on a “collection” of doctors in various fields but rather what many in EM (around DFW) are actually looking at.
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