Medical aspects of COVID19

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  • This topic has 16 replies, 7 voices, and was last updated 2 weeks ago by wheelsee. This post has been viewed 583 times
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    • #145407
      wheelsee
      Participant

        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.

        https://view.joomag.com/covid-19-ies-updates/0513609001584549595

      • #145409
        wheelsee
        Participant

          From 2 of our ED docs (and yes, I have their permission to share)

        • #145410
          wheelsee
          Participant

            Working with Joe to get the limitation fixed.

          • #145415
            Andrew
            Participant

              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.
            • #145427
              Joe (G.W.N.S.)
              Moderator

                From 2 of our ED docs (and yes, I have their permission to share)

                Part 1

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              • #145438
                Joe (G.W.N.S.)
                Moderator

                  From 2 of our ED docs (and yes, I have their permission to share)

                  Part 2

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                • #145449
                  Joe (G.W.N.S.)
                  Moderator

                    From 2 of our ED docs (and yes, I have their permission to share)

                    Part 3

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                  • #145475
                    First Sergeant
                    Moderator

                      Thanks for this.

                      FILO
                      Signal Out, Can You Identify
                      Je ne regrette rien
                      In Orbe Terrum Non Visi

                    • #145535
                      idahocajun
                      Participant

                        @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!

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                      • #145537
                        idahocajun
                        Participant

                          Intubation hood:

                          Simple PVC, easy to move. Place plastic over, intubate using video scope. I’ve used it a few times, doesn’t really limit or cause issues. Once tube in, throw away plastic and good to go!

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                        • #145541
                          wheelsee
                          Participant

                            Coronavirus May ‘Reactivate’ in Cured Patients, Korean CDC Says

                            https://www.bloomberg.com/news/articles/2020-04-09/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.

                          • #145548
                            Joe (G.W.N.S.)
                            Moderator

                              …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.

                              :yes:

                            • #145628
                              wheelsee
                              Participant
                              • #145632
                                wheelsee
                                Participant

                                  Archived newsletters from IES (Integrative Emergency Services, the company I work for)

                                  Resources

                                • #145796
                                  wheelsee
                                  Participant

                                    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”

                                    https://link.springer.com/content/pdf/10.1007/s00134-020-06033-2.pdf?fbclid=IwAR0zVPnt3QusBSkiI-Ah5_CqBPblXqOajeAleoIehE85ZVGxOMaEBtyki7g

                                  • #146006
                                    wheelsee
                                    Participant

                                      From the Journal of Thrombosis and Haemostasis (published Mar 25)

                                      https://onlinelibrary.wiley.com/doi/abs/10.1111/jth.14810

                                      Discusses the use of anti-coagulants in COVID19 patients.

                                    • #147238
                                      wheelsee
                                      Participant

                                        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.

                                        2020 Cardiology Update by Amal Mattu

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