Moxley said:

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Big Al 1992 said:

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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!

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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

Thanks for answering.

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AggieMD04 said:

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Reveille said:

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Max06 said:

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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?

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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.

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Yes. To add to that, in my ER here in Iowa, we are allowed one surgical mask per day and one N95 mask that we are to use multiple days until it is basically unusable. We get one gown per patient, which hangs outside the room, and the doctor, nurse, and tech all use that same gown for interactions with that patient. I'm an ER doc in a major city, and probably the second or third largest hospital in the state, and this is all we have. Please believe me when I say this is not something that is just being overhyped by the media. We are all nervous because we are afraid we are not sufficiently protected when we treat COVID patients.

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oh no said:

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anyone have a good link or some good recs or instructions for homemade masks?

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Reveille said:

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H.E. Pennypacker said:

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Thanks for the updates Dr Rev. I'm going to start wearing my homemade mask out at the grocery store etc. I'll sterilize it in my Phone Soap machine upon my return home.

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That sounds perfect! I think we all need to start doing this kind of thing. I think if you look at South Korea and Japan where the wear more masks we see less spread of the virus!

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PPlayboy87 said:

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Question for the doctors on here. . .

I've read in some places that it's a good idea to shave one's beard during this time. Is this good information? Would it be because a mask would then fit/work better, or some other reason? Just curious. I've had a beard for 30 years, but if it's gotta go, it's gotta go.

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OldArmy71 said:

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Excellent question, and I'd like to piggyback off of it since no doctors responded to my question on the larger board.

I watched this video on Texags and also sent from a friend.

Among many points the doctor thereon makes is that only sustained, close proximity to a sick person can get you infected from that person's breathing. Thus at his hospital he says that the only time the care team wears N95 masks is when they are doing things that would cause the patient to cough or expel droplets. He says that other than that, everyone wears surgical masks, and no one is getting sick. He added that that was the procedure in Hong Kong and Singapore and no health providers got sick. (See minute 31.)

However, a new study from the U of Nebraska, not yet peer reviewed, seems to contradict the first doctor.

The new study says that air samples positive for the virus were found throughout the rooms of the infected and even outside in the halls.

The study said (among other things) that "the data was suggestive" that the virus was shed by mildly ill people who were not coughing or feverish or receiving oxygen by nose. In other words, people who were not obviously ill or engaged in visibly expelling droplets (coughing, sneezing) shed the virus around the room simply by breathing.

Another example happened in Washington state where 60 members of a choir gathered to practice, claiming that they did not touch and tried to keep some distance among themselves, and about 45 got sick and two died. Pretty clearly those people got sick from what I guess would be a two-hour exposure to the forceful ejection of droplets that comes with singing.

What do doctors on this board think about this issue?

Is it safe to visit three or four family members in a large, open room, without getting in someone's face?

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3rd Generation Ag said:

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Source LA times.chorus where the virus spread.

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Exsurge Domine said:

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Agristotle said:

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I thought the current wisdom is that masks do not help protect you. Is that incorrect?

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I believe masks mainly stop you from infecting others, and stop you from touching your mouth frequently. The more people who wear masks the better it is for everyone. Less people spreading = less people catching

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maroonbeansnrice said:

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OldArmy71 said:

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Excellent question, and I'd like to piggyback off of it since no doctors responded to my question on the larger board.

I watched this video on Texags and also sent from a friend.

Among many points the doctor thereon makes is that only sustained, close proximity to a sick person can get you infected from that person's breathing. Thus at his hospital he says that the only time the care team wears N95 masks is when they are doing things that would cause the patient to cough or expel droplets. He says that other than that, everyone wears surgical masks, and no one is getting sick. He added that that was the procedure in Hong Kong and Singapore and no health providers got sick. (See minute 31.)

However, a new study from the U of Nebraska, not yet peer reviewed, seems to contradict the first doctor.

The new study says that air samples positive for the virus were found throughout the rooms of the infected and even outside in the halls.

The study said (among other things) that "the data was suggestive" that the virus was shed by mildly ill people who were not coughing or feverish or receiving oxygen by nose. In other words, people who were not obviously ill or engaged in visibly expelling droplets (coughing, sneezing) shed the virus around the room simply by breathing.

Another example happened in Washington state where 60 members of a choir gathered to practice, claiming that they did not touch and tried to keep some distance among themselves, and about 45 got sick and two died. Pretty clearly those people got sick from what I guess would be a two-hour exposure to the forceful ejection of droplets that comes with singing.

What do doctors on this board think about this issue?

Is it safe to visit three or four family members in a large, open room, without getting in someone's face?

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I wouldn't put too much automatic credence in the supposed U. Nebraska citation. I'll let the docs comment on Covid-19 floating around in air samples for any length of time (I am skeptical), but I also find reason to doubt the source of this info. If you click on the link your provided and scan down on the medRxiv page it goes to, to the CC-BY-NC-ND 4.0 International license.source of funding for this article and it leads to a dubious (in my view) Creative Commons, that I will let others do their own internet sleuthing on.

Wasn't Washington Sate more or less ground zero for Covid-19? Agree with you singing is a fairly forceful ejection of breath. 45 got sick? From? Source of this info? Two people in a 60 person choir dead from Covid-19 (again source or article link) does not exclude the possibility they caught it somewhere else in the city?

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