Medical Professionals

[Acameron52]

I’m a Paramedic in Tarrant county and this is without a doubt the slowest we have been in my career. It’s almost eerie how we have not been running calls. I can’t come to a good conclusion to this other than our regulars that call for BS and scared to get in the back of an ambulance.

Personally, I’m not too worried about it. I’m young and healthy and would likely bounce back very quick. I also trust our policies and procedures that are in place to protect us. More than anything I’m scared for the economical side of things. I think it’s going to get bad.

Side note, one of the guys I was working with yesterday has wife that’s an RN at one of the largest hospitals in the area and they were actually sending people home yesterday because it was so slow.

[flywise]

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

That guy should be prosecuted as soon as he is clear of the virus POS

[Roy]

That guy should be prosecuted as soon as he is clear of the virus POS

No kidding! This is horrible. There are a ton of sickos out there trying to spread this thing. There was a guy who had it and went to a store to film himself licking bottles of milk(?) on the shelf trying to spread this. He was charged as a domestic terrorist!

And copy-cats are already doing the same. SMH!!

https://www.policeone.com/coronavirus-covid-19/articles/mo-man-who-licked-walmart-toiletries-charged-with-making-terrorist-threat-tgDTf5ySS6ibv1G7/

[miket]

That guy should be prosecuted as soon as he is clear of the virus POS

Yep. Attempted murder as far as Im concerned. How anyone could be so worthless is beyond me.

[rockyraider]

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.”

My wife is a nurse and we just read this. Can you tell me where this info came from? Very interesting stuff, thanks for posting.

[oktx]

Wise county has its first case.

[rolylane6]

Wise county has its first case.

I knew it was coming eventually but still hate to hear it!

Sent from my SM-N970U using Tapatalk

[brents45]

Thanks Cajun Blake.

[Cajun Blake]

My wife is a nurse and we just read this. Can you tell me where this info came from? Very interesting stuff, thanks for posting.

From an ER doctor working in Orleans Parish. Not sure of exact hospital, likely an Ochsner Health System facility since they bought out lots of hospitals in last 3-4 years

Info updated daily by the LA Dept Health http://ldh.la.gov/Coronavirus/

[TxAg]

Let's ask an expert

[rockyraider]

From an ER doctor working in Orleans Parish. Not sure of exact hospital, likely an Ochsner Health System facility since they bought out lots of hospitals in last 3-4 years

Info updated daily by the LA Dept Health http://ldh.la.gov/Coronavirus/

Gotcha, I just wasn't sure if this was from a published source, someone you personally knew, or what. Not doubting the validity of any of it, I just like to know where info. is coming from with all of the misinformation going around. My wife passed the post on to the MD she works for, very interesting read.

[SaltwaterSlick]

Thx, Blake!

[stickerpatch59]

No kidding! This is horrible. There are a ton of sickos out there trying to spread this thing. There was a guy who had it and went to a store to film himself licking bottles of milk(?) on the shelf trying to spread this. He was charged as a domestic terrorist!

And copy-cats are already doing the same. SMH!!
https://www.policeone.com/coronaviru...Tf5ySS6ibv1G7/

make the punishment for this kind of **** severe and it will stop.

[Efren]

We know a couple who are nurses in two different hospitals. Husband, late 40s, got symptoms and tested positive. She went in afterwards and she was negative. He said he just had flulike symptoms. He said he felt worse after taking the drugs they gave him. Vomiting and diarrhea. He was quarantined at the hospital for seven days. He was in good spirits but basically bored the whole time. He is finally home.

[Dave]

I have a friend who is an ER nurse on the border with Louisiana. He said they are watching what is happening in New Orleans and else where in LA and it feels like an unstoppable wave is headed our way.