Coronavirus Discussion Thread

CCCSD

Forum Asst. Chief
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Give it some serious thought. That mask stays in place and does NOT MOVE. If you have to adjust it, tweak it around or whatever, you stand a good chance you contaminated it and removing it later can be much more difficult.
The #1 source of self contamination is hands to face. Adjusting your mask is an invitation for something to get past it.

Doc at hospital had more post op infections than all other surgeons combined. Observing him in the OR he had a habit of moving his mask about with the back of his hand.
Dude, just stop. Seriously. We all know about touching your face. When you are working in a Hot Zone directly treating patients, you can talk. But not utter BS about sticking masks to your face.

Am THERE. Doing IT.
 

Tigger

Dodges Pucks
Community Leader
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If the medical director and leadership at my part time job thinks I'm going to watch a 45 minute daily update on COVID19 procedures, they must also assume I enjoy some daily crack.

There is so much information out there that it absolutely needs to be dispensed in usable chunks, otherwise providers are just wasting their time and things will be missed. It is asking for trouble to ask staff to stay up on such an information overload, especially for those with multiple jobs and responsibilities right now. I thought having a county medical director would be cool...turns out there is such thing as too much engagement. We don't need the physician calling the station and asking them to build a homemade isolette for the cot.

For those in the podcast realm, I've found EMCases to be supremely helpful in breaking this disease down into digestible topics. While each episode is 35-45 minutes long, they don't attempt to cover a dozen topics in a single segment and the presenters are very easy to understand. You go, Canada.
 

RedBlanketRunner

Opheophagus Hannah Cuddler
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Dude, just stop. Seriously. We all know about touching your face. When you are working in a Hot Zone directly treating patients, you can talk. But not utter BS about sticking masks to your face.
What is your problem? Do you represent the tens of thousands of guests and click bys that visit this forum? Why are you the supreme authority of what is to be posted? Ordinary people visit these forums all the time just looking for information. Just stop driving them away with your elitist trolling.
 

DragonClaw

Emergency Medical Texan
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What is your problem? Do you represent the tens of thousands of guests and click bys that visit this forum? Why are you the supreme authority of what is to be posted? Ordinary people visit these forums all the time just looking for information. Just stop driving them away with your elitist trolling.
You want me to glue a mask to my face with cornstarch and call him the troll?

We're an evidence based group of folks. Submit your findings please.

Anyone here knows I've well gotten into it with CCCSD previously. Take that as a hint on how you sound right now.
 

Peak

ED/Prehospital Registered Nurse
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I'm not saying this at @Tigger but rather as a reflection of many of the members of the medical and public service community that I interact with every day.

This is a war, and it isn't a fair one. We don't have adequate supplies, limited knowledge, and an even more limited time frame.

Keeping up to date with developments day to day may be the difference between keeping yourself, your crew, and your family safe. While this disease does target the old and sick, young healthy people have died from it too.

Nobody would leave an incident briefing at a wild land fire early nor would they leave roll call early on the LEO side. That information, no matter how mundane it may seem, is one of the few things we can try to use.
 

RedBlanketRunner

Opheophagus Hannah Cuddler
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You want me to glue a mask to my face with cornstarch and call him the troll?
Common uses of corn starch: Athlete's foot, chemical free base for makeup, relief from itching from bug bites and irritants like poison ivy (rhus), non toxic base for children to make paints with, deodorant, water based adhesive, diaper rash, sunburn, etc etc.
Got a problem with it, don't use it. Simple.
 
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DragonClaw

Emergency Medical Texan
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Common uses of corn starch: Athlete's foot, chemical free base for makeup, relief from itching from bug bites and irritants like poison ivy (rhus), non toxic base for children to make paints with, deodorant, water based adhesive, diaper rash, sunburn, etc etc.
But that's not what you're suggesting I use it for, is it?

Peer reviewed studies of N95 Cornstarch-sealed masks please.
 

ffemt8978

Forum Vice-Principal
Community Leader
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Sealed? Better reread my post.
Based upon my decades of experience in nuclear engineering, fire fighting and hazmat I would like to point out something you seem to be overlooking. Tips and tricks that you can get away with when using a positive pressure SCBA are down right dangerous when using a respirator. So please stop with the inappropriate tricks.
 

Kevinf

Forum Captain
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Since we're on the topic of respirators, I can't recommend a full-face respirator strongly enough. Having spent all day in poly N95 respirators, half-face respirators, and full-face respirators... by far the most comfortable and secure was the full-face.

Downside, of course, is the cost. A high-end full face is $100-$150, half-face are about $25-$60, and N95s are just dirt cheap (usually :rolleyes:).

Unfortunately, getting your hands on a proper respirator may be difficult these days. HOWEVER, your company is REQUIRED to provide properly fitting PPE. If your supplied PPE is slipping, they MUST provide an alternative per OSHA.
 

RedBlanketRunner

Opheophagus Hannah Cuddler
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Based upon my decades of experience in nuclear engineering, fire fighting and hazmat I would like to point out something you seem to be overlooking. Tips and tricks that you can get away with when using a positive pressure SCBA are down right dangerous when using a respirator. So please stop with the inappropriate tricks.
I agree completely. I suggested tiny bits of corn starch to keep masks from slipping around. A few dots of corn starch paste the size of the head of a pin. I assumed nobody would use enough to compromise the seal! That would be ridiculous. Also agree with the pos press. We had some antique demand type SCBAs at a station I worked for a while. Hand to mouth desperate FD that used discarded and retired equipment. Those demand type units were accidents waiting to happen and greasing them up all the way around with vaseline was mandatory. Crank the straps down so tight you got neck spasms and raging headaches.

Unfortunately, getting your hands on a proper respirator may be difficult these days.
Yup. Thinking everyone is going to have access to new quality masks is Trump think. Some people are going to have to make do. You know, at the rate things are going a few hundred thousand people going to have to resort to various tricks to be safe.

@ffemt8978 Thanks for clarifying. Honestly, in my book, assuming I suggested compromising a seal is dumber than thinking that's what I suggested. I will assume something else here. You've been in a boiling black room, flashlight useless, and thanks to modern plastics burning, C monoxide, hydrogen chlorides, cyanides and PCBs instead of air - on par with getting a case of Covid if that mask leaks? Except of course you can go down in a few seconds. One or two lung fulls.

Corn starch. We had some really stiff Scott SCBAs. Get sweating the things would slide all over your face. Old timer captain came up after we had the masks fitted and added a tiny dab of the starch in a few spots around the outer edge of the seal. Worked like a charm.
I suggested it in response to someone who posted their mask slipped around.
 
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OceanBossMan263

Forum Crew Member
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Should be interesting to see how this FDNY staffing protocol shakes out. Many people only work for FDNY EMS so that they can go to FDNY fire side as a promotion instead of dealing with all of the issues of hoping to get hired off the open competitive exam. Unlike some other municipal departments, they were truly separate jobs until now and just happened to have the same logo on the trucks.
 

Carlos Danger

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I have seen some talk in unofficial channels about two things that I have yet to see anything "official" published about anywhere:

  1. NOT intubating early and instead giving folks as much chance as possible to avoid going on the vent much the same way we typically approach respiratory compromise, in part because vents are so limited in some places and also because of the high mortality rate of patients who get intubated for this (nearly 50%)

  1. NOT reflexively using ARDS vent strategies in intubated patients who lack radiological evidence of ARDS, as has been the prevalent approach and recommendation. Some believe that the primary issue in many patients with COVID-19 is not ARDS but pulmonary vasculopathy (an idea which apparently there is a fair amount of evidence for), in which case high PEEP can cause increased PVR and the problems that follow, potentially contributing to high mortality rate of vented COVID-19 patients.

Anyone seen any mention of either of these things in the clinical media?
 

MonkeyArrow

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I have seen some talk in unofficial channels about two things that I have yet to see anything "official" published about anywhere:

  1. NOT intubating early and instead giving folks as much chance as possible to avoid going on the vent much the same way we typically approach respiratory compromise, in part because vents are so limited in some places and also because of the high mortality rate of patients who get intubated for this (nearly 50%)

  1. NOT reflexively using ARDS vent strategies in intubated patients who lack radiological evidence of ARDS, as has been the prevalent approach and recommendation. Some believe that the primary issue in many patients with COVID-19 is not ARDS but pulmonary vasculopathy (an idea which apparently there is a fair amount of evidence for), in which case high PEEP can cause increased PVR and the problems that follow, potentially contributing to high mortality rate of vented COVID-19 patients.

Anyone seen any mention of either of these things in the clinical media?
I've seen a lot of talk about the first point too through various channels. Not intubating early, awake proning with HFNC, trying CPAP. An interesting topic I've heard is the concept of "silent hypoxemia" or "happy hypoxemia" where you let these individuals who are on high Fi02 non-invasive ventilation with low SpO2s but who are otherwise not in distress sit there for hours and even days with low SpO2s. I don't know how comfortable I personally would feel about that.

As to your second point, most of the COVID+ patients who get intubated at my shop have had the fairly classic ARDS infiltrates. However, I have seen a lot of FiO2/PEEP titration tables in recent days that seem to suggest starting with a low FiO2/PEEP and titrating them up in tandem. We don't really do that that. Upon placement on the vent, we of course use low tidal volume ventilation (aim for 6 mL/kg IBW) but with FiO2 of 1.0 and minimal PEEP (around 5) and have had some success with a high FiO2/lower PEEP strategy, at least initially.

Do you have a link to anyone talking about the pulmonary vasculopathy theory?
 

VentMonkey

Family Guy
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@Remi @MonkeyArrow go to EMCrit and FOAMfrat. Both podcasts have been covering these topics heavily over the last few episodes.

Weingart interviews a doc from Italy in one about vent conservation and what they’ve done in Italy to remedy the situation. It all seems like their approaches are constantly evolving because of the constant inconsistencies in patient presentations.

Also, @RedBlanketRunner drop the political stuff. Your posts are hard enough to read without them.
 

SandpitMedic

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silver

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I agree completely. I suggested tiny bits of corn starch to keep masks from slipping around. A few dots of corn starch paste the size of the head of a pin. I assumed nobody would use enough to compromise the seal!
If you need corn starch to stop it slipping around you are wearing a surgical or N95 mask wrong. The caveat though is people frequently are seen taping masks but that is to reduce fogging of glasses/shields or to help prevent glasses from falling off + comfort w/ glasses..
 

SandpitMedic

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If you need corn starch to stop it slipping around you are wearing a surgical or N95 mask wrong. The caveat though is people frequently are seen taping masks but that is to reduce fogging of glasses/shields or to help prevent glasses from falling off + comfort w/ glasses..
Don’t encourage him.
 

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