Coronavirus Discussion Thread

akflightmedic

Forum Deputy Chief
3,814
2,458
113
I just like being snarky. :)

I looked up their stats...not terrible but not amazingly diminished either. They are willing to try something different, so at least we will have a model to compare our actions versus others for when the next wave hits.

But even if their model worked, we (USA) would never copy it. We like to be stubborn mostly...:p
 

FiremanMike

Just a dude
1,024
579
113
I just like being snarky. :)

I looked up their stats...not terrible but not amazingly diminished either. They are willing to try something different, so at least we will have a model to compare our actions versus others for when the next wave hits.

But even if their model worked, we (USA) would never copy it. We like to be stubborn mostly...:p

I’m not necessarily saying their mode worked, but it’s really the only comparison we have to say whether or not our strict lockdown was useful..
 

Peak

ED/Prehospital Registered Nurse
1,023
603
113
Do you believe those items influence the fact their lack of oppressive lockdown is not showing a significant increase in infection/mortality?

FYI Their recorded cases in Sweden started at the beginning of March, which is about when our numbers became trackable, so in terms of viral introduction, they aren't that far behind us (if you believe covid didn't enter the US before late February..)

I don’t believe we actually started in February, I think we started seeing cases as early as December based on the number of FLS kids we saw in the state with negative influenzas.

I think one of the greatest hurdles we face in making any kind of reliable model is how little reliable testing we actually have.
 

VFlutter

Flight Nurse
3,728
1,264
113
I guess that's my question...I've not read anything at all about recommendations for "just in case" VA ecmo for patients that only need vv. It isn't a casual decision going to ecmo in the first place, let alone determining which mode to use.

To clarify, I am not advocating placing hemodynamically stable patients only in need of respiratory support on VA ECMO just in case however there are some patients who are borderline, on minmal to moderate vasopressor support or slight cardiac dysfunction, that traditionally would be expected to improve with VV support may be better off leading towards early VA due to how we have been seeing COVID patients progress.

There are many recommendations for ECMO but when it comes down to shocky patients with multi-system organ failure the decision on which mode to initiate gets a little grey. Some stabilize quickly after improved oxygenation with VV ECMO and come off pressor support, some do not and require conversion to VA. However with a COVID positive patient I would rather cannulate once and not have to crash on to VA or code a patient on VV later

Simply put I can easily flow 150-180 mL/kg/min of IWB on VA, I can’t get close to that with almost any VV setup.

Why would you need to flow that much? What pump and oxygenator are you using? Because the rated flow of Ped Quadrox is ~3L so any kid over 11kg is out of luck
 
Last edited:

Peak

ED/Prehospital Registered Nurse
1,023
603
113
Why would you need to flow that much? What pump and oxygenator are you using? Because the rated flow of Ped Quadrox is ~3L so any kid over 11kg is out of luck

Our perfusionists built our ECMO setups with various parts that they prefer, it’s a bit of a Frankenstein machine.

We titrate flow based on the patient goals. If they aren’t perfusing and need more flow (as opposed to some other intervention), they get more flow. We favor flow and filling the vascular space over pressors or needing to rely on using the lungs in addition to the pump.

Again, we don’t view ECMO as an early therapy, so by the time we cannulate our patients are pretty sick (probably more so than most other programs). Based on prior ECMO conversations here we evidently also staff to a much higher level than many other ECMO programs.
 

silver

Forum Asst. Chief
906
116
43
We have yet to offer ECMO to a COVID patient (so far all of our patients have either done well enough to not need ECMO or their chronic health status makes them very unlikely to recover), but yes we have flowed that high on acute respiratory disease without cardiac component before.

Oh my comment earlier I thought you were putting COVID patients on...oops.
 

Carlos Danger

Forum Deputy Chief
Premium Member
4,466
3,161
113
Anyone paying attention to Sweden?

Voluntary social distancing, no lockdown, schools still in session, et.. 1400 deaths in a population of 10.9 million..

Would love to hear your thoughts..

Exactly what we should have been doing in most of the US: Strongly advise the vulnerable to quarantine themselves, and advise everyone else to clean their hands frequently and use common sense. Done.

Instead, we are trying to force EVERYONE to stay home, and citing paddle boarders and surfers (CA) and people going for early morning jogs on empty beaches (NC), and giving $500 tickets to people attending church services in their cars with their windows rolled up (MS) and making people wear filthy, completely ineffective cloth masks in public (NY). We're telling people that they can go to Home Depot but they can't buy paint or gardening supplies but they can buy state lottery tickets (MI), and people from out to state can come in to vacation in rental homes, but state residents can't go to their own second residences (MI). The feds have added $2T to our already outrageous debt and weakened the dollar by printing $4T out of thin air, all so that they can send $1,200 checks to people who haven't lost their jobs and give massive amounts of money (that they could never justify doing on its own merits) to a laundry list of pet industries that have absolutely nothing to do with the pandemic.

Obliterating individual liberties, putting millions of people out of work, destroying businesses, AND putting the lead foot down on the accelerator of the car headed towards fiscal ruin, over a virus that will likely end up having a CFR comparable to the seasonal flu. Awesome!

Whatever small amount of faith I still had in our political "leaders" before March is all used up now.

You mean a country that values human life over profit (from the very top down)? A socialist system that has one of the highest quality of life ratings with access to healthcare, high employment, and many other elements of a civil, proper society which tries to ensure no one suffers?

Yeh, 'Murika is so far from that.

Not to get off topic, but Sweden is not a socialist country. The have a thriving market economy and actually rank higher in some indexes of economic freedom than the US does. They do have a generous welfare state. Thats pretty easy to manage when you have a tiny, culturally homogenous population, a very healthy GDP per capita, little debt and a political system that actually works.
 

akflightmedic

Forum Deputy Chief
3,814
2,458
113
Not to go off topic, but I did not say they were a socialist country. I said "socialist system". And who are you? Name changer should let people know....LOL
 

VFlutter

Flight Nurse
3,728
1,264
113
Not to go off topic, but I did not say they were a socialist country. I said "socialist system". And who are you? Name changer should let people know....LOL

I vote for a "Artist formally known as..." feature
 

RedBlanketRunner

Opheophagus Hannah Cuddler
337
57
28
Want to do a comparison try Singapore right now. Report a fever and there's a solid chance you will be on your way to a hospital in an ambulance in an hour. When your country only has people as a natural resource things are decidedly different.
 

chriscemt

Forum Lieutenant
164
43
28
Anyone paying attention to Sweden?

According to the IHME site the projected peak in Sweden is the 29th of April; they will require 1093 ICU beds and have only 79 available.

They will definitely be the interesting counterpoint to social distancing.
 

FiremanMike

Just a dude
1,024
579
113
According to the IHME site the projected peak in Sweden is the 29th of April; they will require 1093 ICU beds and have only 79 available.

They will definitely be the interesting counterpoint to social distancing.

There's only 79 ICU beds in the entire country of Sweden?
 

SandpitMedic

Crowd pleaser
2,300
1,249
113
Exactly what we should have been doing in most of the US: Strongly advise the vulnerable to quarantine themselves, and advise everyone else to clean their hands frequently and use common sense. Done.

Instead, we are trying to force EVERYONE to stay home, and citing paddle boarders and surfers (CA) and people going for early morning jogs on empty beaches (NC), and giving $500 tickets to people attending church services in their cars with their windows rolled up (MS) and making people wear filthy, completely ineffective cloth masks in public (NY). We're telling people that they can go to Home Depot but they can't buy paint or gardening supplies but they can buy state lottery tickets (MI), and people from out to state can come in to vacation in rental homes, but state residents can't go to their own second residences (MI). The feds have added $2T to our already outrageous debt and weakened the dollar by printing $4T out of thin air, all so that they can send $1,200 checks to people who haven't lost their jobs and give massive amounts of money (that they could never justify doing on its own merits) to a laundry list of pet industries that have absolutely nothing to do with the pandemic.

Obliterating individual liberties, putting millions of people out of work, destroying businesses, AND putting the lead foot down on the accelerator of the car headed towards fiscal ruin, over a virus that will likely end up having a CFR comparable to the seasonal flu. Awesome!

Whatever small amount of faith I still had in our political "leaders" before March is all used up now.



Not to get off topic, but Sweden is not a socialist country. The have a thriving market economy and actually rank higher in some indexes of economic freedom than the US does. They do have a generous welfare state. Thats pretty easy to manage when you have a tiny, culturally homogenous population, a very healthy GDP per capita, little debt and a political system that actually works.
Wow. Can I get an AMEN!
 

Summit

Critical Crazy
2,647
1,253
113
Anyone paying attention to Sweden?

Voluntary social distancing, no lockdown, schools still in session, et.. 1400 deaths in a population of 10.9 million..

Would love to hear your thoughts..
If you scaled Swedens 1540 deaths up to the US population it would be 46,370 to the US's 39,291. Sweden is a poor comparison to non-nordics and it is a misconception that they are doing nothing.

Swedes naturally social distance, many live alone, very high rate of remote workers, and as a smaller more cohesive society than the US, naturally do the things they ought to be doing to limit the virus. There are a lot of factory and business shutdowns/furloughs, much tourism and travel have stopped, domestic traffic is way down. Schools are running normally for younger children.
 

RedBlanketRunner

Opheophagus Hannah Cuddler
337
57
28
Slightly more serious problem. <5000 ventilators presently available in all of Africa. >1,200,000,000 people at risk. + religious, regional, cultural and logistics issues will prevent access to proper health care for tens of millions + significant malnutrition throughout many areas.
 

E tank

Caution: Paralyzing Agent
1,484
1,283
113
Slightly more serious problem. <5000 ventilators presently available in all of Africa. >1,200,000,000 people at risk. + religious, regional, cultural and logistics issues will prevent access to proper health care for tens of millions + significant malnutrition throughout many areas.
So...getting my Casio hand computer calculator out....famine, war lord of the flies culture, 3rd world totalitarian opportunistic thuggery....Covid flu not even sparking on the radar....I'm missing the point...obviously....


people lucky to be dying of Covid-19 in CAR...am I close?
 

Bullets

Forum Knucklehead
1,584
215
63
Slightly more serious problem. <5000 ventilators presently available in all of Africa. >1,200,000,000 people at risk. + religious, regional, cultural and logistics issues will prevent access to proper health care for tens of millions + significant malnutrition throughout many areas.
Which i am sure will get totally equal coverage on western news....
 
OP
OP
Akulahawk

Akulahawk

EMT-P/ED RN
Community Leader
4,809
1,186
113
Slightly more serious problem. <5000 ventilators presently available in all of Africa. >1,200,000,000 people at risk. + religious, regional, cultural and logistics issues will prevent access to proper health care for tens of millions + significant malnutrition throughout many areas.
Honestly, I really don't think COVID19 is going to really have much of a blip on things there. For much of Africa, COVID19 will either go largely unrecognized for what it is or many of the really sick will die before they're able to reach (or often afford) high-quality healthcare that is capable of handling vented patients. The ones that have severe symptoms and don't die will eventually recover and it'll (sadly) be just another problem among all the other problems there. It's for all those "religious, regional, cultural, and logistics issues" that I say this.
 
Top