Medical Professionals

[brysdad]

I know we have multiple medical professionals on this site from EMTB all the way up to MD. Would anyone be willing to give their observations about what you’re seeing on the ground? I see friends of friends sharing their friend’s account on social media but those stories are too far removed from me to tell what’s what. I live in Hays County and we have 11 cases. The county population is about 225k and we just got locked down. This seems so bizarre and I’m legitimately interested what our TBH medical folks have to say.

[LFD2037]

We’re only allowed to say so much due to HIPAA. What kind of answers are you looking for?
I’ll answer what I legally can.

[Smell the Glove]

Nvm.

[Smell the Glove]

I will say this. If you have a parent or grandparent in a facility for dementia or hospice, this is a nightmare scenario.

[Black Ice]

We’re only allowed to say so much due to HIPAA. What kind of answers are you looking for?
I’ll answer what I legally can.

How much worse is it than the flu? I keep seeing the celebrities catch it and they seem fine.


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[Lungbustr]

My wife and all her people are prepared for it the best they can with the only issue so far being the amount of ppe available.

It seems to be more the calm before the storm here in this part of Texas. Southeast Texas. Hopefully the actual storm never materializes.

[flywise]

I work just on the border of Austin. I believe in our city we have 2 or 3 cases. We don't know who they are but their residences are flagged meaning if we get a call there we take certain precautions.
I'm not worried about my life or the lives of my family with this stuff.
I'll say this as well, in 18 years we typically run call after call from weak minded people who dial 911 for the dumbest crap from the basic cold to replace batteries in their smoke detectors and it seems non of these things are an issue until 2am. Well nearly 100% of those things have ceased. It seems all the sudden people actually can live with the common cold with out calling for an ambulance and i guess they all learned how to replace their batteries.

[texashunter]

I work just on the border of Austin. I believe in our city we have 2 or 3 cases. We don't know who they are but their residences are flagged meaning if we get a call there we take certain precautions.
I'm not worried about my life or the lives of my family with this stuff.
I'll say this as well, in 18 years we typically run call after call from weak minded people who dial 911 for the dumbest crap from the basic cold to replace batteries in their smoke detectors and it seems non of these things are an issue until 2am. Well nearly 100% of those things have ceased. It seems all the sudden people actually can live with the common cold with out calling for an ambulance and i guess they all learned how to replace their batteries.

Hey Kirby, if your bored and want something to do, I would love for you to come and change the batteries in all my smoke detectors, its a real PITA for me to have to do it! Stay safe at work.

[brysdad]

We’re only allowed to say so much due to HIPAA. What kind of answers are you looking for?
I’ll answer what I legally can.

Just generally are hospitals getting swamped anywhere? Are they full of sick people who can’t get tests?

[SaltwaterSlick]

My wife is an OR surgical nurse in a big hospital in the Houston area. She works the night shift 7/12's... The whole hospital system has cut their hours because of no elective cases being done while they sit around and "wait" for something to happen... so far, it's not happening... That's not to say that the hospital is not busy, but it's for sure not overwhelmed... Also, for the most part, this CV-19 doesn't require "surgery" so that is part of the issue for her and her staff. What they're doing is cutting back on elective surgeries to preserve post-op beds in case they are needed for other things. But as of last night, those needs have not materialized...

[Traildust]

My wife is an OR surgical nurse in a big hospital in the Houston area. She works the night shift 7/12's... The whole hospital system has cut their hours because of no elective cases being done while they sit around and "wait" for something to happen... so far, it's not happening... That's not to say that the hospital is not busy, but it's for sure not overwhelmed... Also, for the most part, this CV-19 doesn't require "surgery" so that is part of the issue for her and her staff. What they're doing is cutting back on elective surgeries to preserve post-op beds in case they are needed for other things. But as of last night, those needs have not materialized...

How can that be.....hasn't she watched the news reports?

Crazy times!

[flywise]

Hey Kirby, if your bored and want something to do, I would love for you to come and change the batteries in all my smoke detectors, its a real PITA for me to have to do it! Stay safe at work.

Lol, be my pleasure, so long as it’s not at 2am

[Cajun Blake]

Long read but very detailed with facts from a Dr. on the front lines in New Orleans. If you’re in the medical field, you’ll understand the terminology and disposition. If your family member is a doctor or nurse, share this with them



"I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.

Clinical course is predictable.... 2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.

Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.

81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.

Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT's of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.

China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.

Diagnostic:
CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.

Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%. CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated. Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.

Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.

A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.

An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.

Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.

Disposition:
I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won't make it back.

We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.

Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the "lockdown", our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.

Treatment:
Supportive, worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.

Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic.”

[friscopaint]

I work just on the border of Austin. I believe in our city we have 2 or 3 cases. We don't know who they are but their residences are flagged meaning if we get a call there we take certain precautions.
I'm not worried about my life or the lives of my family with this stuff.
I'll say this as well, in 18 years we typically run call after call from weak minded people who dial 911 for the dumbest crap from the basic cold to replace batteries in their smoke detectors and it seems non of these things are an issue until 2am. Well nearly 100% of those things have ceased. It seems all the sudden people actually can live with the common cold with out calling for an ambulance and i guess they all learned how to replace their batteries.

We have 4 on quarantine over a smoke detector call. Guy knew he was positive and called. Fort Worth. Call volume definitely way down !

[oktx]

Both of my kids are RN’s. One is a hospice nurse and the other is an ICU nurse. Neither has confirmed any cases in Wise County yet. I read today their CV testing is up and running now.