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Topic: July 1st CA COVID update if yer interested
Replies: 22   Last Post: Jul 4, 2020 10:36 AM by: ClemTig®
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July 1st CA COVID update if yer interested

[34]
Posted: Jul 1, 2020 8:10 PM
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I've been off for a week, just got back. We have 7 COVID + people in our 30 bed ICU. 3-4in our ED waiting for an ICU bed.
Not sure what numbers on the floor are.

I've heard wolf cried a few too many times to know.. the surge, the surge, the surge... never happened.

Now I'm hearing our MDs and management talkin about second wave the same way.

I know we have more cases than we've had, and are consistently admitting more. I know we do everything we can to keep people off the ventilator. I'm at work right now, and my 62yo Covid pos pt is encouraged to "self pronate," sleep and rest on his belly, we give remdesivir and steroids, and use CPAP/BIPAP machines along with High Flow Nasal Cannulas (nasal prongs that are humidified and can deliver high liter/min flow and 100% oxygen).

My guy is on max 40L/min and 100%. Our others in this ICU are intubated, medically paralyzed, and proned. Our anecdotal evidence is that folks who end up on the vent don't come off alive. We have had a couple be intubated and survive, but the vast majority don't. Our pts have been older. Again, just my experience here.

Be safe y'all... GOOO TIGERS!!!

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Re: July 1st CA COVID update if yer interested

[4]
Posted: Jul 1, 2020 8:42 PM
    Reply

Thanks for posting. News folks need to hear.


Our medical folks in the USA are under appreciated heroes!

[3]
Posted: Jul 1, 2020 9:43 PM
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Son and DIL are both medical professionals in FL .... situation deteriorating here. Like in CA just unsure of how bad.

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Trend in disposition?

[2]
Posted: Jul 1, 2020 9:47 PM
    Reply

Diabetic? High BP? Blood type?

All these crazy stats and notes in the news. Do you see trends too?

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I think you're asking about underlying health issues

[7]
Posted: Jul 1, 2020 10:01 PM
    Reply

and if a particular comorbidity/existing diagnosis is disproportionately affected..

Yes and no.

Certainly the more underlying health problems, the more likely they are to be here in the ICU than people at home or even on the floor. I havent seen where one preexisting condition affects more than another. But there does seem to be an inflammatory component and clotting issues. So I would say any vascular disease or inflammatory diseases (uncontrolled blood sugars on a diabetic) are more like to have a difficult time... again all anecdotal based on what I'm seeing.

That said, lots of people want to suggest #s are skewed bc someone could have terrible health, get COVID, and die whether dorectly.ir indirectly from the virus. Thing is, we do our flu numbers this way too.

Prolly a long worded not helpful answer ??

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What do you think about this article, Soy?

[4]
Posted: Jul 1, 2020 9:48 PM
    Reply

https://www.investmentwatchblog.com/the-coronavirus-may-actually-be-a-vascular-and-not-a-respiratory-disease/


I'll circle back and read it, but just alluded to that idea

[2]
Posted: Jul 1, 2020 10:06 PM
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in an above answer about trends... I don't know. It's hard to say bc COVID pts typically have severe ARDS and are septic. Sepsis causes loss of vascular tone and "leaky" vessels leading to low blood pressure.

Low blood pressure is not something the kidneys want. So COVID aside, it's common to expected for our ARDS pts to experience multisystem failure like renal failure.

Then the question becomes, is this the secondary complications like in sepsis/ARDS, or something else? Interesting.. thanks for posting!

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CORRECTION: most COVID pts do NOT experience ARDS

[2]
Posted: Jul 1, 2020 10:12 PM
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Just, the ones I see in the ICU are almost always in ARDS... that's why they are here.

I think there are tons of asymptomatic folks who'll never know...

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Re: July 1st CA COVID update if yer interested

[1]
Posted: Jul 1, 2020 9:50 PM
    Reply

I had a very good friend and co-worker who was intubated very early in the outbreak, I didn’t realize how lucky I was that he is still with us.

Thanks for the update. Stay safe.


You be safe too!

[5]
Posted: Jul 1, 2020 9:53 PM
    Reply

Thanks for an update and your personal account. Thanks for your care of these people that need you.

2020 white level member

Re: July 1st CA COVID update if yer interested

[3]
Posted: Jul 1, 2020 10:23 PM
    Reply

I think it is different now than back in March and April. My daughter is an ICU nurse in the Upstate and was getting volume managed back then because they had cancelled so many elective procedures. They were also rarely seeing actual COVID patients in the ICU unless they were in for something else and started to show symptoms. The COVID patients were well contained on a separate floor and a separate dedicated hospital just for COVID patients.

Now she is very busy from both increased elective procedures and many more COVID patients. She is personally dealing with many herself now. She also said that now many of the patients are younger, and she has seen a large increase in Hispanic patients. Not sure if that’s just particular to the Upstate area or not. Some have speculated that the later outbreak in Mexico has reached back into parts of the US.

I’m glad to hear what you’re saying about treatments. She said similar things about ventilators back in April...people were rarely coming off.

Thanks for the info and stay safe!

2020 orange level member

Same here. I’m a Nephrologist in Columbia

[4]
Posted: Jul 1, 2020 10:26 PM
    Reply

We are really only seeing bad cases (people with renal failure) and it’s not pretty. We have our positive outpatient dialysis patients running in a separate unit and for the most part they’ve done OK.

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Re: July 1st CA COVID update if yer interested

[4]
Posted: Jul 1, 2020 11:04 PM
    Reply

Love hearing from you. Always in our prayers!

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right on the money MFO, these people are the best of us...***

[1]
Posted: Jul 2, 2020 7:32 AM
    Reply




Always appreciate Soy's pragmatic accounts

[3]
Posted: Jul 2, 2020 8:45 AM
    Reply

Bet he and his family were over the moon to spend time together...that's been scarce time this year!

From the outset and initial weeks into the pandemic, several points have remained consistent and, thus would suggest how folks should govern themselves accordingly.
1. Assisted living facilities - just stay away...hard to say when visitation can resume (anyone have experience with relatives/selves of late?)
2. Over 60 (higher/lower?) with a compromised condition - high risk
3. Compromised condition - pretty high risk
4. Over 60 - some risk - some folks are in better shape (like to think I'm in that box!), by far, than others much younger...so...hate coloring outside the lines...
5. Ventilators - from early on...with Covid, they're all too often a postponement of the inevitable. Almost a death sentence...get affairs in order.
6. Distancing, washing/sanitizing, masks (I've come to like mints!), limiting the 'circle of contacts' isn't hurting a thing.
7. Cultural - an extension of #6, in many respects. Whether a NYC, the extended family Sunday gathering, or '5 to a room' living circumstances sans isolation...and similar scenarios sure look to be putting a match to gasoline.

All else appears conjecture, aside from various medical sources that 'perceive' the virus has weakened/mutated somewhat. And asymptomatic...talk about a Pandora's Box!


Re: July 1st CA COVID update if yer interested

[1]
Posted: Jul 2, 2020 11:16 AM
    Reply

Soywalker, why are they treating the patients with Dexamethasone? I understand a clinical study in UK has shown significant improvement for patients on vents or very close to needing one. The WHO is supporting it’s use based on that study.


Re: July 1st CA COVID update if yer interested


Posted: Jul 2, 2020 11:19 AM
    Reply

smillsap1 said:

Soywalker, why are they treating the patients with Dexamethasone? I understand a clinical study in UK has shown significant improvement for patients on vents or very close to needing one. The WHO is supporting it’s use based on that study.


Sorry, meant to ask are they treating with Dexamethasone?


@smillsap1 Great question


Posted: Jul 3, 2020 7:43 PM
    Reply

Think of ARDS (acute respiratory distress syndrome) as the lungs consequences when there is an insult to the body, typically infection or sepsis, but also can result from thoracic trauma.

The lungs have an inflammatory response that (crude explanation) results in their being a separation of the end point air sacs (alveoli) in the lungs from the smallest blood filled capillaries. Because of this, the oxygen in the air sacs cannot be diffused to the capillaries from the alveoli nor the carbon dioxide (CO2) waste from the capillaries back to the alveoli to be breathed out.

As a result, these pts are hard to oxygenate and the high co2s result in more acidic blood (co2 is an acid) and lower pH that the body does not function well with.

Dexamethasone is a steroid. One property of steroids is that they decrease the inflammatory response. For the most part we NO LONGER use steroids in ARDS as the research and outcomes have not been impacted to merit their use. However, quite frankly, we ain't know nothin about COVID. Enough people die, and MDs start sayin, screw it, let's try dexamethasone (decadron).

Enough MDs saw enough anecdotal positive response with the drug, for now, we are giving it for COVID.

Best I could do to keep it brief but informative without meaning to offend if you have background.

Stay safe, GO TIGERS!

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Re: July 1st CA COVID update if yer interested

[1]
Posted: Jul 2, 2020 12:41 PM
    Reply

Thanks for posting. You stay safe friend!

2020 orange level member

Re: July 1st CA COVID update if yer interested

[1]
Posted: Jul 2, 2020 12:51 PM
    Reply

Take Zinc, D3 and C (2x Daily Dose) for preventative.


Re: July 1st CA COVID update if yer interested


Posted: Jul 3, 2020 1:25 PM
    Reply


Take Zinc, D3 and C (2x Daily Dose) for preventative.




I predict somewhere down the road what you just prescribed will be shown to be one of the most effective preventatives against a bad case of Covid-19. No joke, however Big pharma is not going to like that news to get out.


Re: July 1st CA COVID update if yer interested

[1]
Posted: Jul 3, 2020 5:51 PM
    Reply

smillsap1 said:


Take Zinc, D3 and C (2x Daily Dose) for preventative.




I predict somewhere down the road what you just prescribed will be shown to be one of the most effective preventatives against a bad case of Covid-19. No joke, however Big pharma is not going to like that news to get out.



Agree for the most part as long as you get Clean Sources of these above and not cheap crap from Wal-Mart, Costco or other Big Box retailers.


Re: July 1st CA COVID update if yer interested


Posted: Jul 4, 2020 10:36 AM
    Reply

I predict it will have no effect. Getting Remdesivir in pill form and treating early will be the key. Should have it by early fall.

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