.

If you manage vents then I assume you're transport, RT or CCRN so you are more into long term management than myself. I was on staff for the first positive swab for the CLT metro area, and these cases we are seeing fall into a handful of categories.

Firstly, with protocols for testing changing so quickly, what was relevant a week ago, for testing has, and will continue to change.

When the sick as shit ones come into the ED, other than PPE its sepsis protocol and airway management business as usual.

Next we've got visually sick and uncomfortable people. Just a across the lobby glance they look like the flu. Added to that almost have a uncontrollable dry cough. We've CT most of these and its ground glass city in their chest. Seeing that for weeks now. And up until labcorp and quest swabs, if they were under 100.4 temp (which most were) they didnt get a covid state swab. Most were afebrile and able to maintain RA sats low to mid 90s, so D/C to home and assume quarantine.

Then there are patients that probably more in a urgent care or PCP workup category. Look like they dont feel well but mild fever, maybe no fever, cough sore throat. C/O sob but dont look it nor have any issue rambling on.

Further still some c/o symptoms that they dont exactly present with on exam. Depending on provider and their story of confirmed contact they maybe get swabbed. Maybe not.

Last are the who the hell knows. Yesterday pulled a chick out of a car who had a pocket full of xanny bars and had suboxone listed on home meds. Not breathing, no pulse. Worked her for a while ofcourse. After the dust settled family said bronchitis type symptoms for week PTA that didnt improve with antibiotics. So who knows with that one.

I'd be interested to know what yall are doing long term management wise. Maybe could influence our short time we have them and improve outcomes for some of these folks.
 
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If you manage vents then I assume you're transport, RT or CCRN so you are more into long term management than myself. I was on staff for the first positive swab for the CLT metro area, and these cases we are seeing fall into a handful of categories.

Firstly, with protocols for testing changing so quickly, what was relevant a week ago, for testing has, and will continue to change.

When the sick as shit ones come into the ED, other than PPE its sepsis protocol and airway management business as usual.

Next we've got visually sick and uncomfortable people. Just a across the lobby glance they look like the flu. Added to that almost have a uncontrollable dry cough. We've CT most of these and its ground glass city in their chest. Seeing that for weeks now. And up until labcorp and quest swabs, if they were under 100.4 temp (which most were) they didnt get a covid state swab. Most were afebrile and able to maintain RA sats low to mid 90s, so D/C to home and assume quarantine.

Then there are patients that probably more in a urgent care or PCP workup category. Look like they dont feel well but mild fever, maybe no fever, cough sore throat. C/O sob but dont look it nor have any issue rambling on.

Further still some c/o symptoms that they dont exactly present with on exam. Depending on provider and their story of confirmed contact they maybe get swabbed. Maybe not.

Last are the who the hell knows. Yesterday pulled a chick out of a car who had a pocket full of xanny bars and had suboxone listed on home meds. Not breathing, no pulse. Worked her for a while ofcourse. After the dust settled family said bronchitis type symptoms for week PTA that didnt improve with antibiotics. So who knows with that one.

I'd be interested to know what yall are doing long term management wise. Maybe could influence our short time we have them and improve outcomes for some of these folks.


what do you mean by ground glass?
 
what do you mean by ground glass?

Charliesgrave is correct, not that he needs my validation.

Reason I brought that pattern up is it has been a presumptive sign of covid19. Some of the folks had a clean (or needing clarification) CXR. South Korea and China would end up just skipping the nasopharyngeal covid swab and go right for the CT chest looking for that ground glass pattern.

I've seen the probe position in NY and heard that form some fellow ED staff up there that their icu counterparts had luck in their ICU/CCUs with that technique. Most of what I've seen is bilateral involvement in the lungs so with the good lung down technique maybe less effective. Side note, first time an RT showed me that it was like watching witchcraft! I was so impressed! I've done that with my tubed 20s-30s vaper crowd to good success.

You're right about the hesitation to swab by some. We are, and will continue to see more loosening of swabbing protocol. Or the opposite and mild cases get a presumptive DX and sent home while admission cases swab or CT chest. Something about these swabs is I've heard fail rate and false negatives are pretty high. Similar numbers in failure of flu swabs.

I've been hearing this nebulizers and some other RT equipment that circulates air outside the patient have been spreading in into the air in the room. Have you heard the same?

Be careful, its out there plenty now. It's been over 2 weeks since we saw our first groundglass CT pattern. Fine line on HIPAA with that case but they didnt get swabbed because only a mild fever. Travel but not to the hard hit places on the CDC list at that time. We picked it up ruling out a PE and felt like covid screen was gravy.

For my own safety I've been treating any respiratory pt as a PUI in my precautions. Remember they are seeing lots of this is already comprised respiratory PTs. So what looked like a copd, chf, asthma exacerbation very well could be that now, just with covid on board. Just my opinion and mindset of (avoid) being exposed
 
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My “go to” site in all this is a YouTube channel called MedCram.com. It’s run by a pulmonologist in California. He has made available his videos on mechanical ventilation and modes of ventilation. He’s also doing nearly daily updates on COVID-19 epidemiology. He has a pay site as well which has been approved for CME, but all his important stuff is free.
 
Very smart about just assuming the frequent flyers are infected. Also about the humidified o2 is interesting, I had not considered that but it makes sense.

Check out the link I posted in my first post on the thread. It is a lengthy power point but has been one of the best information sources I've been referred to yet. It's been cool to see how its changed since January too. Hoping they update it again.

Thanks for starting this post btw! I've refrained from posting on other covid threads for multiple reasons. -Jim
 
Here’s the link for ventilator management:



This has been posted before but worth reviewing for medical personnel who may be brought into their local hospitals for an “all hands on deck” scenario.
 
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I've glanced through the PP, but hopefully things are quiet tonight and I can actually digest it.

I'd be very curious what everyone's organization is doing with CPAP/BiPAP. The minute a patient is considered PUI, they are a no go for us, which may lead to chf exacerbations etc who we could turn around getting tubed instead.
Our facility mirrors that as well. Acceptable risk to end up getting tube they say. I just called RT to ask just now
 
This is the most intelligent and comprehensive explanation for a layman of Covid-19 that I have seen. It is worth your time to watch. It is the first of three videos that address what it is, how it spreads, how it kills, and why it is important to give this serious attention.

 
Charliesgrave is correct, not that he needs my validation.

Reason I brought that pattern up is it has been a presumptive sign of covid19. Some of the folks had a clean (or needing clarification) CXR. South Korea and China would end up just skipping the nasopharyngeal covid swab and go right for the CT chest looking for that ground glass pattern.

I've seen the probe position in NY and heard that form some fellow ED staff up there that their icu counterparts had luck in their ICU/CCUs with that technique. Most of what I've seen is bilateral involvement in the lungs so with the good lung down technique maybe less effective. Side note, first time an RT showed me that it was like watching witchcraft! I was so impressed! I've done that with my tubed 20s-30s vaper crowd to good success.

You're right about the hesitation to swab by some. We are, and will continue to see more loosening of swabbing protocol. Or the opposite and mild cases get a presumptive DX and sent home while admission cases swab or CT chest. Something about these swabs is I've heard fail rate and false negatives are pretty high. Similar numbers in failure of flu swabs.

I've been hearing this nebulizers and some other RT equipment that circulates air outside the patient have been spreading in into the air in the room. Have you heard the same?

Be careful, its out there plenty now. It's been over 2 weeks since we saw our first groundglass CT pattern. Fine line on HIPAA with that case but they didnt get swabbed because only a mild fever. Travel but not to the hard hit places on the CDC list at that time. We picked it up ruling out a PE and felt like covid screen was gravy.

For my own safety I've been treating any respiratory pt as a PUI in my precautions. Remember they are seeing lots of this is already comprised respiratory PTs. So what looked like a copd, chf, asthma exacerbation very well could be that now, just with covid on board. Just my opinion and mindset of (avoid) being exposed

On the ambulance now, we are "strongly discouraged" against any Nebs or C-PAP in the back of the unit, unless totally necessary. Do any nebs on scene, preferably outside, before transport. If you have to neb in the ambulance, a face shield and mask is required, also required if you have to C-PAP someone, along with putting a HEPA filter on the exhaust port. Intubation, mask and gown.
 
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