MoT's WDF

[mention]Bbrou33[/mention]:

"Areas that are looking at numbers only and thinking "oh we only have x confirmed cases and only y hospitalized" is stupid. That means you have umpteen more who aren't confirmed positive or haven't hot your hospital yet but will very soon and they are still walking around getting many many others sick. These numbers really don't mean squat right now."
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Man, you are so right!

yinzburgher wrote: ↑Wed Mar 25, 2020 1:10 am On my last day at the hospital I had a rule-out COVID pt. An underlying medical condition had left them anemic and immunocompromised. Recently traveled on a plane. Came in with fevers and shortness of breath. The docs were thinking COVID and it certainly could have been but it probably could just as likely been another respiratory illness. A further complication developed at the hospital could have once again been consistent with COVID or could have been a side-effect of a treatment. So some quicker test results might have been helpful in this case. Anyway, this pt's oxygen requirements were increasing very quickly. They progressed from a nasal cannula to a higher flow mask to BiPAP (non-invasive ventilation) in fairly short order. Next step would be a mechanical ventilator. This pt was conversant (when not too short of breath), mentally very sharp, and seemed well aware of the seriousness of the situation. Occasionally when awake, they would turn on one of the 24 hour cable news channels with nothing but COVID coverage. Needless to say, that's gotta be an unfortunate and bizarre situation to find yourself in. It bothers me a bit that I don't know whether this patient was CV positive or negative. At some point I'll likely text one of the nurses to find out the result and hopefully hear some good news about how they're doing.

Well this didn't end up how I hoped. The nurse I texted said that the pt's test came back COVID positive and they are about to pass. She said the family which lived in another state was about to have a video conference. I'm assuming that meant the nurse would take an iPad in the room to see the pt, like I mentioned with another pt. To add some context......this pt looked absolutely terrible in the morning when I came on shift for my last day. Fever, chills to the point of rigors, a fast heart rate with arrhythmia, rapid and labored breathing. It's amazing how much of this was temporarily fixed with some just IV acetaminophen (it's existed in the US for a number of years now). Eliminating a fever always helps a great deal with tachycardia and tachypnea. I also gave an IV med and started a new drip to help the arrhythmia. And I had a little "scared straight" talk with the pt to let them know that this was serious business and when they moved around too much in the bed, their oxygen numbers were going way too low. Time to sit still, relax, and concentrate on slow deep breaths. It all helped. Just a few hours later looking way better. Around that time I asked the pt if they were keeping their family updated (I knew they weren't local). I got back kind of an eye roll and a smirk and a "not really".....there was a story there but I didn't wanna pry and wasn't about to have such a dyspneic pt start talking at length. A couple hours later the pt started declining again. Didn't look as bad as in the morning but required BiPAP to stay well oxygenated. Not good. Hopefully this pt made some contact with family before getting intubated. This pt wasn't very old but did have a very significant oncology-related illness.

[mention]Dub Rubb[/mention] and [mention]Sporkboy[/mention] I really appreciate the kind words. It's a strange thing to do the same thing you've always done but suddenly have it be much more relevant. I'm fortunate to have a job I can feel great about. For that matter I've just been fortunate in life. I have the occasional down times like anyone else but what I've discovered is that during those rare down times, all I have to do is put 100% into my every day job and I can come away feeling good and sleeping very well. Not everybody has that. It's this little cheat code or life hack that rarely fails me. It's all a bit more selfish than you might guess.

[mention]tjcdas[/mention] the antibiogram question is an interesting one. I don't think it's something that I've looked at closely enough to take notice. I might try asking an ID doc about it. My guess would be that susceptibility and resistance not only varies by geographical region but from facility to facility as well. With regard to nosocomial infections, I can say that every once in a while I show up at a facility that seems 10-15 years behind the curve when it comes to prevention of nosocomial infections, particularly nursing practices related to CLABSI, CAUTI, and VAP. I know pna from nursing homes used to get treated more like CAP but I feel like a good doc should know that they might need to broaden/tweak antibiotics to cover the range of bugs more common in nursing homes.

[mention]Bbrou33[/mention] I just turned 41. I have chronic back pain but no major medical problems and I try to stay fairly fit. Although my sense is that with regard to COVID the no health problems thing really matters but being fit probably doesn't. My plan is to be as careful as I can to avoid exposure and get good rest when I can. I feel I could be carrying it around already but with no symptoms. There's almost no chance of getting a test soon so I just plan to do everything to not to expose anyone else, patients, co-workers or others. My dad would definitely my considered "at risk" so I won't be visiting with family for a long time. So I might as well keep working, help out, make money, and try to get an antibody test as soon as I can. Now doesn't seem like a good time to just take it easy though. I already feel a little bad being out where it's still relatively calm when I could probably be helping more in NYC. A shout to your girlfriend for putting in the time and effort to get people tested. Not to mention just putting herself in that situation to be exposed. Aahhh....that text from your GF's brother is pretty bad. A week or two back I had the realization after listening to interviews with Italian doctors and nurses that statistically this will likely get somebody I've worked with at some point. Not exactly a comforting thought. But unfortunately there's just no magic bullet for this thing.

On a positive note, due to the stay at home order - crime is down.

And gun sales to people who have never owned a gun are way up.

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PetWatch wrote: ↑Thu Mar 26, 2020 1:10 pm On a positive note, due to the stay at home order - crime is down.


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And pollution.

Just got a call from my boss in South Africa and looks like he might be stuck there for three weeks. South Africa is shutting down pretty much everything tonight at midnight. There are two flights he's trying to get, but it doesn't look good.

edit: He just got the last seat on the last flight out to London. Crazy times

Amid all the turmoil it is great to see some humanity, innovation and decency...

https://www.cnn.com/2020/03/26/tech/dys ... index.html

Latest is gun sales being shut down in the county after some waffling back and forth.

I guess we won't be able to shoot this f-ker down.

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PetWatch wrote: ↑Thu Mar 26, 2020 1:36 pm Latest is gun sales being shut down in the county after some waffling back and forth.

I guess we won't be able to shoot this f-ker down.

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Just a heads up to everyone, this is a politically charged topic that we obviously won't be debating here.

ManOnTime wrote:

PetWatch wrote: ↑Thu Mar 26, 2020 1:36 pm Latest is gun sales being shut down in the county after some waffling back and forth.

I guess we won't be able to shoot this f-ker down.

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Just a heads up to everyone, this is a politically charged topic that we obviously won't be debating here.

My apologies MoT, I was just trying to make some light hearted banter.


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PetWatch wrote: ↑Thu Mar 26, 2020 2:40 pm

ManOnTime wrote:

PetWatch wrote: ↑Thu Mar 26, 2020 1:36 pm Latest is gun sales being shut down in the county after some waffling back and forth.

I guess we won't be able to shoot this f-ker down.

Sent from my SM-G950U using Tapatalk

Just a heads up to everyone, this is a politically charged topic that we obviously won't be debating here.

My apologies MoT, I was just trying to make some light hearted banter.


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No harm, no foul. Just wanted to say something in case anyone took it as an invitation to go jumping on soapboxes.

Off topic. - MoT

Today's Headline:

Entire senior home in New Jersey, 94 people, presumed to have coronavirus

This is the home that I have reported on. 24 already determined to have the coronavirus; the other 70 are presumed to have it too.

One person already has died.

The Sultan of SoWhat wrote: ↑Thu Mar 26, 2020 4:12 pm Today's Headline:

Entire senior home in New Jersey, 94 people, presumed to have coronavirus

This is the home that I have reported on. 24 already determined to have the coronavirus; the other 70 are presumed to have it too.

One person already has died.

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Just after posting this, the mayor's robocall came.

The worst news is that the number of fatalities from the nursing home is now 3.

Here are some excerpts from the robocall:

without St. Joe’s [the nursing home] numbers Woodbridge has 40
positive Coronavirus cases which is up from 28 yesterday, our largest increase so
far.
The cases are spread out geographically all over Woodbridge and they are split
evenly between male and female. Ages range from 76 all the way down to 14
although that young man has been fever free for three days which is great news.
The number of cases in the State of New Jersey spiked terribly overnight . . . .
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So, things are getting worse--no time to think or talk about crowding people together in restaurants and churches!

The Sultan of SoWhat wrote:

The Sultan of SoWhat wrote: ↑Thu Mar 26, 2020 4:12 pm Today's Headline:

Entire senior home in New Jersey, 94 people, presumed to have coronavirus

This is the home that I have reported on. 24 already determined to have the coronavirus; the other 70 are presumed to have it too.

One person already has died.

-------

Just after posting this, the mayor's robocall came.

The worst news is that the number of fatalities from the nursing home is now 3.

Here are some excerpts from the robocall:

without St. Joe’s [the nursing home] numbers Woodbridge has 40
positive Coronavirus cases which is up from 28 yesterday, our largest increase so
far.
The cases are spread out geographically all over Woodbridge and they are split
evenly between male and female. Ages range from 76 all the way down to 14
although that young man has been fever free for three days which is great news.
The number of cases in the State of New Jersey spiked terribly overnight . . . .
--------

So, things are getting worse--no time to think or talk about crowding people together in restaurants and churches!

I'll be working at Hackensack University Medical tomorrow. I haven't heard what the situation is like since I was there last week.

Let's be Instagram friends @bbrou33

[mention]Bbrou33[/mention]

"I'll be working at Hackensack University Medical tomorrow."

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Thanks for all you do. Stay safe.

Just to lighten the mood a little.