Coronavirus Discussion Thread

Kavsuvb said:
In my State of Connecticut for example, they seem to have left out EMT's and only are asking for Paramedics, PA, NP, MD, RT's and Do's.
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They want the advanced practice providers. I know one new Jersey hospital has pulled most of their medics from the field and are using them in the hospital. Now they are back filling the field with out of state providers. And I have see way to many tik toc videos of basics running lights and sirens from states away in a convoy fashion as they are coming to help new your. *Facepalm*
 
Science and things

ETA: I found this from a trusted source one facebook, but im having some issues verifying it so this may be fake afterall.
FB_IMG_1586657506652.jpg
 
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Phillyrube said:
So has it come down to this? Guy dragged off a bus for not wearing a mask?
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Unfortunately, this type of thing is the predictable result of mass hysteria + ignorance. The longer this goes on and the more we catastrophize and exaggerate the danger, the more of this type of thing we’ll see.
 
Another r/o COVID VA-ECMO flight. Keep seeing severe cardiac complications with or without "ARDS"
 
Kavsuvb said:
In my State of Connecticut for example, they seem to have left out EMT's and only are asking for Paramedics, PA, NP, MD, RT's and Do's.
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What role do you envision EMTs playing?
 
Sled Driver said:
In Borough Park Brooklyn, while an FDNY FF from E282 / L148 was checking on hydrants he was harassed by Hasidic Jewish boys. One of them went up to the FF and sneezed in his face. 4 days later the FF felt flu like symptoms and was able to get tested for COVID-19, his test came back positive.
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Well, following up on the above.

nypost.com

Exclusive | NYC firehouse crippled by coronavirus as 11 firefighters test positive

A Borough Park firehouse has been crippled by COVID-19 — with 11 firefighters testing positive and a dozen others suffering symptoms — as it responds to emergencies in a Hasidic community that larg…
nypost.com nypost.com


I would not let any Boss disrespect to me that way, he ran his mouth, now time to back it up and step into the parking lot.
 
GMCmedic said:
I did more digging on this, all of these docs are opthalmologist. I'm calling this an internet hoax.
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Kinda like when yur working a code and a doctor shows up and wants to call the shots. What kind of doc are you? Dermatologist. Heres the radio, talk to my doc.
 
VFlutter said:
Another r/o COVID VA-ECMO flight. Keep seeing severe cardiac complications with or without "ARDS"
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Ok, educate me. Why VA vs. VV-ECMO? Are these patients post-arrest/ MODS? I’m seriously looking for some firsthand education.
 
VentMonkey said:
Ok, educate me. Why VA vs. VV-ECMO? Are these patients post-arrest/ MODS? I’m seriously looking for some firsthand education.
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Some of the patients we are seeing are having significant cardiac complications that could be Cytokine Storm, Myocarditis, or Kakotsubo like cardiomyopathy requiring VA. Others primarily need VV but may be on high pressor requirments that preclude VV. Generally pressor requirments go down once VV is initiated due to improved oxygenation however some are still crashing so VA is safer. Some are post arrest.

Some of it is chicken or the egg, do they just happen to be COVID positive or is COVID an instigating factor for MI or worsening HF
 
VFlutter said:
Some of the patients we are seeing are having significant cardiac complications that could be Cytokine Storm, Myocarditis, or Kakotsubo like cardiomyopathy requiring VA. Others primarily need VV but may be on high pressor requirments that preclude VV. Generally pressor requirments go down once VV is initiated due to improved oxygenation however some are still crashing so VA is safer. Some are post arrest.

Some of it is chicken or the egg, do they just happen to be COVID positive or is COVID an instigating factor for MI or worsening HF
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This is the second time this week ive heard mention of Takotsubo. IIRC it was 3rd or 4th hand that they were finding it during caths at UofL.
 
GMCmedic said:
This is the second time this week ive heard mention of Takotsubo. IIRC it was 3rd or 4th hand that they were finding it during caths at UofL.
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It’s a thing.
 
VentMonkey said:
Ok, educate me. Why VA vs. VV-ECMO? Are these patients post-arrest/ MODS? I’m seriously looking for some firsthand education.
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You can also typically oxygenate better with VA ECMO than VV. You are flow limited on VV as the "venous" side can end up pulling blood from the "arterial" side of the VV catheter. Also keep in mind that ECMO only supports a portion of the cardiopulmonary flow, there is still going to be flow whether on VV or VA through the heart and lungs.

We very rarely perform VV, we would rather perform VA and suppress native cardiac function.
 
Peak said:
You can also typically oxygenate better with VA ECMO than VV. You are flow limited on VV as the "venous" side can end up pulling blood from the "arterial" side of the VV catheter. Also keep in mind that ECMO only supports a portion of the cardiopulmonary flow, there is still going to be flow whether on VV or VA through the heart and lungs.

We very rarely perform VV, we would rather perform VA and suppress native cardiac function.
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Your group planning to put in VADs and transplant these patients during the height of the pandemic?
 
silver said:
Your group planning to put in VADs and transplant these patients during the height of the pandemic?
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The height of the pandemic? The vast majority of our beds in the state sit empty.
 
Peak said:
The height of the pandemic? The vast majority of our beds in the state sit empty.
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Emphasis on the word planning. ECMO is bridging to somewhere right (even if its recovery) but every path takes time? What is your group's plan during the height of your pandemic if you are taking in these VA patients now?

We certainly are not currently doing VA, even the phrase "STEMI activation" is more or less non-existent.
 
silver said:
Emphasis on the word planning. ECMO is bridging to somewhere right (even if its recovery) but every path takes time? What is your group's plan during the height of your pandemic if you are taking in these VA patients now?

We certainly are not currently doing VA, even the phrase "STEMI activation" is more or less non-existent.
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VA-ECMO as bridge to recovery, lesser support i.e Impella, or withdrawal. Our local center has created a separate unit just for COVID ECMO. I know one of the patients went for a valve. I would assume they would still do a VAD if needed. Viral infection isn't a hard stop as with a fungal or bacterial.

Peak said:
You can also typically oxygenate better with VA ECMO than VV. You are flow limited on VV as the "venous" side can end up pulling blood from the "arterial" side of the VV catheter. Also keep in mind that ECMO only supports a portion of the cardiopulmonary flow, there is still going to be flow whether on VV or VA through the heart and lungs.

We very rarely perform VV, we would rather perform VA and suppress native cardiac function.
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What are you doing about LV venting? Re-circ is an issue, but can be mitigated, and max achievable Pa02 is less than VA however VV is still an extremely useful modality.
 
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