Recent COVID 19 experience from an ER doc

11,326 Views | 50 Replies | Last: 3 yr ago by SoulSlaveAG2005
Double Twin Marine
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AG
Doug Ross said:

Don't look at me when nurse Carol murders you for screwing up our ceremony


So what we have is:
- fiance is a nurse
- her name is Carol
- dr not yet dr ag is a friend and in the ceremony
- Doug Ross is in Dallas, dr not yet dr ag is in SA

Yep, that should be enough to make this thread Rule #1 compliant. To the outdoors board...



Sorry Doug Ross, this is definitely some trying times right now and just trying to add a little sense of humor to it.
eric76
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SoulSlaveAG2005 said:

Doc- and any other docs on this board.

We have seen about a 3-4x increase in orders for convalescent plasma over the past 2 weeks.

Any chance you would be willing to help reach out to your patients that are known recovered and help refer them to donate?

I'm happy to provide instructions. As this isn't a typical type of donor, we really need some help from those treating patients to get donors across the threshold.
I have a question about the convalescent plasma.

When I gave blood a couple of weeks ago, I showed them my release from isolation letter in case they might want to go for convalescent plasma instead. They just took my blood normally. Is there any difference in how you collect blood for convalescent plasma?

Logging onto their web site, I see that I'm not eligible to donate blood (or plasma) again until mid August. If I do have enough antibodies to make it worthwhile at present, how likely will that be in August?
SoulSlaveAG2005
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eric76 said:

SoulSlaveAG2005 said:

Doc- and any other docs on this board.

We have seen about a 3-4x increase in orders for convalescent plasma over the past 2 weeks.

Any chance you would be willing to help reach out to your patients that are known recovered and help refer them to donate?

I'm happy to provide instructions. As this isn't a typical type of donor, we really need some help from those treating patients to get donors across the threshold.
I have a question about the convalescent plasma.

When I gave blood a couple of weeks ago, I showed them my release from isolation letter in case they might want to go for convalescent plasma instead. They just took my blood normally. Is there any difference in how you collect blood for convalescent plasma?

Logging onto their web site, I see that I'm not eligible to donate blood (or plasma) again until mid August. If I do have enough antibodies to make it worthwhile at present, how likely will that be in August?


Yes. Convalescent plasma is being drawn via apheresis. Most blood centers are utilizing either a Trima or Alyx machine to collect the plasma. It works by separating youR red cells and plasma in a single use kit, and returns the red cells back into your vein. Basically pulling plasma concentrate from you.

Whole blood is further processed by separation but doesn't have the same volume we can draw with apheresis. Our blood center has only validated convalescent plasma drawn via apheresis, so if we draw a recovered donors whole blood, we can't label the separated plasma as convalescent plasma. We are exploring it though due to antibody testing hopefully opening up some more donors to us.

Most centers also require you to pre register as convalescent plasma. That might be why they couldn't do anything at your last donation. We have to pre qualify every CVPLS donor by storing a copy of their positive test in their file. You should be able
To donate plasma 14-28 days from your last whole
Blood donation. You may want to give them a call and see if there is a pre qualifying process.

In regards to your antibody titer. No one really knows what the levels will be 30/60/90 days from recovery. We are storing a segment from each donation and subsequent donations so that our docs can study that question later down the road.

I have had 4 donors each make it to their 3rd donation (30/60/90 days from recovery) and I have not had any doc complain about the efficacy of the treatment based on any particular unit.
Doug Ross
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AW Aggie said:

Doug Ross said:

Don't look at me when nurse Carol murders you for screwing up our ceremony


So what we have is:
- fiance is a nurse
- her name is Carol
- dr not yet dr ag is a friend and in the ceremony
- Doug Ross is in Dallas, dr not yet dr ag is in SA

Yep, that should be enough to make this thread Rule #1 compliant. To the outdoors board...



Sorry Doug Ross, this is definitely some trying times right now and just trying to add a little sense of humor to it.
Blue star for you AW Aggie

-fiance is an ER nurse who I started dating in residency
-her name isn't Carol, but Carol was the name of the nurse Doug Ross dated in ER
-Dr Not Yet Dr Ag was my roommate for all 3 years of residency and is one of my groomsman
- yup, I am in Dallas, he is in SA
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Doug Ross
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geoag58 said:

What percentage of your patients are over 70?
ehh I would probably say 20-25%. The majority are under 50 years old and I am discharging the vast majority. If you are over 70 years old there is a greater than 75% chance you are admitted for a day or two if mild-moderate symptoms-I feel it is more precautionary. The majority of cases I am seeing is now young people,and the majority of them are fine. They just feel like **** but can go home.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
duck79
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Do you have a lot of younger people that have been coming in due to the fact they are panicking? I have been curious if we weren't constantly hearing numbers, deaths etc thru every avenue would hospitals still be seeing surges or would younger people get it and isolate themselves like many do when getting sick. This isn't a political question. I truly am just curious to hear from a doc how many come in due to "freaking out".
Big Al 1992
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Mother in law was not admitted Yesterday after positive test last week. Fever 99-101. Oxygen 89-96. Labored breathing. Got to ER and they sent her home after 4 hours. Told her NyQuil and inhaler every 4 hours. Thought they'd at least watch her over night.
MaroonDontRun
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Big Al,

Does she have a pulse oximeter at home? My dad is currently going through Covid and also had breathing distress so after we got the positive test, one of the first things I did was order them a pulse oximeter from Amazon. I have mom keeping close tabs on the oxygen levels just in case it drops too low.

If my dad's conditions worsen I am also going to check on supplemental oxygen for him at home. He is currently doing pretty well as the breathing distress has disappeared and he has his appetite back but I also understand that this virus likes to make a return after some folks appear to have gotten through the worst of it. I am optomistic but don't know exactly how far along we are so I am remaining vigilant.

Hope your MIL can weather this thing unscathed.

Big Al 1992
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Thx. Yes - she has one - that's how she knew her O2had "bounced around from 89-96" The low readings and difficulty breathing had her doc advise her go to ER. Disappointed they didn't offer supplemental O2 or even a z-pak for possible secondary bacterial infection. HCQ didn't even come up. Er letting her go with NyQuil and an inhaler (albuterol) did not sound reasonable.
MaroonDontRun
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In my experience interacting with doctors we have to be forceful when requesting treatment options. I did mention remdesivir with my initial telehealth discussion with dads doctor but realized this could only be administered in the hospital and I'm going to do my best to avoid hospitalization so I didn't press them on it.

Given the mixed opinions of HCQ I considered it but didn't request it.
bullard21k
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Any doctors seeing any severe patients with covid causing severe kidney issues either directly or indirectly?
Touchless
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Doug Ross said:

geoag58 said:

What percentage of your patients are over 70?
ehh I would probably say 20-25%. The majority are under 50 years old and I am discharging the vast majority. If you are over 70 years old there is a greater than 75% chance you are admitted for a day or two if mild-moderate symptoms-I feel it is more precautionary. The majority of cases I am seeing is now young people,and the majority of them are fine. They just feel like **** but can go home.
I tried asking this earlier as well, but didn't get anything on it. How does this current age group you see compare to what you were seeing early on in March and April? It seems like it's a younger demographic and what you said above also seems to support that, but I don't know what you were seeing at the beginning.
samurai_science
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Doug Ross said:

Young people are still dying....young people are still developing ARDS. That is what scares me the most. I understand the economic downfall, but we can't open things up yet.

Do we still need to be shut down Doc?
Doug Ross
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Touchless said:

Doug Ross said:

geoag58 said:

What percentage of your patients are over 70?
ehh I would probably say 20-25%. The majority are under 50 years old and I am discharging the vast majority. If you are over 70 years old there is a greater than 75% chance you are admitted for a day or two if mild-moderate symptoms-I feel it is more precautionary. The majority of cases I am seeing is now young people,and the majority of them are fine. They just feel like **** but can go home.
I tried asking this earlier as well, but didn't get anything on it. How does this current age group you see compare to what you were seeing early on in March and April? It seems like it's a younger demographic and what you said above also seems to support that, but I don't know what you were seeing at the beginning.
Yup I agree with this 100%. Definitely more of a younger demographic. Early on it seemed to be a lot of elderly nursing home patients. I think the nursing homes have done a great job of preventing the infiltration of covid into their facilities so those numbers have been very small. Still seeing some elderly patients but they all live at home, usually with a handful of younger family members. Majority is still younger patients, 30-50 years old.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
eric76
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SoulSlaveAG2005 said:

eric76 said:

SoulSlaveAG2005 said:

Doc- and any other docs on this board.

We have seen about a 3-4x increase in orders for convalescent plasma over the past 2 weeks.

Any chance you would be willing to help reach out to your patients that are known recovered and help refer them to donate?

I'm happy to provide instructions. As this isn't a typical type of donor, we really need some help from those treating patients to get donors across the threshold.
I have a question about the convalescent plasma.

When I gave blood a couple of weeks ago, I showed them my release from isolation letter in case they might want to go for convalescent plasma instead. They just took my blood normally. Is there any difference in how you collect blood for convalescent plasma?

Logging onto their web site, I see that I'm not eligible to donate blood (or plasma) again until mid August. If I do have enough antibodies to make it worthwhile at present, how likely will that be in August?


Yes. Convalescent plasma is being drawn via apheresis. Most blood centers are utilizing either a Trima or Alyx machine to collect the plasma. It works by separating youR red cells and plasma in a single use kit, and returns the red cells back into your vein. Basically pulling plasma concentrate from you.

Whole blood is further processed by separation but doesn't have the same volume we can draw with apheresis. Our blood center has only validated convalescent plasma drawn via apheresis, so if we draw a recovered donors whole blood, we can't label the separated plasma as convalescent plasma. We are exploring it though due to antibody testing hopefully opening up some more donors to us.

Most centers also require you to pre register as convalescent plasma. That might be why they couldn't do anything at your last donation. We have to pre qualify every CVPLS donor by storing a copy of their positive test in their file. You should be able
To donate plasma 14-28 days from your last whole
Blood donation. You may want to give them a call and see if there is a pre qualifying process.

In regards to your antibody titer. No one really knows what the levels will be 30/60/90 days from recovery. We are storing a segment from each donation and subsequent donations so that our docs can study that question later down the road.

I have had 4 donors each make it to their 3rd donation (30/60/90 days from recovery) and I have not had any doc complain about the efficacy of the treatment based on any particular unit.
I don't guess it matters for me. I got my test results from giving blood two weeks ago. The antibody test is negative.
Touchless
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SoulSlaveAG2005
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eric76 said:

SoulSlaveAG2005 said:

eric76 said:

SoulSlaveAG2005 said:

Doc- and any other docs on this board.

We have seen about a 3-4x increase in orders for convalescent plasma over the past 2 weeks.

Any chance you would be willing to help reach out to your patients that are known recovered and help refer them to donate?

I'm happy to provide instructions. As this isn't a typical type of donor, we really need some help from those treating patients to get donors across the threshold.
I have a question about the convalescent plasma.

When I gave blood a couple of weeks ago, I showed them my release from isolation letter in case they might want to go for convalescent plasma instead. They just took my blood normally. Is there any difference in how you collect blood for convalescent plasma?

Logging onto their web site, I see that I'm not eligible to donate blood (or plasma) again until mid August. If I do have enough antibodies to make it worthwhile at present, how likely will that be in August?


Yes. Convalescent plasma is being drawn via apheresis. Most blood centers are utilizing either a Trima or Alyx machine to collect the plasma. It works by separating youR red cells and plasma in a single use kit, and returns the red cells back into your vein. Basically pulling plasma concentrate from you.

Whole blood is further processed by separation but doesn't have the same volume we can draw with apheresis. Our blood center has only validated convalescent plasma drawn via apheresis, so if we draw a recovered donors whole blood, we can't label the separated plasma as convalescent plasma. We are exploring it though due to antibody testing hopefully opening up some more donors to us.

Most centers also require you to pre register as convalescent plasma. That might be why they couldn't do anything at your last donation. We have to pre qualify every CVPLS donor by storing a copy of their positive test in their file. You should be able
To donate plasma 14-28 days from your last whole
Blood donation. You may want to give them a call and see if there is a pre qualifying process.

In regards to your antibody titer. No one really knows what the levels will be 30/60/90 days from recovery. We are storing a segment from each donation and subsequent donations so that our docs can study that question later down the road.

I have had 4 donors each make it to their 3rd donation (30/60/90 days from recovery) and I have not had any doc complain about the efficacy of the treatment based on any particular unit.
I don't guess it matters for me. I got my test results from giving blood two weeks ago. The antibody test is negative.


Well shucks.
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