Is your shop seeing cases?

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IlDestriero said:
80% of the cases at my Children’s Hospital aren’t elective. Many may not be very time sensitive, but the ENT cases, spinal fusions, sports medicine, hernias, strabismus, plastics, GI, etc., etc. will ALL still be there when we start up again. In a few months we will go from famine to feast and make up all of the time and money we lost working to 6 or more every night.
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If we'll still be alive, after working late every night (hint: stress and adrenaline depress immunity).
 
I don’t work with CRNAs anymore, but in my old group we would’ve laid them off. They can apply for unemployment.
Where are they going to go? Everyone is basically in the same position right now. Their best bet is to stay right where they are and wait for the elective surgeries to come back.
 
dhb said:
Isn't it the perfect scenario for ECMO?
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Ecmo in a pandemic is for Trump alone i bet. Even if it did improve mortality which we dont have any idea about its absolutely unsustainable.

Apparently this isnt just plain ARDS from influenza, it seems to involve a viral CM also. That required VA. Plus thrombocytopenia. Absolute disaster. We can run 8 circuits overnight but its just not going to happen. Perfusionists are already so thin on the ground

Tube, prone, norepi, pray thats about it. Maybe quinine
 
Newtwo said:
Ecmo in a pandemic is for Trump alone i bet. Even if it did improve mortality which we dont have any idea about its absolutely unsustainable.

Apparently this isnt just plain ARDS from influenza, it seems to involve a viral CM also. That required VA. Plus thrombocytopenia. Absolute disaster. We can run 8 circuits overnight but its just not going to happen. Perfusionists are already so thin on the ground

Tube, prone, norepi, pray thats about it. Maybe quinine
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Blood is expected to be on a major shortage with most donation centers shut down, or people staying away from the open ones.
 
pjl said:
Blood is expected to be on a major shortage with most donation centers shut down, or people staying away from the open ones.
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Theres still a lot of places still doing livers, hearts and lvl I trauma....bout to get real rough in those shops..
 
SaltyDog said:
@nimbus , you said you worked over the weekend. Damage report?
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Just one tib-fib fracture on motorcycle wheelie man last night. Even trauma has slowed down.

I spoke to an ICU resident who said there is 1 confirmed patient on a vent and 2 PUI on O2 who are awaiting results.

Report from the county last night is that there are 15 covid patients on ventilators.
 
East coast small city with big rural catchment area. Two positives, both on nasal cannula only at this point.

Elective and semi-elective cases cancelled, truly urgent/emergent only.

Our ambulatory pre-op/OR/PACU is in a different part of the hospital, with its own air handlers, and the whole thing can become negative pressure when needed. We're planning on converting that space to a CoVid ward when the time comes.

Sent from my SM-G930V using SDN mobile
 
Major academic institution in NYC.

200+ confirmed positives (likely many more) inpatient.

50-100 patients on vents.

Multiple deaths, Several on vv ecmo (some young/healthy).

Anesthesia machines used in the icus, and OR’s converted. Quickly running out of ppe/vents.

It’s beyond a disaster here.
 
Hospital in South. Multiple COVID in house.

Active gubernatorial order to halt non emergent surgeries.

We have multiple TKA, knee scopes, gastric sleeves, elective hernias.
 
Back to doing cabg's. Supposedly theres a tavr on schedule for tomorrow. I haven't checked yet. Had a suspected covid pt die myseriously about a day after surgery. Nothing official has been released though so could be anything.
 
MirrorTodd said:
Back to doing cabg's. Supposedly theres a tavr on schedule for tomorrow. I haven't checked yet. Had a suspected covid pt die myseriously about a day after surgery. Nothing official has been released though so could be anything.
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We’re they undiagnosed? Staff quarantined or no?
 
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chocomorsel said:
Seriously? Still performing cases? And y’all don’t have a problem with that?
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I very much do. Other hospitals in this city have turned away these cases.

It feels like some of our surgeons want to be the last one at the beach during the hurricane. And I am chained to them against my will as they go try to ride some waives.
 
ucladoc2b said:
I very much do. Other hospitals in this city have turned away these cases.

It feels like some of our surgeons want to be the last one at the beach during the hurricane. And I am chained to them against my will as they go try to ride some waives.
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If you are really afraid for your safety you can do something about it.
If you aren’t too worried, then more power to you.

Some people aren’t. And you aren’t chained.
 
IlDestriero said:
80% of the cases at my Children’s Hospital aren’t elective. Many may not be very time sensitive, but the ENT cases, spinal fusions, sports medicine, hernias, strabismus, plastics, GI, etc., etc. will ALL still be there when we start up again. In a few months we will go from famine to feast and make up all of the time and money we lost working to 6 or more every night.
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If people don’t have insurance then I’m not sure they’ll reschedule. But hey I could be wrong
 
pjl said:
The lack of insurance will likely hurt quite a bit if there truly are the unemployment rates predicted. That said, I am hopeful the post-quarantine world will pop back pretty quick.
It will be interesting to see society’s altered priorities after all this is over.
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Oh yeah society’s priorities are pretty clear right now. Everyone will clap and cheer for the HC “provider” on the front line but then then hoard surgical masks and meds.
 
chocomorsel said:
If you are really afraid for your safety you can do something about it.
If you aren’t too worried, then more power to you.

Some people aren’t. And you aren’t chained.
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I am a resident so my ability to push back is quite limited. Also, they pretty much avoid testing anyone.

I really wish our admin would do the right thing.
 
kidthor said:
What Happens If Health-Care Workers Stop Showing Up? Unless the country does dramatically more to provide them with the equipment they need to do their job safely, it risks disaster.
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"Six months into the 15-month Ebola epidemic, health-care providers stopped coming to work. They had little PPE. They saw their friends die without any special care. Their colleagues began abandoning their jobs, one by one, until there was no one left. There was nowhere for people to obtain treatment for stomach pain, childbirth, heart attacks, car crashes, or any other routine or unpredictable health event. As a result, experts estimate that more people died from illnesses like malaria and diarrhea than Ebola.

When health-care providers get sick, become disabled, or die, they can no longer provide care for anyone, not just infected patients.

In Italy, at least 2,000 health-care workers have been infected and are not providing care. Some have died. Some hospitals cohort, or group, providers so that they care for only infected patients, leaving others to care for the uninfected. Others providers can’t work, because they are quarantined after possible exposures or because of known infections. But that is the way it has to be. The core ethics principle for physicians and nurses is primum non nocere—“First, do no harm”—and the last thing we want to do is spread the infection to our patients or other health-care staff."
 
ucladoc2b said:
I am a resident so my ability to push back is quite limited. Also, they pretty much avoid testing anyone.

I really wish our admin would do the right thing.
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That sucks for you. Didn’t know you were a resident. My apologies.
What’s your region? You guys seeing cases in your shop? Remind me as I am going a little nutty and don’t remember. Too much time on my hands and I am losing it.
 
chocomorsel said:
What kind of PPE do you all have and are using? Complete coverage or are some parts of skin left out?
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Blue gown, bouffant, plastic glasses, double glove, N95, regular surgical mask over N95.

Blue gowns are critical, they are telling people to sterilize them with a caviwipe and reuse (insane imo). Also reusing N95s...
 
vector2 said:
Blue gown, bouffant, plastic glasses, double glove, N95, regular surgical mask over N95.

Blue gowns are critical, they are telling people to sterilize them with a caviwipe and reuse (insane imo). Also reusing N95s...
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What's the reasoning behind the use of flimsy gowns? You're not catching it through your clothes.
 
FFP said:
first10em.com

COVID Ethics: Should clinicians see patients without appropriate PPE? - First10EM

Should clinicians see patients without appropriate PPE? It is a difficult ethical question, but one we may need to consider during a pandemic.
first10em.com first10em.com
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This is what really concerns me as a graduating med student. By the time I start residency, this thing could either be under control or beyond cataclysmic. In the latter case, the amount of pressure we'd be under to cut corners with our own safety as HCWs will be intense. For attendings, you have the option to quit if what you are asked to do exceeds your risk vs reward threshold. As residents, we will not have this option, since quitting will be tantamount to lifelong career and financial suicide. If the admin tells us to see suspected but not yet confirmed SARS2 patients without proper PPE, what can we do as residents? Either career suicide or risk literal suicide by getting blasted repeatedly with huge infectious doses.
 
vector2 said:
Blue gown, bouffant, plastic glasses, double glove, N95, regular surgical mask over N95.

Blue gowns are critical, they are telling people to sterilize them with a caviwipe and reuse (insane imo). Also reusing N95s...
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I am gonna have to agree with another poster that, that feels very inadequate. The plastic blue gowns? So parts of face and neck exposed as well as the back which could be touching surfaces in the room.
In comparison to the videos I have seen from a China in full spacesuits. Seems like the Italians and Middle East are a small step below them.

Hopefully healthcare workers don’t start dropping like flies.
Do you feel safe? That this is adequate? How do you guys remove PPE?

I think we need the Chinese assistance here or actually people who work in these high risk level containment labs. How many healthcare workers in New York are testing positive?
I may have to just stay home and pass work on this one.
 
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chocomorsel said:
The plastic blue gowns? So parts of face and neck exposed as well as the back which could be touching surfaces in the room.
In comparison to the videos I have seen from a China in full spacesuits. Seems like the Italians and Middle East are a small step below them.
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It is shameful that we have no clear answer on what the best PPE is, and that they (the feds, the states, professional societies, medical boards, etc) can't issue a clear directive. Every hospital is doing something different, every state is different, every professional society is different.

Even the ASA/APSF guidance for airway management isn't being followed by most anesthesiologist departments - which is crazy.

The full-on hazmat suits used in China should be used by us unless there is clear and convincing evidence that something else works as well / better.

Protecting us is easy - give us the PPE. This country sent someone to the Moon and the invented the internet. That stuff is hard. Making a bunch of hazmat suits (or whatever PPE) NOW and giving it to us is easy.
 
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kidthor said:
It is shameful that we have no clear answer on what the best PPE is, and that they (the feds, the states, professional societies, medical boards, etc) can't issue a clear directive. Every hospital is doing something different, every state is different, every professional society is different.

Even the ASA/APSF guidance for airway management isn't being followed by most anesthesiologist departments - which is crazy.

The full-on hazmat suits used in China should be used by us unless there is clear and convincing evidence that something else works as well / better.

Protecting us is easy - give us the PPE. This country sent someone to the Moon and the invented the internet. That stuff is hard. Making a bunch of hazmat suits (or whatever PPE) NOW and giving it to us is easy.
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I think this thing is going to sink this country's healthcare system. At least its reputation.

How can the "biggest superpower in the world" not have enough and effective PPE for it's staff? You know if they aren't completely covered and aren't doing complete decon in between patients, they are likely spreading it to other patients and workers.

And yet people on hear are talking about the Chinese in poor taste, when they seem to have enough PPEs and are donning it properly?

People, including me now, are buying their own suits and masks online which is all well and dandy except for the fact that delivery dates are three to four weeks away? Equipment about to run out in a week or so my colleagues are telling me?

This is not right, and I may be in the minority when I say this, but I am not volunteering to work in a hospital with poor or ineffective PPE and sacrificing myself. This is not the military and if we are inadvertently spreading this virus because of lack of proper equipment we are breaking the Oath of "do no harm".

Healthcare workers are being put at risk in this country, and IMO unnecessarily. Is it not possibly for some cargo shipment of equipment from China? As in a plane, chartered by some wealthy Billionaire flies to wherever these PPE's are made and flies back every day with fresh supplies? We got plenty of billionaires in this country. Or a go fund me. Ok, maybe that's what is needed. Let me do some research and possibly find a way to help.

Anyway, I am going a little nuts here being couped up at home but I think I will stay home and watch from sidelines.
 
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