MICU, NICU and now SICU all covid.


Leaves CCU - roughly 20 beds for non covid ICU. Dire situation. Really, really a bad time to have a non covid medical emergency.

Just consulted on my 7th covid of the day. 1/2 of them elderly DNR, in ICU - beginning to think we are going to have to make tough decisions. Don't think those pts should occupy precious ICU beds now. Terrible.

Prayers going up

We are out of BIPAP and HFNC units. Vents close to being depleted. Didn't think I'd ever say that from beginning.

Damn. Good luck and you are in out prayers.

Marcus, thank you for what you are doing both there and here. Praying for you, your team and patients.

Saw several people in Publix today without masks. Wish they understood what you're seeing.

I'm wondering how my university (JSU) will handle the spring semester.

SCQ said:

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Hang in there, you have tough decisions to make. Mass casualty has a look we've never seen or expected. Prayers sent your way daily for wisdom and strength

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people expected this and warned about it.

Mom went to ER (Florida) with blood clot. Long story short, after sitting in a wheel chair for 5 hrs a Dr finally saw her for like 5 minutes and couldn't put her in a bed as all beds within 3 counties were full, patients in hallways, etc.

Again, to keep this short the doc came up with a creative way to send her home and get some treatment. Staff and care are just depleted and overwhelmed and because she wasn't dying yet and could be helped "good"enough that's what was done. Crazy that that is happening.

Very similar situation here. I'm working on a regular floor now. Have multiple people who would otherwise be in ICU who are being kept on the regular floor due to lack of beds. Have been out of ICU beds for the last week. When I left work this morning we were holding multiple ICU patients in the ER with nowhere to put them. We had two on our floor who need it to be in ICU and there are no beds. But again, none of this has been broadcast to the public in any way. People in the area have no idea what's going on. We are doing the best we can.

The most frustrating aspect to me is something you touched on several weeks ago. We have 40-year-olds who need to be in ICU and our ICU beds are currently occupied by a bunch of people who had no quality-of-life even before Covid. We had a lady on our floor who was in her late 80s, dementia, no movement on the right side due to a stroke, needing constant suctioning because she couldn't even clear her own secretions. She should have been in hospice months ago. Family wanted her to be a full code. We had to code her, probably broke half her ribs. Now taking up an ICU bed.

Have a MIL being sent home for hospice tonight from a nearby ICU. She is 72, was a long time smoker that has a DNR. She also refused a bipap, which may be a blessing for someone else. I just hope this goes quickly.

Much respect for you med pros out there. This sucks for all.

Cactus Jack said:

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The most frustrating aspect to me is something you touched on several weeks ago. We have 40-year-olds who need to be in ICU and our ICU beds are currently occupied by a bunch of people who had no quality-of-life even before Covid. We had a lady on our floor who was in her late 80s, dementia, no movement on the right side due to a stroke, needing constant suctioning because she couldn't even clear her own secretions. She should have been in hospice months ago. Family wanted her to be a full code. We had to code her, probably broke half her ribs. Now taking up an ICU bed.

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This is something few people understand until they see it. Especially the CPR part. CPR works like 80% of the time on TV, it works 5-10% of the time in real life. But when doctors bring this up they're accused of having God complexes.

I've said it before and I'll say it again, everyone should watch Extremis on Netflix. It's nowhere near experiencing it in real life, but it should give some perspective to if you're ever in such a position.


Also, re: COVID

I'm so sorry. That sucks. I work tele (only a nurse). There are patients we would normally be sending to IMCU or ICU for BP issues, chest pain, EKG Changes that we simply can't. It sucks. And it's sickening to watch people treat it like no big deal. I believe we are only at 25% in BCS. can't imagine what it's like there.

new straw said:

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I'm so sorry. That sucks. I work tele (only a nurse). There are patients we would normally be sending to IMCU or ICU for BP issues, chest pain, EKG Changes that we simply can't. It sucks. And it's sickening to watch people treat it like no big deal. I believe we are only at 25% in BCS. can't imagine what it's like there.

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I hope it doesn't get as bad there. We've had multiple septic shock patients on levophed drips in the ER being taken off the levo and sent to regular floors for a 5:1 tele nurse to try to manage. People are coming to our floor with systolic blood pressures in the 70s and all we can really do is fluid bolus and hope they don't code. It's gotten that bad.

Then on top of that, we are getting all the drug/etoh withdrawal patients, many of whom are repeat admits. Our hospital policy has always been to take them through the entire withdrawal process. To me we need to be screening anyone coming into the ER and if their withdrawal symptoms are light enough or if they have a history of drinking we need to just give them beer. They aren't going to stop drinking after they leave. These are very difficult patients and it's hard to find time for the other people when you're trying to keep Larry the Cable Guy from peeing on the floor and/or falling on his ass.

I feel like I'm living in a different country here in Virginia. We still have 45% of our ICU beds available. Restaurants are open for in person dining. Gyms are open. Salons open. Many schools open as well.

What in the world are we doing differently than these places that are getting hammered? Is it a demographic thing? Very strange.

Cactus Jack said:

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new straw said:

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I'm so sorry. That sucks. I work tele (only a nurse). There are patients we would normally be sending to IMCU or ICU for BP issues, chest pain, EKG Changes that we simply can't. It sucks. And it's sickening to watch people treat it like no big deal. I believe we are only at 25% in BCS. can't imagine what it's like there.

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I hope it doesn't get as bad there. We've had multiple septic shock patients on levophed drips in the ER being taken off the levo and sent to regular floors for a 5:1 tele nurse to try to manage. People are coming to our floor with systolic blood pressures in the 70s and all we can really do is fluid bolus and hope they don't code. It's gotten that bad.

Then on top of that, we are getting all the drug/etoh withdrawal patients, many of whom are repeat admits. Our hospital policy has always been to take them through the entire withdrawal process. To me we need to be screening anyone coming into the ER and if their withdrawal symptoms are light enough or if they have a history of drinking we need to just give them beer. They aren't going to stop drinking after they leave. These are very difficult patients and it's hard to find time for the other people when you're trying to keep Larry the Cable Guy from peeing on the floor and/or falling on his ass.

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Your ER is failing you if you are admitting that many drug/ETOH withdrawals. Give them a single dose of phenobarbital or give them a Librium taper and discharge. Even prior to the pandemic I almost never admitted EtOH withdrawal unless they are having seizures or severe withdrawal symptoms.

new straw said:

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Because vaccines don't work immediately and they are also not required

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The patients currently in ICUs were mostly infected before the vaccine distribution was widespread. How it is possible any person in LTCF is getting infected at this point? They can figure out how to keep college football players safe but not people in healthcare facilities. Embarrassing.

The only contact my MIL had in the last 2 weeks was at a different nearby hospital. GI bleeding, ER admit, hospitalization for multiple tests. Discharged on Christmas, no contact with anyone, symptoms for several days, admitted for Covid on NYE.

Not upset with anyone, but this stuff is anywhere and everywhere.

We're getting the trickle down effect of this in our small rural hospital. We admitted an NSTEMI on a levo drip for the first time in the 10 years I've been here, because all the larger hospital were at capacity and refused transfer. We've had many other patients get denied a transfer despite needing ICU care or being at high risk for needing ICU care for the same reason. In November no one was taking our sick COVID patients. Now no one is taking anything else.

Given how poorly our system has held up under the pandemic, I wouldn't be surprised if this "breaks" the system in some permanent way. Our system is centralized. Whether it's burns, trauma, specialty care or critical care, it's design to send all the most difficult patients to large, central locations. When those places are full and not taking patients, the rest of us don't have anywhere near the resources to do a good job.

proc said:

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The only contact my MIL had in the last 2 weeks was at a different nearby hospital. GI bleeding, ER admit, hospitalization for multiple tests. Discharged on Christmas, no contact with anyone, symptoms for several days, admitted for Covid on NYE.

Not upset with anyone, but this stuff is anywhere and everywhere.

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That's interesting. My sister got it from a friend who contracted it in the hospital. I wonder if hospitals and medical care facilities are a major transmission vector.

Both my parents got and only place they have been is at needed Dr appointment. No other people or even stores (friends bring food). It is inevitable for most as it's just everywhere.

Gumby said:

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proc said:

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The only contact my MIL had in the last 2 weeks was at a different nearby hospital. GI bleeding, ER admit, hospitalization for multiple tests. Discharged on Christmas, no contact with anyone, symptoms for several days, admitted for Covid on NYE.

Not upset with anyone, but this stuff is anywhere and everywhere.

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That's interesting. My sister got it from a friend who contracted it in the hospital. I wonder if hospitals and medical care facilities are a major transmission vector.

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I think hospitals are a major transmission vector for a lot of things. I contracted MRSA while at the hospital when my youngest was born. A lot of nasty stuff floating around those hallways.

Im sorry Marcus. It must be a horrible day, every day.