COVID-19 from the ER

15,725 Views | 61 Replies | Last: 4 yr ago by Pelayo
Doug Ross
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-One major problem we are dealing with is the high number of patients coming to the ER because "they need to be tested for Corona", or "my doctor sent me to the ER to be tested". The media/government has given the false claim that we can test everyone. This is false. There are many problems with testing everyone for Covid19. First, we don't have the supplies. To be honest I think we have enough actual "tests" to do it, but with every test comes masks/gloves/face shields/N95 mask/personal protective equipment. Our nurses need to be fully protected to do the test. And wasting those resources on a patient who has a mild cough and low grade fever is a waste to our system.

-Second, the COVID-19 nasopharyngeal swab test itself is not that accurate. The test is only accurate about 70% of the time. So given this information, even if I test a patient, and their test is negative, I am still instructing that patient to quarantine themselves for 14 days, because a negative result is wrong 30% of the time if the patient really has it. If you are not "sick", ie don't need to be admitted to the hospital, the management does not change. Regardless if I test a patient or not, I am quarantining you and recent contacts for 14 days based on concerning symptoms. The only argument that could be made for testing everyone is data collection, and tbh at the ground level, dealing with patients on a face-to-face basis, I don't care about that. PEOPLE NEED TO STOP COMING TO THE HOSPITAL IF THEY HAVE MILD SYMPTOMS. They need to self-quarantine for 14 days and only come to the ER if they can't breathe or are too weak to walk. This message cannot be expressed enough. A positive test result may give an individual peace of mind, but we need to think about the greater good here. Everyone needs a war time mentality.

-Every time we test someone who doesn't really need it, we are putting a nurse at risk who has to administer the test.

-One of the few benefits we have seen is a low number of patients coming to the ER for unreasonable complaints (aka "my right foot has been hurting for 7 years, please fix this today). People are afraid to go the hospital, which they should be. I am too.

-Our resources are being diminished quickly. The nationwide shortage is putting the entire ER/ICU medical staff at a huge risk when dealing with these patients. We are trying to encourage any dentist/doctor's office whom has closed/painters/oil miners, to donate any N95 masks, gloves, basic masks, sanitary wipes to their local ERs and ICUs. I ask everyone reading this, to do the same thing too.

-Social distancing, to be honest I don't know if this thing will resolve until it is a nationwide lock down, minus going out for basic needs.

-The incubation period (time it takes for you to develop symptoms after being exposed), is about 4 days. So, if people are properly quarantining themselves for at least 4 days, and have no symptoms, they can feel pretty confident they won't get it. But every time they step out into a public area, that clock resets back to zero.

-Not gonna lie, I downplayed this. I was wrong. I thought it was gonna be slightly worse than our flu season. **** got real when I started seeing people in their 40s with no medical problems have to get intubated and placed on ventilators because of respiratory failure. Every day I am more and more afraid to go to work. I used to pride myself on being the coolest/calmest guy in the room, no matter what came through the door: heart attacks/strokes/gunshot wounds/guy who gets cut in half after getting run over by a train/cardiac arrest. None of that got my pulse above 80, but COVID scares the **** out of me.

-People who are actually sick enough to be admitted to the hospital come in about 4/5 days after symptoms begin, (8/9 days after exposure). Major cities in Texas started their quarantine on around March 17. If we are going to see real results it probably won't start until March 25-27ish. The "flattening the curve" is real. I hope we can do it, but time will tell.to be honest I think this is gonna take a lot more.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Windy City Ag
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Quote:

Quote:

One major problem we are dealing with is the high number of patients coming to the ER because "they need to be tested for Corona", or "my doctor sent me to the ER to be tested".

Are you a medical professional? I am trying to pair this comment with the comments in another thread from actual medical professionals saying the opposite.
Doug Ross
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AG
Windy City Ag said:

Quote:

Quote:

One major problem we are dealing with is the high number of patients coming to the ER because "they need to be tested for Corona", or "my doctor sent me to the ER to be tested".

Are you a medical professional? I am trying to pair this comment with the comments in another thread from actual medical professionals saying the opposite.
I am an emergency medicine doctor

edit: I believe there is a huge disconnect between the knowledge of covid between ICU/ER doctors and other specialties at this time. Please send link to the other thread if possible.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Windy City Ag
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Quote:

Second, the COVID-19 nasopharyngeal swab test itself is not that accurate. The test is only accurate about 70% of the time. So given this information, even if I test a patient, and their test is negative, I am still instructing that patient to quarantine themselves for 14 days, because a negative result is wrong 30% of the time if the patient really has it. If you are not "sick", ie don't need to be admitted to the hospital, the management does not change. Regardless if I test a patient or not, I am quarantining you and recent contacts for 14 days based on concerning symptoms.
Ahh! Sorry.
Exsurge Domine
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Doug Ross said:

-One major problem we are dealing with is the high number of patients coming to the ER because "they need to be tested for Corona", or "my doctor sent me to the ER to be tested". The media/government has given the false claim that we can test everyone. This is false. There are many problems with testing everyone for Covid19. First, we don't have the supplies. To be honest I think we have enough actual "tests" to do it, but with every test comes masks/gloves/face shields/N95 mask/personal protective equipment. Our nurses need to be fully protected to do the test. And wasting those resources on a patient who has a mild cough and low grade fever is a waste to our system.

-Second, the COVID-19 nasopharyngeal swab test itself is not that accurate. The test is only accurate about 70% of the time. So given this information, even if I test a patient, and their test is negative, I am still instructing that patient to quarantine themselves for 14 days, because a negative result is wrong 30% of the time if the patient really has it. If you are not "sick", ie don't need to be admitted to the hospital, the management does not change. Regardless if I test a patient or not, I am quarantining you and recent contacts for 14 days based on concerning symptoms. The only argument that could be made for testing everyone is data collection, and tbh at the ground level, dealing with patients on a face-to-face basis, I don't care about that. PEOPLE NEED TO STOP COMING TO THE HOSPITAL IF THEY HAVE MILD SYMPTOMS. They need to self-quarantine for 14 days and only come to the ER if they can't breathe or are too weak to walk. This message cannot be expressed enough. A positive test result may give an individual peace of mind, but we need to think about the greater good here. Everyone needs a war time mentality.

-Every time we test someone who doesn't really need it, we are putting a nurse at risk who has to administer the test.

-One of the few benefits we have seen is a low number of patients coming to the ER for unreasonable complaints (aka "my right foot has been hurting for 7 years, please fix this today). People are afraid to go the hospital, which they should be. I am too.

-Our resources are being diminished quickly. The nationwide shortage is putting the entire ER/ICU medical staff at a huge risk when dealing with these patients. We are trying to encourage any dentist/doctor's office whom has closed/painters/oil miners, to donate any N95 masks, gloves, basic masks, sanitary wipes to their local ERs and ICUs. I ask everyone reading this, to do the same thing too.

-Social distancing, to be honest I don't know if this thing will resolve until it is a nationwide lock down, minus going out for basic needs.

-The incubation period (time it takes for you to develop symptoms after being exposed), is about 4 days. So, if people are properly quarantining themselves for at least 4 days, and have no symptoms, they can feel pretty confident they won't get it. But every time they step out into a public area, that clock resets back to zero.

-Not gonna lie, I downplayed this. I was wrong. I thought it was gonna be slightly worse than our flu season. **** got real when I started seeing people in their 40s with no medical problems have to get intubated and placed on ventilators because of respiratory failure. Every day I am more and more afraid to go to work. I used to pride myself on being the coolest/calmest guy in the room, no matter what came through the door: heart attacks/strokes/gunshot wounds/guy who gets cut in half after getting run over by a train/cardiac arrest. None of that got my pulse above 80, but COVID scares the **** out of me.

-People who are actually sick enough to be admitted to the hospital come in about 4/5 days after symptoms begin, (8/9 days after exposure). Major cities in Texas started their quarantine on around March 17. If we are going to see real results it probably won't start until March 25-27ish. The "flattening the curve" is real. I hope we can do it, but time will tell.to be honest I think this is gonna take a lot more.


God Bless you Doc, hope you guys get all the equipment you need! Are you in Houston? My wife is a school nurse and I think she might have some n95 masks in the office that she won't need this school year. I'll ask and see if she can donate them to you.

How is the capacity holding up? Using some back of the napkin numbers if Texas has 550 cases and 20% off them need hospitalization that would seem to only be 110 hospitalized cases in Texas. Are things manageable right now or are the numbers being under reported?
saltyoldguy
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Thank you for the info sir. God bless you and your coworkers.
cone
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AG
where are you practicing?
Proposition Joe
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Stay strong out there Doug.
bay fan
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S
Those comments sound as if they are coming from front line to me.
lazuras_dc
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Bump. Agree with you on all rational and logical levels even though I am not a physician. Been trying to tell everyone I know.

Mild symptoms stay home and quarantine !! A positive test isn't changing your treatment ! Go to ER if you have shortness of breathe and more severe symptoms.
Doug Ross
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Exsurge Domine said:

Doug Ross said:

-One major problem we are dealing with is the high number of patients coming to the ER because "they need to be tested for Corona", or "my doctor sent me to the ER to be tested". The media/government has given the false claim that we can test everyone. This is false. There are many problems with testing everyone for Covid19. First, we don't have the supplies. To be honest I think we have enough actual "tests" to do it, but with every test comes masks/gloves/face shields/N95 mask/personal protective equipment. Our nurses need to be fully protected to do the test. And wasting those resources on a patient who has a mild cough and low grade fever is a waste to our system.

-Second, the COVID-19 nasopharyngeal swab test itself is not that accurate. The test is only accurate about 70% of the time. So given this information, even if I test a patient, and their test is negative, I am still instructing that patient to quarantine themselves for 14 days, because a negative result is wrong 30% of the time if the patient really has it. If you are not "sick", ie don't need to be admitted to the hospital, the management does not change. Regardless if I test a patient or not, I am quarantining you and recent contacts for 14 days based on concerning symptoms. The only argument that could be made for testing everyone is data collection, and tbh at the ground level, dealing with patients on a face-to-face basis, I don't care about that. PEOPLE NEED TO STOP COMING TO THE HOSPITAL IF THEY HAVE MILD SYMPTOMS. They need to self-quarantine for 14 days and only come to the ER if they can't breathe or are too weak to walk. This message cannot be expressed enough. A positive test result may give an individual peace of mind, but we need to think about the greater good here. Everyone needs a war time mentality.

-Every time we test someone who doesn't really need it, we are putting a nurse at risk who has to administer the test.

-One of the few benefits we have seen is a low number of patients coming to the ER for unreasonable complaints (aka "my right foot has been hurting for 7 years, please fix this today). People are afraid to go the hospital, which they should be. I am too.

-Our resources are being diminished quickly. The nationwide shortage is putting the entire ER/ICU medical staff at a huge risk when dealing with these patients. We are trying to encourage any dentist/doctor's office whom has closed/painters/oil miners, to donate any N95 masks, gloves, basic masks, sanitary wipes to their local ERs and ICUs. I ask everyone reading this, to do the same thing too.

-Social distancing, to be honest I don't know if this thing will resolve until it is a nationwide lock down, minus going out for basic needs.

-The incubation period (time it takes for you to develop symptoms after being exposed), is about 4 days. So, if people are properly quarantining themselves for at least 4 days, and have no symptoms, they can feel pretty confident they won't get it. But every time they step out into a public area, that clock resets back to zero.

-Not gonna lie, I downplayed this. I was wrong. I thought it was gonna be slightly worse than our flu season. **** got real when I started seeing people in their 40s with no medical problems have to get intubated and placed on ventilators because of respiratory failure. Every day I am more and more afraid to go to work. I used to pride myself on being the coolest/calmest guy in the room, no matter what came through the door: heart attacks/strokes/gunshot wounds/guy who gets cut in half after getting run over by a train/cardiac arrest. None of that got my pulse above 80, but COVID scares the **** out of me.

-People who are actually sick enough to be admitted to the hospital come in about 4/5 days after symptoms begin, (8/9 days after exposure). Major cities in Texas started their quarantine on around March 17. If we are going to see real results it probably won't start until March 25-27ish. The "flattening the curve" is real. I hope we can do it, but time will tell.to be honest I think this is gonna take a lot more.


God Bless you Doc, hope you guys get all the equipment you need! Are you in Houston? My wife is a school nurse and I think she might have some n95 masks in the office that she won't need this school year. I'll ask and see if she can donate them to you.

How is the capacity holding up? Using some back of the napkin numbers if Texas has 550 cases and 20% off them need hospitalization that would seem to only be 110 hospitalized cases in Texas. Are things manageable right now or are the numbers being under reported?
So I practice in DFW, but please encourage your wife to donate to local Houston EDs, it would be much appreciated!! We are not at max capacity at this point, but we are close. This disease is so delicate, we could tip the scale at any moment. I do believe 100% that the number of cases in Texas are under reported, and I personally am a reason for this.

I do not order COVID screening on patient's unless they are admitted inpatient or have severe underlying medical conditions (cancer patients undergoing chemo, HIV, etc). As in previous posts, the test does not change management. Anyone with mild symptoms or has been in contact with someone with URI symptoms should be quarantined for 14 days. A positive/negative test result may give an individual some peace of mind, however, I strongly believe this lack of testing is at the best interest of our health care providers and community as a whole.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Exsurge Domine
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Doug Ross said:

Exsurge Domine said:

Doug Ross said:

-One major problem we are dealing with is the high number of patients coming to the ER because "they need to be tested for Corona", or "my doctor sent me to the ER to be tested". The media/government has given the false claim that we can test everyone. This is false. There are many problems with testing everyone for Covid19. First, we don't have the supplies. To be honest I think we have enough actual "tests" to do it, but with every test comes masks/gloves/face shields/N95 mask/personal protective equipment. Our nurses need to be fully protected to do the test. And wasting those resources on a patient who has a mild cough and low grade fever is a waste to our system.

-Second, the COVID-19 nasopharyngeal swab test itself is not that accurate. The test is only accurate about 70% of the time. So given this information, even if I test a patient, and their test is negative, I am still instructing that patient to quarantine themselves for 14 days, because a negative result is wrong 30% of the time if the patient really has it. If you are not "sick", ie don't need to be admitted to the hospital, the management does not change. Regardless if I test a patient or not, I am quarantining you and recent contacts for 14 days based on concerning symptoms. The only argument that could be made for testing everyone is data collection, and tbh at the ground level, dealing with patients on a face-to-face basis, I don't care about that. PEOPLE NEED TO STOP COMING TO THE HOSPITAL IF THEY HAVE MILD SYMPTOMS. They need to self-quarantine for 14 days and only come to the ER if they can't breathe or are too weak to walk. This message cannot be expressed enough. A positive test result may give an individual peace of mind, but we need to think about the greater good here. Everyone needs a war time mentality.

-Every time we test someone who doesn't really need it, we are putting a nurse at risk who has to administer the test.

-One of the few benefits we have seen is a low number of patients coming to the ER for unreasonable complaints (aka "my right foot has been hurting for 7 years, please fix this today). People are afraid to go the hospital, which they should be. I am too.

-Our resources are being diminished quickly. The nationwide shortage is putting the entire ER/ICU medical staff at a huge risk when dealing with these patients. We are trying to encourage any dentist/doctor's office whom has closed/painters/oil miners, to donate any N95 masks, gloves, basic masks, sanitary wipes to their local ERs and ICUs. I ask everyone reading this, to do the same thing too.

-Social distancing, to be honest I don't know if this thing will resolve until it is a nationwide lock down, minus going out for basic needs.

-The incubation period (time it takes for you to develop symptoms after being exposed), is about 4 days. So, if people are properly quarantining themselves for at least 4 days, and have no symptoms, they can feel pretty confident they won't get it. But every time they step out into a public area, that clock resets back to zero.

-Not gonna lie, I downplayed this. I was wrong. I thought it was gonna be slightly worse than our flu season. **** got real when I started seeing people in their 40s with no medical problems have to get intubated and placed on ventilators because of respiratory failure. Every day I am more and more afraid to go to work. I used to pride myself on being the coolest/calmest guy in the room, no matter what came through the door: heart attacks/strokes/gunshot wounds/guy who gets cut in half after getting run over by a train/cardiac arrest. None of that got my pulse above 80, but COVID scares the **** out of me.

-People who are actually sick enough to be admitted to the hospital come in about 4/5 days after symptoms begin, (8/9 days after exposure). Major cities in Texas started their quarantine on around March 17. If we are going to see real results it probably won't start until March 25-27ish. The "flattening the curve" is real. I hope we can do it, but time will tell.to be honest I think this is gonna take a lot more.


God Bless you Doc, hope you guys get all the equipment you need! Are you in Houston? My wife is a school nurse and I think she might have some n95 masks in the office that she won't need this school year. I'll ask and see if she can donate them to you.

How is the capacity holding up? Using some back of the napkin numbers if Texas has 550 cases and 20% off them need hospitalization that would seem to only be 110 hospitalized cases in Texas. Are things manageable right now or are the numbers being under reported?
So I practice in DFW, but please encourage your wife to donate to local Houston EDs, it would be much appreciated!! We are not at max capacity at this point, but we are close. This disease is so delicate, we could tip the scale at any moment. I do believe 100% that the number of cases in Texas are under reported, and I personally am a reason for this.

I do not order COVID screening on patient's unless they are admitted inpatient or have severe underlying medical conditions (cancer patients undergoing chemo, HIV, etc). As in previous posts, the test does not change management. Anyone with mild symptoms or has been in contact with someone with URI symptoms should be quarantined for 14 days. A positive/negative test result may give an individual some peace of mind, however, I strongly believe this lack of testing is at the best interest of our health care providers and community as a whole.


Makes sense to me doc. Take care of yourself and we'll see about donating those masks to a local hospital
fullback44
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Everyone that has mask, gloves, etc, at home or work should donate them to the local hospitals.... these donations may get them through the next 2-4 weeks until new mask get delivered
TexasAggie_02
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God bless and keep strong!
Doug Ross
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fullback44 said:

Everyone that has mask, gloves, etc, at home or work should donate them to the local hospitals.... these donations may get them through the next 2-4 weeks until new mask get delivered
This cannot be stated enough. Currently many hospitals are having to reuse the same mask with multiple patients. It is by no means the safest method but it is all we can do at this point. Supply is short and we have to do the best with what we have. It is a war zone in ERs and ICUs right now.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Poot
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Thanks for fighting the good fight, Doc!
dr_boogs
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Dr. Ross - you are STILL the calmest guy in the room. You ARE up to the challenge. I'll pray for your health, resilience, and courage. Hang in there! We will beat this because of tens of thousands of tough, resilient Americans just like you. Thank you for being such a tremendous example to those around you.
The Fall Guy
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Where are you at Doug?
Doug Ross
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The Fall Guy said:

Where are you at Doug?
Dallas
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Windy City Ag
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Quote:

Please send link to the other thread if possible.

Dr. Ross, here is the thread I was mentioning.

https://texags.com/forums/84/topics/3101630
tarrantcountyag
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Thanks Doc. Keep up the good work.
PikesPeakAg
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Doug,

Your fear is understandable. You are one of the few on here who is on the front lines. The ICU/pulmonary guys are a distant second as they don't triage the larger number of patient's in the ER like you guys do. As frightening as it seems, several things offer hope. The recently approved POC testing with 45 minute turn around time and the most recent info on therapeutics, particularly the plaquenil stuff. The idea that this can be identified quickly and may be treatable with existing generic drugs makes this more managable in my mind.

Some of us will turn positive. It's inevitable. Rest assured that the majority of our colleagues will go all in and treat us with the promising treatments if we develop respiratory progression at the minimum. You never know what's real but someone on this board was the comment that Italy did not treat early with meds as the W.H.O. had not "approved" certain treatments. Their system is so overwhelmed, who knows what reality is. To be sure most of US critical care docs aren't waiting for the RCT trials to go for it. Time is critical as this point. (We can always have an open label trial and place the guys that want to wait for RCT's in the control arm of 14 days of isolation + vents if needed.)

Good Luck. Stay Healthy!

No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
AustinAg2K
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Quote:

We are trying to encourage any dentist/doctor's office whom has closed/painters/oil miners, to donate any N95 masks, gloves, basic masks, sanitary wipes to their local ERs and ICUs.


My wife does a lot of sewing, and was thinking of trying to sew masks for hospitals. We weren't sure if they could be used, though, because they obviously wouldn't be N95. Is there value in making more non N95 masks, or does everything need to be N95?
Proposition Joe
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Aside from being able to source N95 masks and the like (and aside from just of course staying home), is there anything any of us can be doing to help you guys out?
Malachi Constant
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Thank God there are people like you doc.
Doug Ross
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Proposition Joe said:

Aside from being able to source N95 masks and the like (and aside from just of course staying home), is there anything any of us can be doing to help you guys out?
Educate friends and family!!! This is the biggest thing we can change as a group which requires minimal resources. We need to be educating everyone about the course of disease, the suspected symptoms, when to quarantine, whom to quarantine, and when you need to go to the hospital. This is without a doubt the biggest impact we can make at no cost.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Spotted Ag
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Y'all know who has lots of masks and gloves. College science departments
Grapesoda2525
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Doug Ross said:

Windy City Ag said:

Quote:

Quote:

One major problem we are dealing with is the high number of patients coming to the ER because "they need to be tested for Corona", or "my doctor sent me to the ER to be tested".

Are you a medical professional? I am trying to pair this comment with the comments in another thread from actual medical professionals saying the opposite.
I am an emergency medicine doctor

edit: I believe there is a huge disconnect between the knowledge of covid between ICU/ER doctors and other specialties at this time. Please send link to the other thread if possible.
Thanks for your valuable insight Doug.

Just one question, who or what is to blame for the lack of testing? Why are countries like South Korea and Italy kicking our butt on the testing front?


Yes I'm aware that Italy is much worse off than us when it comes to health tho.
OldArmyBrent
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AustinAg2K said:

Quote:

We are trying to encourage any dentist/doctor's office whom has closed/painters/oil miners, to donate any N95 masks, gloves, basic masks, sanitary wipes to their local ERs and ICUs.


My wife does a lot of sewing, and was thinking of trying to sew masks for hospitals. We weren't sure if they could be used, though, because they obviously wouldn't be N95. Is there value in making more non N95 masks, or does everything need to be N95?


I think there are some groups doing this in some areas. They provide the materials and then pick up the completed masks to be sanitized.
Infection_Ag11
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I feel your pain man, I've been getting called by the ER guys a lot these last few weeks and you can hear the tension in their voice every time.
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DallasAg 94
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Not a Bot
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South Korea and Japan deal with outbreaks like this all the time. They've been through SARS, bird flu, etc. They've had about 2 decades to learn/develop plans. We had a very "can't happen here" attitude at all levels of government.
Doug Ross
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PikesPeakAg said:

Doug,

Your fear is understandable. You are one of the few on here who is on the front lines. The ICU/pulmonary guys are a distant second as they don't triage the larger number of patient's in the ER like you guys do. As frightening as it seems, several things offer hope. The recently approved POC testing with 45 minute turn around time and the most recent info on therapeutics, particularly the plaquenil stuff. The idea that this can be identified quickly and may be treatable with existing generic drugs makes this more managable in my mind.

Some of us will turn positive. It's inevitable. Rest assured that the majority of our colleagues will go all in and treat us with the promising treatments if we develop respiratory progression at the minimum. You never know what's real but someone on this board was the comment that Italy did not treat early with meds as the W.H.O. had not "approved" certain treatments. Their system is so overwhelmed, who knows what reality is. To be sure most of US critical care docs aren't waiting for the RCT trials to go for it. Time is critical as this point. (We can always have an open label trial and place the guys that want to wait for RCT's in the control arm of 14 days of isolation + vents if needed.)

Good Luck. Stay Healthy!


Thanks for kind words.

The POC will be interesting. A quick turn around could drastically change management. Use of nebulized medicine and BiPAP/CPAP, puts healthcare workers at risk so we are trying to avoid use when possible. A quick POC could allow us to be confident in treating a patient as CHF rather than COVID.

There also have been some scary EKGs floating around on twitter. Patient's presenting with chest pain, with an ischemic EKG, only to have a negative cath and positive covid later. Instead found diffuse myocardial ischemia....myocarditis vs takostubo...that pathophys is very interesting and more will be uncovered soon. However, itwill be very easy to miss a COVID patient who presents as classic chest pain and vise versa.

The plaquenil/azithro evidence is interesting. ICU docs in DFW are treating this way....like you said, without a RCT... what do we have to lose when a patient is critical? Plaquenill/azithro vs having to put a 45 yo on ECMO? I'll take the former anytime.
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White Liberals=The Worst
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God bless you doc, thanks for the "on the ground" info and please stay safe.

That being said, we need to somehow strike a balance imo. If this extends a month or, God forbid, more.....things could get really ugly for a long time in our country.

This is truly unprecedented and scary in more ways than one.
Orlando Ayala Cant Read
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AG
OP is a hero. God bless.
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