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Confessions of an ICU doctor during COVID

Discussion in 'BBS Hangout: Debate & Discussion' started by BallaDoc, Jul 5, 2020.

  1. Senator

    Senator Member

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    This is the only post I can tell what part you wrote, so I'll repeat again, all the posters in my thread posted in May that dismissed social distancing and pretended it wasn't a big deal were liberals who spend all their time hating on Trump. "It's not like Sweden at all." Quarantine was in effect and people just weren't taking it seriously because the body count didn't look like NY. This is not a political issue - it is very much an American inability to use common sense.

    At the same time, Texas has a large population of fat and unhealthy people who laughed at me when I told them to modify their diets. That means they're easily taken out by any kind of bug. I do think hospitals should be more selective in who they have to treat and give all first responders and doctors a little more breathing space instead of working them into the ground. It's hard enough for me to were a mask for 2 hours at a time, can't imagine wearing a double mask on a 12 hour shift with a gown on sticking needles in patients.
     
    BallaDoc likes this.
  2. bobrek

    bobrek Politics belong in the D & D

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    Do you think the President has done a good job leading the USA through this pandemic?
     
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  3. BallaDoc

    BallaDoc Member

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    You are correct sir. I’m sorry for my ignorance. Anti science knows no political affiliation. The people that are anti virus can be anyone as we all know. A lot of anti Vaxxers are indeed left from my personal experience. The federal administration is its own entity.
     
  4. BallaDoc

    BallaDoc Member

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    Agreed again. Anti maskers and science come in all forms. Critical thinking is incredibly low. But my initial gripes in that quote were targeted at elected officials who brushed this off and feign shock when the numbers picked up.
     
  5. BallaDoc

    BallaDoc Member

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    lol I have give solutions in what to do in the past. I can list them for you again. Enforcement of mask policies. Strict lockdown. Contact tracing. Increase ppe and vent and non vent production. Increase funding to vaccination researchers. Not removing whistleblowers when they tell you certain meds are unsafe. Increase telecommunications visits for telehealth. Increased communication with standalone ER for surge capacity. Mobilize guard for possible makeshift hospitals. QE
    /helicopter money to people so they’re not choosing work vs. life (I know the feds can do it. They gave 500 billion to large corps why can’t they to 300 million Americans).

    when we opened up cases were even down trending. When we’re peaking we still don’t have any strict plans from the state or federal government. Maybe your politicians should be figuring that out. We just try to save lives.
     
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  6. Buck Turgidson

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    I made one post in that thread and I stand by it:
     
  7. Senator

    Senator Member

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    No, but neither did England. The difference between the 2 countries is that 1 has a population that listens to their leaders. Now England is starting to open up bars... together as a country .. we'll see how they are 1 month from now.

    The telling sign is that when quarantine was instituted, even when states were vigilant, people DGAF. As an adult I'm capable of making my own decisions , especially when we have so much info about how dangerous it is, and not expecting a politician to spoon feed me. If Americans could use the old McGrady saying... "it's on me"... we'd be heading into a really good place now.Aren't you embarrassed of constantly blaming Trump when he wasn't the one who put hundreds of thousands of "protestors" out together a couple weeks ago? Everybody forgot about quarantine then .
     
  8. rocketsjudoka

    rocketsjudoka Contributing Member
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    @BallaDoc
    Thank you for sharing this information and it matches a lot of what I’ve heard from friends In the medical field. Your anger and frustration are completely understandable and not misplaced.

    One of the things that you’ve mentioned is that is that how this disease affects people differently and that it is affecting more than the elderly. It does seem like there are people who are dealing with some long term effects of this disease with a range of problems besides respiratory such as neurological issues and blood clots. I have. Few friends who are younger than 40 who have been dealing with these issues for months now.

    Your description of intubating people and the dangers and difficulty with it matches with what I’ve heard. One thing I heard from a former Judo student who is an ER doctor in Germany is that they’ve been seeing success with high oxygen treatment and not intubating. Ive heard that other facilities are seeing success with that too. I’m not a doctor and the only medical training I’ve had is sports and disaster related first aid so I can’t tell you more than that. I certainly am not qualified or will pretend I can tell you how to do your job but passing on some information that I hope is helpful.

    Thank you again for sharing and speaking out. Hopefully more people will listen to what you and others have to say.
     
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  9. BallaDoc

    BallaDoc Member

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    you’re comments on high flow oxygen supplementation are the very internal debate we’ve been having. It has been a very hard ethical dilemma for me personally on when to intubate.

    I have been very conservative on when to intubate. Generally speaking before covid if I had a white cxr (white from inflammatory fluid) that doesn’t respond to high flow oxygen and is working a tad bit hard I intubate early to allow the lungs to rest and fight the disease

    Covid is very strange. Well have patients on max high flow settings comfortably talking to you while their oxygen levels are flashing red behind them. We call it happy hypoxia.

    the problem becomes do you park someone in such high settings knowing the disease doesn’t just go away and will likely worsen over the next couple days and intubate with less time or intubate early when you have reserve. If you delay intubation what happens if they start coughing or vomiting or choking or the mask falls off. If you delay then you are showering the nursing staff with more contagious viral particles since high flow is not a closed circuit.

    I have delayed intubation as long as I can but once the requirements are too high or other organ dysfunction settles in or there is nothing else I can treat to improve the breathing then I pull the trigger and put the tube in.

    keep in mind this strategy also is limited by our supply chain of non invasive machines. Which we are also running out of.
     
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  10. bobrek

    bobrek Politics belong in the D & D

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    You and I agree that Trump had not done a good job of leadership during this pandemic. I cannot remember the last time he spoke at length about the severity of the situation. I cannot remember the last time he appeared with Fauci or others at a press conference. He continually refuses to set an example and use a mask. He has made fun of people wearing masks. He continually puts people at risk by scheduling events and not insisting that attendees wear masks and distance. As a matter of fact the administration has gone out of their way to put people closer together at his events.

    Sure he cut off travel from China, but what he neglects to mention is how tens of thousands of mostly US citizens were allowed back in to the USA from China after his ban (as they should have been) with little to no testing, quarantine or follow up.

    He continues to insist this will magically go away. He only looks at death rates which fortunately are low, while neglecting the pain and suffering folks go through at times to recover. He neglects the pain of folks not being able to visit their loved ones in a hospital, even for non COVID related events.

    He boasts about the surging job market while ignoring the fact those are people going back to existing jobs.

    And I'M the one that should be embarrassed?
     
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  11. BallaDoc

    BallaDoc Member

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    I agree with you again whole heartedly. As an adult ignorance is not a cop out. There is enough data information and medical advice out there that I feel no sympathy for you if you don’t listen. The problem with this strategy though is assuming your general population can think critically.

    If your elected officials do not take this seriously. If your news outlets call it a hoax. If your social media platforms allow the spread of faux science. And your guru influenced poscastwrs spread opinion as data then the population will not critically think and keep the rest of us safe.
     
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  12. Buck Turgidson

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    Yep.
     
    #52 Buck Turgidson, Jul 6, 2020
    Last edited: Jul 6, 2020
  13. ElPigto

    ElPigto Member
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    @BallaDoc I wouldn't waste energy on bigtexx. His whole argument is based on current deaths and everything else doesn't matter. I've seen the arguments go on for days and its futile. He is egotistical, entitled, typical "Karen" and there is really no point of engaging in civil conversation.

    I am curious, what has your success rate been with the drugs that have seen mixed results?
     
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  14. BallaDoc

    BallaDoc Member

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    During the first wave in Texas our success rates were great we had very low mortality. At that time we were mainly using antivirals and inflammatory inhibitors. We were also intubating earlier.

    this second wave has been devastating. I haven’t seen our mortality nights since I started night shifts and I’ll likely look at them after a few days of recovery but they will likely be abysmal. The mortality rates and morbidity rates I think will be terrifying for my institution personally. At this current time we are using high dose steroids, anti vitals, “anti inflammatory renal replacement membranes” I honestly think the numbers for this wave will be way worse. Not sure what we did differently but these patients are much sicker. Have used bypass ona couple young patients without much improvement. We have also delayed intubation now. Not sure if that is playing a role or not.

    I also work at the VA in SA. Our cases are picking up in general at the hospital but not so much in the IcU yet thankfully. We use the same treatment regimen there that we do at my other institution. I’ll post stats when I get them.
     
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  15. ElPigto

    ElPigto Member
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    That sucks brother, stay safe. Believe me, many of us are doing what we can to minimize our risk of catching this ****. We seriously care about you all in the frontlines and know that your resources are finite, including trained staff for critical care. I keep telling everyone I can to stay safe. I share articles, share my thoughts, whatever I can do to keep others alerted, including friends and my own family.

    I am sorry that we can't reach everybody. It's the price we pay for living in a free society that is full of entitled brats. Please keep your head above water and know that many of us are sending our positive energy your away along with complying with guidelines and such. We don't want to be a burden on you guys and also end up in the hospital.

    One more comment, I've heard their is a different strain this second wave, maybe that's why what worked previously is not working now?
     
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  16. BallaDoc

    BallaDoc Member

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    One thing that is making waves now, plaquenil (I’ll leave the politics out of it since the whistleblower report can get heated), was found to increase mortality by the VA.

    For those not in the known plaquenil was touted by trump as a cure all initiall. the VA is a federal hospital system throughout the nation that provides free health care to people who served in the army (didn’t have to just be soldiers by the way just enlisted).

    The IcU directors at the Va I work at are some of the heads of PNA guidelines for the world. They run the ICU for a federally subsidized national healthcare plan/hospital and they found plaquenil increased mortality.
     
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  17. BallaDoc

    BallaDoc Member

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    Thank you for those words. I truly am pained to see some of the patients we do. Some of them had no choice but to go back to work since they couldn’t make rent or eat. My mom is in this situation now. She’s a pharm tech for Walmart. 5 co employees tested positive and she’s too scared to go back to work. My dad is semi retired and we are first generation immigrants so they do not have a lot of options at the time. She is choosing work knowing the risk it carries. I empathize with the people who make the same decisions now. I wish you all the best. I sincerely hope I do not see any of you.

    I have seen the article titles about mutated strains. I have not read enough on this topic to comment on it sadly. I will say the lockdown being lifted plus mass congregations are playing a major role in this now. I will also say if this mutation is true it will make vaccination success controversial. I’m not sure if the same antigens/proteins that are being targeted by the vaccine are the ones being mutated or not. Something to keep an eye on.
     
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  18. ElPigto

    ElPigto Member
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    Thanks for the response. Both of my parents are in Mexico. They are separated and live in different cities. I've kept on my mom and dad everyday to stay safe. I tried to convince my mom to stop working and I would send her money for necessities, but she refused to listen to me. My dad, well I wouldn't be able to convince him to leave his job although I did plant the seed letting him know that if he wants to quit I will support him financially 100%.

    My mom lives around a bunch of people that believe it's a hoax, so I asked her that if she insisted on staying open to close access to her store and hand stuff to people and also wash hands constantly and wear a mask. I got through to her. My dad, he works in a convenience store and is a cashier. I am worried about him every day and I just keep on him to keep his mask on and wash his hands frequently.

    I feel powerless having my folks far from me. I love them and I just hope they don't catch this awful virus.
     
  19. ThatBoyNick

    ThatBoyNick Member

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  20. BallaDoc

    BallaDoc Member

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    I’m so sorry you guys are going through this. In this day and age we have access to so much information but how much of it is reputable is a different story. This has led to our parents and loved ones being put into danger far too often. I wish you the best and wish I could offer something more than positive vibes.
     

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