Effect of avoiding intubation......

13,031 Views | 58 Replies | Last: 4 yr ago by John J 01
riley290
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AG
yeah I didn't realize there was this level of discussion, I haven't been around texags much in a while.

I run them more wet than most people would likely prefer and once they move from the infectious to inflammatory stage I am very liberal with steroids and IL-6 inhibitors, almost everyone goes on anticoagulation unless you have a contraindication. My admissions come in incredibly ill now because nobody will come to hospital until they're about to die so its hard for me to know what helps in the early infectious stage at this point. intubation is almost a death sentence, I will tolerate you tanking for a long time before I will intubate, prolonged RRs in the 40's or hypoxia in the 60-70s for a few hours if you are not having arrhythmia issues. I'm praying for some type of legal immunity after this is over because it has truly been trial by fire the last few months.

I have a collection of maybe 250 of the worst CT scans I have ever seen. Imaging I would have believed was incompatible with life just a few months ago.
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Charpie
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AG
God bless you and all the doctors fighting this thing. As a lay person reading this, I have to admit I have no idea what y'all are talking about. But I read these threads to my teenager who is likely gonna do something in the medical field and she translates. I'm so proud of you guys. Keep up the good fight y'all
cone
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AG
did any of those CT scans make it out of the ICU?
Marcus Aurelius
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AG
I have been erring on the dry side. How easy access to IL-6 inhibitors? Also anticoagulating anyone in ICU with d - dimer elevation (seems like all.)
Comeby!
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AG
So basically, my fat ass better not get COVID or I'm f'ed. Got it. Good to know.
Charpie
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Comeby! said:

So basically, my fat ass better not get COVID or I'm f'ed. Got it. Good to know.


Yo tambien
riley290
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AG
I'm getting much more pushback from the pharmacy with the actemra now. They want hep panels and quantiferon and HIV screens. We've come to the agreement that they'll give it to me as long as I draw the labs first but we don't have to wait for the results.

Soon I'll run into a supply issue like everything over the last two months. Currently I am short on ventimasks, MDIs, phlebotomists and its almost impossible to get blood products. I am lucky there are a lot of residents from India and Cuba who are expert phlebotomists from their time as medical students in their country who will help me obtain labs as I'm a worthless bougie American trained doctor. A lot of people here will hate me for saying it but the residents in NYC should all be given medals and offered permanent residence, they are legitimate heros who could have gone back to their homes and been doctors but chose to stay.
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FishrCoAg
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Any thoughts on the theory the virus reduces oxygen carrying capacity of hemoglobin? Read that somewhere else saying ventilators did not help and maybe made things worse.
Marcus Aurelius
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AG
Wow great stuff man. My experience with toci has been nothing short of miraculous. But all the hospitals in this state battling for doses. Can't get sirulamab. God bless you in NYC. I get freaked out here dealing with 5-10. Can't imagine dealing with your volume. Please be safe.
Marcus Aurelius
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AG
FishrCoAg said:

Any thoughts on the theory the virus reduces oxygen carrying capacity of hemoglobin? Read that somewhere else saying ventilators did not help and maybe made things worse.
I have commented on this on several threads. IMO it is not. Their PO2s are damn low. And PO2s correlate with the normal O2 / Hgb dissociation curves. I.E. no rogue Hgb species.


https://texags.com/forums/84/topics/3105794/replies/56359323
riley290
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AG
yes, a few have gone home. some came back and died and some have stayed home and a few have gone to Javits or Roosevelt island to continue to be treated so i'm not sure what happened with them.
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cone
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AG
are these absurd CTs tracking with the general perception of people most effected - advanced age and/or comorbidities (including obesity)?
riley290
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AG
how did you get the doctor tag?
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riley290
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For the most part but I had a 31 year old woman with a 2 week old baby on a vent for 19 days as well before she walked out. A 36 year old former marine and construction worker who was 185lb, a fair number in their 40s. But otherwise the old, sick and fat are most at risk of very severe disease (as is true in every medical condition).
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Marcus Aurelius
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email/message the staff with your state MD license. Great to have you on here.
cone
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what drugs got pushed on the younger cohort? any of them get actemra?

want to share this with you and marcus



and this as an oral remdesivir analog (which would be huge imo)

goodAg80
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AG
riley290 said:

how did you get the doctor tag?
https://texags.com/forums/84/topics/3102278/replies
riley290
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yes, i use actemra on any severe cases. I agree with the 4 treatments given, I follow that essentially plus high dose steroids and anticoagulation during severe cases. I also give a lot of Vitamin C and aspirin.

I've been liberal with the anxiolytics and mild sedation as well to keep the patients proned, its scary giving things that inhibit respiratory drive so much but once they get anxious and start moving or flipping I have to move to mechanical ventilation where the outcomes are so poor I'll do anything to avoid at this point.
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cone
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AG
any weight on the NSAIDs reluctance by the french?

i really really really wish we could get a good control study with the HCQ zinc combo in really early stage

i know that's not when people are getting treated generally... but it would be absolutely worth knowing if it did anything outside of anecdote
ham98
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cone said:

any weight on the NSAIDs reluctance by the french?

i really really really wish we could get a good control study with the HCQ zinc combo in really early stage

i know that's not when people are getting treated generally... but it would be absolutely worth knowing if it did anything outside of anecdote
There are lupus patients who take HCQ regularly. I wonder if there is any data on how many of them have had severe cases.
agdad4x
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glad I lost that 80 lbs or so over the last 10 mths !
Comeby!
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AG
Great job man!
HouAggie2007
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Great job, if anything now is the time for others to start trying while at home. Go walk, get out of the house. Eat better at home.
agdad4x
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just trying to keep up with agson #2 - he has lost over 100 lbs -agson #1 has lost about 50 but he was always thin to begin with - dad and #2 are kinda chunky
John J 01
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AG
agdad4x said:

just trying to keep up with agson #2 - he has lost over 100 lbs -agson #1 has lost about 50 but he was always thin to begin with - dad and #2 are kinda chunky


"kinda chunky" made me Lol, so thanks for that! But seriously, congrats on the tremendous weight loss for you and your sons. I dropped over 40lbs over the last year myself, so I know that takes a lot of dedication. But like someone said above, maybe more people will take advantage of the opportunity to eat better and exercise more. It's worth it!
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