The Vaccine

[tabbibus]

If we can limit ourselves to constructive discussions... that would be great.

kthxbye

 

[tabbibus]

Tab, I was wondering if you could share what you (or your group) currently does to treat someone that is admitted into the ICU for covid?

Thanks

Sorry, missed this. Given our crunch for beds, the folks who at this point come to us have to be very low on oxygen despite maximal support (high flow/pressure nasal cannula, bipap mask). So unfortunately most of them end up on the ventilator within the next 24 hours. Once on the vent we do paralyze the and prone them (put them on their belly). This helps with oxygenation. There is very little else we can do for these folks other than "supportive care". By the time they come to me, they already have been on steroids, received actemra, remdesivir (which we know think does not even work), vitamins, antibiotics. If we find another fixable issue great, but mostly it is simply covid making a mess in their lungs.

If a patient qualifies, and if there are beds available elsewhere, we send them for ECMO, which is a machine that oxygenates the body outside of the lungs. Again, simply another method of supportive care, does not fix the issue but rather buys us more time. Unfortunately, ECMO beds are extremely limited. And not every patient qualifies for it (specific criteria).

We also do plasma exchange. This completely experimental. It seemed to work great for the first waves, but with delta we've had much less success.

So sadly it is a matter of supporting the body and wait for it to heal. Some do. Most don't.

 

[Robconn]

I would say what I have experienced is the most thorough exposure, thereby causing the greatest most expansive immune response. This to the widest variety of pathogen variants..

1. Direct exposure to the early variant from LA.
2. Direct fluid exposure to the variant from NYC.
3. Direct fluid exposure to active Covid in one of my grilfriends.
4. The two part Pfizer.
5. 7 mos later a "Moderna " booster.

Result: Covid what ?...............................

There have been reports of natural immunity being better. There have also been contradictory reports of natural immunity waning over time. Couple that with all the fog of the vaccines and what they can do and not. Mix this with the whole political narrative that's being pushed and you have pudding.

So.................The best is obviously a mixture. You don't need to be a physician to figure that out.

So what I truly believe is demonstrated by my behavior. Thats MY choice. I believe it doesn't have to be yours.
But alas, true choice is falling by the wayside.

So last night I was assaulted by a patient. It Happens. Nurse gave Naloxone, Narcan, due to the patient’s oxygen levels dropping and wanting to exhaust every possible therapy in order to avoid using bipap, opti-flow, or vent all in short supply. It worked!!! Patient began to breath and oxygen saturation increased. Patient got the best of me ripped my PPE from my face while kicking and punching me. Covid positive. Oxygen dropped from 50’s. To 30’s. Eventually pinned patient down and re-secured non rebreather mask. patient was subsequently sedated but never regained oxygen to safe levels nor able to regain state of composure. Decision made to emergently intubate. Patient Was chemically paralyzed and placed on vent.
So couple of takeaways. Don’t do drugs! When dealing with reversal of narcotics, be prepared for patient agitation and extreme strength, even when severe illness persists. Although PPE is worn in acute setting, there may be a failures of such PPE. So glad personally I had vaccine. This exposure was unforeseen and knowing the worst of a disease now will be the true test of the Benefit the vaccine affords. Only injury was bruised ego. Not every day a severely ill patient gets the best of me. ill keep you posted should I exhibit any symptoms. Not sure if will asymptotic either, but will continue to us PPE in public as being vaccinated and having known exposure can still pass it to others.

 

[tabbibus]

So last night I was assaulted by a patient. It Happens. Nurse gave Naloxone, Narcan, due to the patient’s oxygen levels dropping and wanting to exhaust every possible therapy in order to avoid using bipap, opti-flow, or vent all in short supply. It worked!!! Patient began to breath and oxygen saturation increased. Patient got the best of me ripped my PPE from my face while kicking and punching me. Covid positive. Oxygen dropped from 50’s. To 30’s. Eventually pinned patient down and re-secured non rebreather mask. patient was subsequently sedated but never regained oxygen to safe levels nor able to regain state of composure. Decision made to emergently intubate. Patient Was chemically paralyzed and placed on vent.
So couple of takeaways. Don’t do drugs! When dealing with reversal of narcotics, be prepared for patient agitation and extreme strength, even when severe illness persists. Although PPE is worn in acute setting, there may be a failures of such PPE. So glad personally I had vaccine. This exposure was unforeseen and knowing the worst of a disease now will be the true test of the Benefit the vaccine affords. Only injury was bruised ego. Not every day a severely ill patient gets the best of me. ill keep you posted should I exhibit any symptoms. Not sure if will asymptotic either, but will continue to us PPE in public as being vaccinated and having known exposure can still pass it to others.

Wish you well my friend. RTs are truly in the thick of it. Next time, throat punch the patient.

 

[Enduro900]

Sorry, missed this. Given our crunch for beds, the folks who at this point come to us have to be very low on oxygen despite maximal support (high flow/pressure nasal cannula, bipap mask). So unfortunately most of them end up on the ventilator within the next 24 hours. Once on the vent we do paralyze the and prone them (put them on their belly). This helps with oxygenation. There is very little else we can do for these folks other than "supportive care". By the time they come to me, they already have been on steroids, received actemra, remdesivir (which we know think does not even work), vitamins, antibiotics. If we find another fixable issue great, but mostly it is simply covid making a mess in their lungs.

If a patient qualifies, and if there are beds available elsewhere, we send them for ECMO, which is a machine that oxygenates the body outside of the lungs. Again, simply another method of supportive care, does not fix the issue but rather buys us more time. Unfortunately, ECMO beds are extremely limited. And not every patient qualifies for it (specific criteria).

We also do plasma exchange. This completely experimental. It seemed to work great for the first waves, but with delta we've had much less success.

So sadly it is a matter of supporting the body and wait for it to heal. Some do. Most don't.

Tab, thank you I appreciate your work and cannot even begin to understand how hard it has been facing this everyday for the last year and a half.

Can you touch on the vitamin D element? When someone is admitted, do you test for Vitamin D level, or has giving this become a common aspect of Treatment in the hospitals?

Thx

 

[Julian]

Nurse gave Naloxone, Narcan, due to the patient’s oxygen levels dropping and wanting to exhaust every possible therapy in order to avoid using bipap, opti-flow, or vent all in short supply. It worked!!!

So the narcotics help with oxygen levels???....but the patient tripped out on them attacking you?

 

[tabbibus]

Tab, thank you I appreciate your work and cannot even begin to understand how hard it has been facing this everyday for the last year and a half.

Can you touch on the vitamin D element? When someone is admitted, do you test for Vitamin D level, or has giving this become a common aspect of Treatment in the hospitals?

Thx

at least for us, it is simply part of the standard of care. We don't check levels routinely.

 

[Robconn]

So the narcotics help with oxygen levels???....but the patient tripped out on them attacking you?

Narcan is a reversal agent. It reverses the effects of narcotics. In cases of severe addiction, the administration of Narcan can cause convulsions and seizures. So it should be administered in small doses over time.
In other instances narcotics are given to reduce work of breathing but patients are closely monitored.

 

[tabbibus]

Basically y'all ended his trip quite abruptly and he freaked out.

As a resident I once pushed narcan and dude went hypertensive and had an MI. So we gave him morphine. ha...

drugs. bad.

As a side note, I sometimes give patients with severe shortness of breath a touch of morphine because it relaxes them and removes some of the sensation of air hunger, then they breath a bit calmer and oxygenate a bit better. Not on the vent of course, on the vent they get tasty tasty IV vitamin F(entanyl)

 

[Evil Sports]

Hey Tabb, is this more of regional thing? Its seems the south is really in the thick of it but yet up here in New England its not (AS) bad

 

[tabbibus]

Hey Tabb, is this more of regional thing? Its seems the south is really in the thick of it but yet up here in New England its not (AS) bad

The wave is slowly moving north. But yes, some areas are not as bad, yet. Hopefully never. I did see a few weeks ago that states with lower vaccination rates and high "anti-mitigation" sentiments / policies were the worst off. Not sure if that trend still stands.

 

[Evil Sports]

Lets hope this trend continues

 

[tabbibus]

Some interesting data from today

Looks like hotspots are moving north and GA is getting lighter



GA is definitely downtrading



Finally, amazing to see how delta has taken over fully.

 

[Evil Sports]

My unscientific belief is we have passed the curve for this wave. If you factor in all the people with previous infection and consider the stats that so few of those get it again, then add in the number of vaxd I cant see how we could get to the [HASH=93]#s[/HASH] of January again.

 

[Bruce]

Its seems the south is really in the thick of it but yet up here in New England its not (AS) bad

Delta hit some, at the time mostly unvaccinated, southern states early and hard. Listening to White House briefings I have heard concern about that delta wave expanding into more populous states.

My thinking is that with ~90% of the infections, hospitalizations and deaths in my state being among the 50% who are unvaccinated that the states with high vaccination rates should not see the overwhelmed hospitals that many southern states have.

On the positive side vaccination rates increase as delta spread. The number of vaccines dosed often was for to six times the number of positive tests on a daily basis. Now we seem to be seeing a decline in new cases, which is partially explained by home testing, combined with a decrease in hospitalizations.

I just passed a 9.88mm kidney stone at a time when elective procedures were unavailable due to hospitals being overwhelmed.

 

[tabbibus]

My unscientific belief is we have passed the curve for this wave. If you factor in all the people with previous infection and consider the stats that so few of those get it again, then add in the number of vaxd I cant see how we could get to the [HASH=93]#s[/HASH] of January again.

That's my feeling as well.

 

[Lurch]

Some interesting data from today

Looks like hotspots are moving north and GA is getting lighter

Impact of seasonality?

 

[Julian]

This image shows the same chart as @Evil Sports above, but also adds the active cases. When I point at the high points on the last peak (January), the peak in Daily Cases happened on Jan 11th, while the peak in Active cases was reached Jan 25 (14 days later). If you compare the current daily case peak, that happened on Sept 2nd, so if all else was equal, we'd see us reach the "Active Cases" peak on Sept 16th, which we didn't - but hopefully will see that soon!

 

[haknslash]

The wave is slowly moving north. But yes, some areas are not as bad, yet. Hopefully never. I did see a few weeks ago that states with lower vaccination rates and high "anti-mitigation" sentiments / policies were the worst off. Not sure if that trend still stands.

That is the same trend we are seeing in Alabama. Hospital rates are dropping steadily as are the case numbers. Death numbers are climbing now but that’s expected due to the lag of deaths being reported. I think or hope the Delta has moved on to other areas as it spiked like crazy here since August with beds over capacity. Thankfully seems they are getting some relief. Let’s hope it continues to trend that way.

I freaking hate this crap. I know nothing will ever be done wherever this originated or got out but just posses me off how it has flipped the world in its ass. Not only from the deaths but just how people treat each other these days. Like it has stripped something from everyone’s soul in some form. Makes me sad and mad.

 

[Bruce]

Hopefully this modeling is accurate

Is The Worst Over? Models Predict A Steady Decline In COVID Cases Through March

Though infections are still sky-high, the U.S. may be turning a corner, according to a consortium of researchers who forecast the pandemic. And we may well be spared a winter surge.

www.npr.org