We've been vaccinating cattle for Coronavirus for years, so it's not like a new species or something. I hope that helps them get a leg up on a vaccine for this particular strain faster!RCR06 said:This is something I've been wondering about and even tried to do some online research about just to see if anyone had successfully made a vaccine for any corona virus. It was very difficult because the first name this virus had in the media was corona virus, which as we now know is a type of virus not the name of this specific one(covid-19). This leads me to believe there's a fair chance this may take longer than 12-18 months to develop. The encouraging thing is that different approaches are being tested across the world so hopefully one will work.BiochemAg97 said:First, the flu vaccine takes about a year to make in sufficient doses for everyone. That is why it is not always very effective. They have to guess what flu viruses will be the biggest problems the next year, and sometimes they are wrong. So that would take about 12 months.Counterpoint said:
Question that will probably sound extremely dumb to all the amazing medically knowledgeable folks on here...
For this vaccine, why can't we use the exact same process that we use to make the flu vaccine, except insert the inactivated SARS-CoV-2 virus instead of the inactivated flu virus? Or, if that IS how we do it, why do we have to test it for a year or more? If it's because the virus is so new, aren't the flu strains they put in the flu vaccine new every year also?
Second, we would spend 12 months making a vaccine that we have no idea if it works. We do not currently have a human corona virus vaccine and corona viruses behave differently than flu viruses in some aspects.
Sounds like a bad plan to me.
Third, there are several candidate vaccines being tested, including some fairly new vaccine technologies. It is possible that if the newer vaccine technologies work, but everyone is modeling the time frame based on the flu vaccine and/or clinical trial timelines for other recently developed vaccines. It is better to project the expected time based on current knowledge and get the vaccine early than to tell everyone we will have a vaccine in August and not have one until next year.
Covid-19 Update Aggie Physician
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Last: 2 yr ago by tamc91
I concur that it is real, as real as any shortage I've ever seen and I've been buying things for industrial users for well over 30 years. They were hard to find almost as soon as COVID 19 started up in Washington. We were lucky about a week ago and got a full pallet as it was coming through customs (for 40+ power plants). Since then, we haven't been able to find any at all to provide any backup. (If you are in the industrial sector and use them as part of your process, start conserving them in any way you can!)TAMUallen said:Max06 said:
Forgive me if this has already been answered- I've seen a ton of Facebook posts about mask shortages and tons of people making fabric masks.
Is the mask shortage that real, and are home made masks even useful?
The mask shortage is definitely real. Homemade masks are more useful than no mask and can be just as useful depending on the material used.
I'm just praying that they are all being diverted to the medical and first responder communities and not being deferred to black market or other less than optimal users.
Hey Doc Rev
Can you differentiate ventilate, intubate and what machines are used for what and how they help the patient. The media rattles these terms out there with no context - probably because they have no idea and are just reading a screen. Also read some docs are having better luck aspirating lungs of fluid then putting on a machine - is that a possibility?
Thanks again to you and all the MDs, RNs, PAs, and NPs!
Can you differentiate ventilate, intubate and what machines are used for what and how they help the patient. The media rattles these terms out there with no context - probably because they have no idea and are just reading a screen. Also read some docs are having better luck aspirating lungs of fluid then putting on a machine - is that a possibility?
Thanks again to you and all the MDs, RNs, PAs, and NPs!
HeadCiv78 said:We've been vaccinating cattle for Coronavirus for years, so it's not like a new species or something. I hope that helps them get a leg up on a vaccine for this particular strain faster!RCR06 said:This is something I've been wondering about and even tried to do some online research about just to see if anyone had successfully made a vaccine for any corona virus. It was very difficult because the first name this virus had in the media was corona virus, which as we now know is a type of virus not the name of this specific one(covid-19). This leads me to believe there's a fair chance this may take longer than 12-18 months to develop. The encouraging thing is that different approaches are being tested across the world so hopefully one will work.BiochemAg97 said:First, the flu vaccine takes about a year to make in sufficient doses for everyone. That is why it is not always very effective. They have to guess what flu viruses will be the biggest problems the next year, and sometimes they are wrong. So that would take about 12 months.Counterpoint said:
Question that will probably sound extremely dumb to all the amazing medically knowledgeable folks on here...
For this vaccine, why can't we use the exact same process that we use to make the flu vaccine, except insert the inactivated SARS-CoV-2 virus instead of the inactivated flu virus? Or, if that IS how we do it, why do we have to test it for a year or more? If it's because the virus is so new, aren't the flu strains they put in the flu vaccine new every year also?
Second, we would spend 12 months making a vaccine that we have no idea if it works. We do not currently have a human corona virus vaccine and corona viruses behave differently than flu viruses in some aspects.
Sounds like a bad plan to me.
Third, there are several candidate vaccines being tested, including some fairly new vaccine technologies. It is possible that if the newer vaccine technologies work, but everyone is modeling the time frame based on the flu vaccine and/or clinical trial timelines for other recently developed vaccines. It is better to project the expected time based on current knowledge and get the vaccine early than to tell everyone we will have a vaccine in August and not have one until next year.
This. I work in the chicken industry, and same thing there, we've vaccinated every bird for various strains of coronavirus for many years. This is a novel strain, not a novel virus. The creation of a vaccine is relativity quick and easy. The time consuming part is proving out the efficacy and safety for use in humans, and production at scale. I think 12-18 months is very realistic, and I'd bet on the shorter end of that range.
Big Al 1992 said:
Hey Doc Rev
Can you differentiate ventilate, intubate and what machines are used for what and how they help the patient. The media rattles these terms out there with no context - probably because they have no idea and are just reading a screen. Also read some docs are having better luck aspirating lungs of fluid then putting on a machine - is that a possibility?
Thanks again to you and all the MDs, RNs, PAs, and NPs!
Cardiac/Pulmonary nurse here.
Intubation is the actual process of putting a breathing tube down into the lungs. Mechanical ventilation is what follows: Attaching the tube to a machine that regulates air in and out of the lung. When we say a patient is intubated, in general it is just another way of saying they are on a vent.
The lungs serve two basic purposes: Getting oxygen into the bloodstream and getting carbon dioxide out. This exchange takes place across tiny little capillaries in tiny little air sacs (alveoli) in the lung. This exchange is very delicate and our bodies do an amazing job of regulating our breathing patterns and chemicals in the blood to help keep everything in balance. Our breathing and metabolic processes work hand-in-hand to regulate the gas contents of our bloodstream.
In an illness like covid-19, the virus is attacking lung tissue and the body's inflammatory response to the virus is a double-whammy. What happens is simply that the body can't get enough oxygen into the bloodstream because some of the alveoli are blocked, inflamed, or swollen with fluid. This also can affect the ability of carbon dioxide to get out. Your brain senses this and causes you to breathe harder/faster. Typically we would start support by putting someone on a nasal cannula with extra oxygen to help make the oxygen exchange more efficient until their lungs can heal enough to be able to effectively use the oxygen out of normal air. Typically, we would progress to a face mask, then possibly a BiPAP, before mechanical ventilation. Covid is being treated a bit differently, so will let the doctors explain the reasoning for that.
If oxygen levels continue to drop, or carbon dioxide levels are very high in the bloodstream (due to lack of good exchange in the alveoli) it will require mechanical ventilation to force more air into the lung in a specific, delicate way to rebalance the blood gases and prevent organ damage. Mechanical ventilation is a very complicated process and ventilator settings will be different for each patient's respiratory and metabolic needs.
Sometimes lung inflammation can cause a change in the permeability of those capillaries, where fluid that should be elsewhere can cross into the alveolar space. This is called pulmonary edema. When your lungs have fluid in them they can't adequately exchange gases. This would also, depending on the severity, cause the need for mechanical ventilation. Pulmonary edema cannot be drawn out with a needle (at least I've never seen it attempted, please correct me if I'm wrong). It is treated with medication and careful oxygen/ventilation support.
There is another condition called a pleural effusion where fluid can build up in the space outside of the lung itself, and this can be drawn off with a needle. I'm not sure of the prevalence of that with covid-19.
That is a very good explanation. Thanks Moxley! I had pleurisy about 10 years ago and it hurt to breathe, resolved on its own with some prednisone, but haven't yet heard if this virus can cause that or similar pain.
I would also guess shipping x number of ventilators to a hospital unit isn't that easy - they aren't just plug and play, and would have to be calibrated etc.
Moxley said:Big Al 1992 said:
Hey Doc Rev
Can you differentiate ventilate, intubate and what machines are used for what and how they help the patient. The media rattles these terms out there with no context - probably because they have no idea and are just reading a screen. Also read some docs are having better luck aspirating lungs of fluid then putting on a machine - is that a possibility?
Thanks again to you and all the MDs, RNs, PAs, and NPs!
Cardiac/Pulmonary nurse here.
Intubation is the actual process of putting a breathing tube down into the lungs. Mechanical ventilation is what follows: Attaching the tube to a machine that regulates air in and out of the lung. When we say a patient is intubated, in general it is just another way of saying they are on a vent.
The lungs serve two basic purposes: Getting oxygen into the bloodstream and getting carbon dioxide out. This exchange takes place across tiny little capillaries in tiny little air sacs (alveoli) in the lung. This exchange is very delicate and our bodies do an amazing job of regulating our breathing patterns and chemicals in the blood to help keep everything in balance. Our breathing and metabolic processes work hand-in-hand to regulate the gas contents of our bloodstream.
In an illness like covid-19, the virus is attacking lung tissue and the body's inflammatory response to the virus is a double-whammy. What happens is simply that the body can't get enough oxygen into the bloodstream because some of the alveoli are blocked, inflamed, or swollen with fluid. This also can affect the ability of carbon dioxide to get out. Your brain senses this and causes you to breathe harder/faster. Typically we would start support by putting someone on a nasal cannula with extra oxygen to help make the oxygen exchange more efficient until their lungs can heal enough to be able to effectively use the oxygen out of normal air. Typically, we would progress to a face mask, then possibly a BiPAP, before mechanical ventilation. Covid is being treated a bit differently, so will let the doctors explain the reasoning for that.
If oxygen levels continue to drop, or carbon dioxide levels are very high in the bloodstream (due to lack of good exchange in the alveoli) it will require mechanical ventilation to force more air into the lung in a specific, delicate way to rebalance the blood gases and prevent organ damage. Mechanical ventilation is a very complicated process and ventilator settings will be different for each patient's respiratory and metabolic needs.
Sometimes lung inflammation can cause a change in the permeability of those capillaries, where fluid that should be elsewhere can cross into the alveolar space. This is called pulmonary edema. When your lungs have fluid in them they can't adequately exchange gases. This would also, depending on the severity, cause the need for mechanical ventilation. Pulmonary edema cannot be drawn out with a needle (at least I've never seen it attempted, please correct me if I'm wrong). It is treated with medication and careful oxygen/ventilation support.
There is another condition called a pleural effusion where fluid can build up in the space outside of the lung itself, and this can be drawn off with a needle. I'm not sure of the prevalence of that with covid-19.
never mind
quick question i've seen discussed but cannot find a clear answer to..
I recall the physician from Louisiana stating that, based on his observations in his hospital, the death rate for patients once intubated was very high - in other words, those patients requiring ventilators have a low survival rate.
are there any statistics on this beyond those anecdotes? what is the survival rate for patients requiring ICU/intubation?
thanks!
I recall the physician from Louisiana stating that, based on his observations in his hospital, the death rate for patients once intubated was very high - in other words, those patients requiring ventilators have a low survival rate.
are there any statistics on this beyond those anecdotes? what is the survival rate for patients requiring ICU/intubation?
thanks!
We're from North California, and South Alabam
and little towns all around this land...
and little towns all around this land...
Haven't seen anything other than anecdotes.
maybe there aren't solid numbers reported on that, but as i understand it, docs won't put a patient on a ventilator until there's fear of tiring out and death already anyway, so it would make sense if a lot of people put on ventilators still end up dying.
There has been speculation about involvement with heme / blood cells as a two-pronged attack on oxygen. Both on the supply / lung side and the transmission / blood side. If that's the case, could explain some of the comorbidity and age interaction... and the anecdotal low success rate with ventilation.
Also new research pointing to cytokine storm being the progression toward death. Not sure how effective a ventilator is at fighting that.
https://www.jci.org/articles/view/137647/version/1/pdf/render.pdf
We have some very difficult discussions to be had... not only in triage between patients with COVID19 but also between COVID19 patients and others who need ventilators. Especially if ventilators have low success rates.
Also new research pointing to cytokine storm being the progression toward death. Not sure how effective a ventilator is at fighting that.
https://www.jci.org/articles/view/137647/version/1/pdf/render.pdf
We have some very difficult discussions to be had... not only in triage between patients with COVID19 but also between COVID19 patients and others who need ventilators. Especially if ventilators have low success rates.
Moxley said:Big Al 1992 said:
Hey Doc Rev
Can you differentiate ventilate, intubate and what machines are used for what and how they help the patient. The media rattles these terms out there with no context - probably because they have no idea and are just reading a screen. Also read some docs are having better luck aspirating lungs of fluid then putting on a machine - is that a possibility?
Thanks again to you and all the MDs, RNs, PAs, and NPs!
Cardiac/Pulmonary nurse here.
Intubation is the actual process of putting a breathing tube down into the lungs. Mechanical ventilation is what follows: Attaching the tube to a machine that regulates air in and out of the lung. When we say a patient is intubated, in general it is just another way of saying they are on a vent.
The lungs serve two basic purposes: Getting oxygen into the bloodstream and getting carbon dioxide out. This exchange takes place across tiny little capillaries in tiny little air sacs (alveoli) in the lung. This exchange is very delicate and our bodies do an amazing job of regulating our breathing patterns and chemicals in the blood to help keep everything in balance. Our breathing and metabolic processes work hand-in-hand to regulate the gas contents of our bloodstream.
In an illness like covid-19, the virus is attacking lung tissue and the body's inflammatory response to the virus is a double-whammy. What happens is simply that the body can't get enough oxygen into the bloodstream because some of the alveoli are blocked, inflamed, or swollen with fluid. This also can affect the ability of carbon dioxide to get out. Your brain senses this and causes you to breathe harder/faster. Typically we would start support by putting someone on a nasal cannula with extra oxygen to help make the oxygen exchange more efficient until their lungs can heal enough to be able to effectively use the oxygen out of normal air. Typically, we would progress to a face mask, then possibly a BiPAP, before mechanical ventilation. Covid is being treated a bit differently, so will let the doctors explain the reasoning for that.
If oxygen levels continue to drop, or carbon dioxide levels are very high in the bloodstream (due to lack of good exchange in the alveoli) it will require mechanical ventilation to force more air into the lung in a specific, delicate way to rebalance the blood gases and prevent organ damage. Mechanical ventilation is a very complicated process and ventilator settings will be different for each patient's respiratory and metabolic needs.
Sometimes lung inflammation can cause a change in the permeability of those capillaries, where fluid that should be elsewhere can cross into the alveolar space. This is called pulmonary edema. When your lungs have fluid in them they can't adequately exchange gases. This would also, depending on the severity, cause the need for mechanical ventilation. Pulmonary edema cannot be drawn out with a needle (at least I've never seen it attempted, please correct me if I'm wrong). It is treated with medication and careful oxygen/ventilation support.
There is another condition called a pleural effusion where fluid can build up in the space outside of the lung itself, and this can be drawn off with a needle. I'm not sure of the prevalence of that with covid-19.
Good explanation. There are a few reasons progression from oxygen by nasal cannula to oxygen by face mask, to BiPAP to, intubation and mechanical ventilation is different in Covid-19.
The first is concern for aerosolization of the virus. All of the processes above except oxygen by nasal cannula and by face mask have potential to turn the virus into an aerosol and allow it to contaminate entire floors of the hospital through the buildings ventilation ducts if the patient is not already in a negative pressure room. Nebulizer treatments and ventilation with bag valve masks (BVMs, they are the things you see paramedics on TV holding over people's faces while they squeeze a bag to give them air during CPR) also have potential for aerosolizing the virus. The people performing intubation or these other airway management procedures have to be careful not to expose themselves to very high levels of aerosolized virus. Health care workers who have had exposure to these high levels of virus have had very poor outcomes. Many young healthy healthcare workers have died.
Doctors who are performing intubation usually pre-oxygenate patients before they intubate them using a BVM to give them max oxygenation of their blood before they try to shove the tube down their trachea as fast as possible since during the process of intubation, the patient is paralyzed using medications (usually) and therefore unable to breathe for themselves. In Covid, we have been skipping the BVM step and instead just pre- oxygenating using oxygen by high flow nasal cannula and/or face masks. This means we have less time to get the tube down before the patients blood oxygen levels drop critically low. Covid has also usually damaged the lung tissues pretty badly by this point as so their blood oxygen drops faster than normal even with BVM ventilation.
We are also seeing very high failure rates when we do try to use BiPAP (this is just like CPAP but it has both a high and low pressure setting, while CPAP just holds the alveoli open at the end of a breath with a low pressure setting so it won't let your lungs drop below that pressure level when you breathe out). With it's potential for aerosolization and high failure rates, most physicians have eliminated BiPAP from their personal Covid-19 airway management algorithm all together.
Covid-19 patients are also not acting like our typical patients with respiratory distress. They don't breathe as fast as you would expect them to to try and compensate for very low blood oxygen levels ( this is a phenomenon known as LaBelle indifference), they should be breathing faster but for some unknown reason they don't have the drive to do so. Their lungs also don't sound bad on physical exam with a stethoscope. Even when they are pretty sick their lungs will sound OK. We have to keep a close eye on labs and O2 SATs to decide when it is time to intubate.
People who do end up intubated typically don't fare well. Around 87% die after intubation and mechanical ventilation. Mechanical ventilation is very rough on the lung tissues, and in Covid-19 these tissues are already in bad shape. We try to avoid intubation when we can for this reason, but early intubation for people who will eventually need it has been shown to lead to better chance of survival. The trick is figuring out who can avoid intubation entirely and who will eventually need it during the course of their disease and try to get those people intubated before they look like they need it. It is not an easy thing to do.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
California Ag 90 said:
quick question i've seen discussed but cannot find a clear answer to..
I recall the physician from Louisiana stating that, based on his observations in his hospital, the death rate for patients once intubated was very high - in other words, those patients requiring ventilators have a low survival rate.
are there any statistics on this beyond those anecdotes? what is the survival rate for patients requiring ICU/intubation?
thanks!
ER doc here: The most recent numbers I've heard (but bear in mind, this changes almost daily) is only 20% survival rate once vented. It's an incredibly poor prognostic sign if someone with this virus requires intubation. Although, to be fair, it's a bad sign when anyone who has a primary respiratory problem requires intubation.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Thanks all for the answers.AggieMD04 said:California Ag 90 said:
quick question i've seen discussed but cannot find a clear answer to..
I recall the physician from Louisiana stating that, based on his observations in his hospital, the death rate for patients once intubated was very high - in other words, those patients requiring ventilators have a low survival rate.
are there any statistics on this beyond those anecdotes? what is the survival rate for patients requiring ICU/intubation?
thanks!
ER doc here: The most recent numbers I've heard (but bear in mind, this changes almost daily) is only 20% survival rate once vented. It's an incredibly poor prognostic sign if someone with this virus requires intubation. Although, to be fair, it's a bad sign when anyone who has a primary respiratory problem requires intubation.
elderly friend of a close colleague in NYC just went on ventilator, was wondering what his prospects were.
some dark days we are in.
We're from North California, and South Alabam
and little towns all around this land...
and little towns all around this land...
Terrific posts, Moxley and Badace52! Thank you for the information.
KR Training staff instructor - www.krtraining.com
Thanks, doc!Reveille said:AgsMyDude said:
Are blood oxygen sensors worth having on hand, like this one?
https://www.amazon.com/dp/B019EKP19Q/ref=cm_sw_r_sms_apa_i_xqqBEbN75VD26
Yes those are helpful and I think now that they affordable every house should have one. Just remember if you do not see I constant pulse beat then it is but picking up correctly so the number is not accurate.
For a healthy person the reading should be between 95 to 100. Consistent readings below 92 requires possible hospitalization.
FYI most Samsung phones have a pulse ox reader but into it. So if you have a Samsung phone you can Google how to use it.
Is it possible to be SOB from CV19 related symptoms yet have healthy oxygen readings?
About 2 weeks ago I started experiencing the following:
- Difficulty getting a full breath/tingle deep in lungs
- Diarrhea
- Lack of appetite (lost 10 pounds without a change in diet and lowest I've weighed in 5 yrs now)
- Sore throat / some congestion (mucus) (I do tend to get this during oak pollen season though).
No fever, no cough.
This weekend I started feeling exhausted. Some slight pain deep in my lungs if exercising (almost like running in the cold). My O2 stats remain in the high 90s, I realize not to take these devices off amazon as gospel. I used to have trouble with anxiety when I was younger so it's possible it's manifesting again with the stress increase going on these days.
Question to Doctors .... about how long does it take to officially confirm most CV cases from the first clinical observation of probable symptoms?
In other words, what's the approximate lag time on what we're seeing officially reported?
In other words, what's the approximate lag time on what we're seeing officially reported?
How are the pulmonary mechanics on the vented patients you're seeing? Fortunately, my area has not had many cases of severe COVID, but notably for the ones that have been tubed they aren't displaying what you'd expect with typical ARDS. Driving and plateau pressures are more or less either normal/not the issue. I've heard other anecdotal accounts from friends/colleagues that they are seeing similar in their COVID patients, where lung compliance isn't the paramount issue. Unsurprisingly there isn't a whole lot of literature out yet either (or at least that I've been able to find). Is this consistent with what you're seeing in your COVID patients?
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
benchmark said:
Question to Doctors .... about how long does it take to officially confirm most CV cases from the first clinical observation of probable symptoms?
In other words, what's the approximate lag time on what we're seeing officially reported?
It depends on which lab is doing the testing and which tests are being used. The first round of tests sent out are taking around 4-10 days to come back depending on how backlogged the lab testing them is. We are still mostly using the first round of tests that were sent out. So a delay in results of about 1 week on average is what I would expect.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
AgsMyDude said:Thanks, doc!Reveille said:AgsMyDude said:
Are blood oxygen sensors worth having on hand, like this one?
https://www.amazon.com/dp/B019EKP19Q/ref=cm_sw_r_sms_apa_i_xqqBEbN75VD26
Yes those are helpful and I think now that they affordable every house should have one. Just remember if you do not see I constant pulse beat then it is but picking up correctly so the number is not accurate.
For a healthy person the reading should be between 95 to 100. Consistent readings below 92 requires possible hospitalization.
FYI most Samsung phones have a pulse ox reader but into it. So if you have a Samsung phone you can Google how to use it.
Is it possible to be SOB from CV19 related symptoms yet have healthy oxygen readings?
About 2 weeks ago I started experiencing the following:
- Difficulty getting a full breath/tingle deep in lungs
- Diarrhea
- Lack of appetite (lost 10 pounds without a change in diet and lowest I've weighed in 5 yrs now)
- Sore throat / some congestion (mucus) (I do tend to get this during oak pollen season though).
No fever, no cough.
This weekend I started feeling exhausted. Some slight pain deep in my lungs if exercising (almost like running in the cold). My O2 stats remain in the high 90s, I realize not to take these devices off amazon as gospel. I used to have trouble with anxiety when I was younger so it's possible it's manifesting again with the stress increase going on these days.
Yes. Our bodies have the ability to maintain a small oxygen reserve because of how oxygen binds to our hemoglobin. In fact, most patients with mild, or even moderate symptoms, might have a normal oxygen saturation. Oxygen demand and consumption increase as we fight off infection, which can potentially lead to depletion of that reserve and then manifest as a lower oxygen saturation on your pulse-oximeter.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
I haven't taken a biology class since freshman year of high school so please bear with me.Quote:
Chloroquine helps prevent the ORF8 from binding the ORD10, ORF3a from binding to some extent and may help treat this disease.
This study seems to point to HCQ's value due to regulation of inflammatory cytokines / preventing the immune system overresponse.
Matching that with this study and the stuff about IL-6 being a good predictor of severity early on, is this the same mechanism as was previously thought to be the benefit with HCQ? Or have we learned something new?
Disasters make us learn a lot about things we would never normally care for. I remember during Harvey we were in the risk area and I was calculating volumes of the reservoirs based on topographical maps and comparing flow rates in and out to see if we would flood.
Often we will never be of help to the real experts, but I certainly know what kind of treatment I want to ask for if I'm hospitalized and the docs don't have a determined course of treatment.
Often we will never be of help to the real experts, but I certainly know what kind of treatment I want to ask for if I'm hospitalized and the docs don't have a determined course of treatment.
Doctors, have you seen this virus affect a person's brain rather than their lungs? A friend of ours has been in and out of the hospital all year on unrelated surgery and complications from that surgery. She went back to the hospital last week with swelling of her brain and they tested her for meningitis. When that came back negative she tested positive for COVID-19. AFAIK, she had no problems with her breathing, just the brain swelling thing.
She's out of the hospital now and recovering at home. Her husband got the sniffles for a few days, but wasn't tested or diagnosed with the disease.
She's out of the hospital now and recovering at home. Her husband got the sniffles for a few days, but wasn't tested or diagnosed with the disease.
Mantis Toboggan MD said:
How are the pulmonary mechanics on the vented patients you're seeing? Fortunately, my area has not had many cases of severe COVID, but notably for the ones that have been tubed they aren't displaying what you'd expect with typical ARDS. Driving and plateau pressures are more or less either normal/not the issue. I've heard other anecdotal accounts from friends/colleagues that they are seeing similar in their COVID patients, where lung compliance isn't the paramount issue. Unsurprisingly there isn't a whole lot of literature out yet either (or at least that I've been able to find). Is this consistent with what you're seeing in your COVID patients?
I'm in the ER so I don't manage the vent very long in most cases (that may be changing soon) and we haven't been hit hard here yet either. I am garnering most of my information on Covid-19 intubation from my ER colleagues in anticipation of the incoming wave.
I have heard that similar to ARDS patients, Covid-19 have been requiring higher PEEP to maintain oxygenation. Most people are recommending a PEEP of 14 to start off and go up from there. I have heard plateau pressures are near normal. Permissive hypercapnia is a tenant of Covid treatment I have heard reiterated.
The biggest thing all the docs warn about is don't overdo fluid resuscitation. This is similar in ARDS too, but apparently much more important with Covid-19. I have seen recommendations to avoid all fluid boluses and maintenance fluids if at all possible.
Most of my colleagues are less than sold on hydroxychloroquine helping at all and many think it may be exacerbating the cardiac and hepatic complications of Covid-19 infection. That said they have still been giving it.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
I'm curious if there has been any data on the correlation between smoking/ vaping?
My thought is that the places that seem to be hit hard still have high levels of smokers (China, Italy, etc.)
I remember early on their was some speculation that the poor air quality in China was a big cause as well, but I haven't seen it discussed lately. . .
My thought is that the places that seem to be hit hard still have high levels of smokers (China, Italy, etc.)
I remember early on their was some speculation that the poor air quality in China was a big cause as well, but I haven't seen it discussed lately. . .
In a previous question/response, I thought the liver was not really adversely affected by the virus. Just the kidneys in addition to heart/lung. Are there issues with the virus damaging the liver or is it more the medication being used (hydroxychloroquine)?Badace52 said:Mantis Toboggan MD said:
How are the pulmonary mechanics on the vented patients you're seeing? Fortunately, my area has not had many cases of severe COVID, but notably for the ones that have been tubed they aren't displaying what you'd expect with typical ARDS. Driving and plateau pressures are more or less either normal/not the issue. I've heard other anecdotal accounts from friends/colleagues that they are seeing similar in their COVID patients, where lung compliance isn't the paramount issue. Unsurprisingly there isn't a whole lot of literature out yet either (or at least that I've been able to find). Is this consistent with what you're seeing in your COVID patients?
I'm in the ER so I don't manage the vent very long in most cases (that may be changing soon) and we haven't been hit hard here yet either. I am garnering most of my information on Covid-19 intubation from my ER colleagues in anticipation of the incoming wave.
I have heard that similar to ARDS patients, Covid-19 have been requiring higher PEEP to maintain oxygenation. Most people are recommending a PEEP of 14 to start off and go up from there. I have heard plateau pressures are near normal. Permissive hypercapnia is a tenant of Covid treatment I have heard reiterated.
The biggest thing all the docs warn about is don't overdo fluid resuscitation. This is similar in ARDS too, but apparently much more important with Covid-19. I have seen recommendations to avoid all fluid boluses and maintenance fluids if at all possible.
Most of my colleagues are less than sold on hydroxychloroquine helping at all and many think it may be exacerbating the cardiac and hepatic complications of Covid-19 infection. That said they have still been giving it.
Cepe said:
I'm curious if there has been any data on the correlation between smoking/ vaping?
My thought is that the places that seem to be hit hard still have high levels of smokers (China, Italy, etc.)
I remember early on their was some speculation that the poor air quality in China was a big cause as well, but I haven't seen it discussed lately. . .
I think it is reasonable to assume that smoking or chronic exposure to respiratory irritants would put a person at a higher risk of having complications related to this virus. I don't think we have the data yet to see how much more at-risk those people are.
The retrospective studies on this virus are going to be very interesting.
Old RV Ag said:In a previous question/response, I thought the liver was not really adversely affected by the virus. Just the kidneys in addition to heart/lung. Are there issues with the virus damaging the liver or is it more the medication being used (hydroxychloroquine)?Badace52 said:Mantis Toboggan MD said:
How are the pulmonary mechanics on the vented patients you're seeing? Fortunately, my area has not had many cases of severe COVID, but notably for the ones that have been tubed they aren't displaying what you'd expect with typical ARDS. Driving and plateau pressures are more or less either normal/not the issue. I've heard other anecdotal accounts from friends/colleagues that they are seeing similar in their COVID patients, where lung compliance isn't the paramount issue. Unsurprisingly there isn't a whole lot of literature out yet either (or at least that I've been able to find). Is this consistent with what you're seeing in your COVID patients?
I'm in the ER so I don't manage the vent very long in most cases (that may be changing soon) and we haven't been hit hard here yet either. I am garnering most of my information on Covid-19 intubation from my ER colleagues in anticipation of the incoming wave.
I have heard that similar to ARDS patients, Covid-19 have been requiring higher PEEP to maintain oxygenation. Most people are recommending a PEEP of 14 to start off and go up from there. I have heard plateau pressures are near normal. Permissive hypercapnia is a tenant of Covid treatment I have heard reiterated.
The biggest thing all the docs warn about is don't overdo fluid resuscitation. This is similar in ARDS too, but apparently much more important with Covid-19. I have seen recommendations to avoid all fluid boluses and maintenance fluids if at all possible.
Most of my colleagues are less than sold on hydroxychloroquine helping at all and many think it may be exacerbating the cardiac and hepatic complications of Covid-19 infection. That said they have still been giving it.
In any critically ill patient who is not oxygenating or perfusing well, you begin to have some damage to all the organs. We call this end-organ failure. The individual cells in the organs stop getting enough oxygen to function normally and some die. Some of the first organs hit are the kidneys and the liver.
You will hear us say the person has developed liver or kidney "failure," due to their illness. So while the virus is not directly attacking the liver in most cases, once it hits the lungs or heart hard enough to limit oxygenation or perfusion, there will be liver damage.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Many thanks for the info!
I keep seeing reference to doctors prescribing hydroxy chloroquine but not zinc to go along with it. I'm not a doctor, but I thought these two worked in tandem to reduce RNA replication by aiding the zinc in getting inside the cells. What are the benefits of hydroxy chloroquine without the zinc?
Sorry guys very busy today! Haven't had time to look at questions till now so will start answering them now.
Here is today's update.
https://www.facebook.com/permalink.php?story_fbid=2655760198040254&id=1998386763777604&__tn__=K-R
Here is today's update.
https://www.facebook.com/permalink.php?story_fbid=2655760198040254&id=1998386763777604&__tn__=K-R
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Yes the shortage is real and yes homemade masks help. Some of my patients have made some that we can give patients to wear if they don't have them.Max06 said:
Forgive me if this has already been answered- I've seen a ton of Facebook posts about mask shortages and tons of people making fabric masks.
Is the mask shortage that real, and are home made masks even useful?
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
I think we all be happy if we just worry about crazy things like Zach Evans again!! I am looking forward to days like that.GaryClare said:
Dr. Coates and the rest of the doctors and experts on TexAgs need to be recognized at a football game so they can get a standing ovation from all of us and receive some degree of the recognition they deserve.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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