Coronavirus Discussion Thread

OP
Akulahawk

Akulahawk

EMT-P/ED RN
Community Leader
4,736
1,143
113
Which i am sure will get totally equal coverage on western news....
Oh yeah... and on the front page of what newspapers there are left...🙄
 

SandpitMedic

Crowd pleaser
2,288
1,241
113
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?
Not only are you close... you are on the X!
 

Summit

Critical Crazy
2,528
1,082
113
I think the primary danger for Africa is if it goes exponential, you could end up with societal and supply chain disruptions of the type the rest of the world is avoiding with public health measures in the US. That is to say, the economy grinds to a halt when people stop going to work because they are sick, taking care of someone who is sick, going to the funeral of someone who was sick, or afraid to show up because they might become sick. This bug spreads a lot easier than ebola. On the other hand, the population age pyramid and comorbidity distribution (as it relates to COVID) is in Africa's favor vs say Italy or USA.
 

VFlutter

Flight Nurse
3,728
1,262
113
It's for all those "religious, regional, cultural, and logistics issues" that I say this.

Just like the Ebloa outbreak when it was nearly impossible to stop some tribes from spending the night in the same room as their deceased relatives or to touch the body as part of the mourning process.

Side note, The Hot Zone is an awesome book
 

Summit

Critical Crazy
2,528
1,082
113
Just like the Ebloa outbreak when it was nearly impossible to stop some tribes from spending the night in the same room as their deceased relatives or to touch the body as part of the mourning process.

Side note, The Hot Zone is an awesome book
Read Preston's new book: Crisis in the Red Zone
It is about the 2014 ebola epidemic. It is every bit as good.
 

mgr22

Forum Deputy Chief
1,393
581
113
Today, I heard for the first time about blood clots anecdotally linked to COVID-19. I'm wondering if any of you have information to share on that; specifically:
1. Are we talking about, say, DIC, or isolated clots?
2. Could cytokine storms be responsible? The literature sounds like that could go either way.
3. What about NSAIDs like ibuprofen and naproxen?

I wasn't able to find studies on this yet, probably because there aren't any.

Thoughts?
 

Peak

ED/Prehospital Registered Nurse
1,023
603
113
Today, I heard for the first time about blood clots anecdotally linked to COVID-19. I'm wondering if any of you have information to share on that; specifically:
1. Are we talking about, say, DIC, or isolated clots?
2. Could cytokine storms be responsible? The literature sounds like that could go either way.
3. What about NSAIDs like ibuprofen and naproxen?

I wasn't able to find studies on this yet, probably because there aren't any.

Thoughts?

I know that an elevated dimer seems to be present in almost every critically ill patient we have seen. Most have had negative vascular ultrasounds and I haven’t seen a remarkable number of PEs. Dimers can certainly be elevated for a variety of reasons beyond clotting, and I’m not entirely sure we fully understand the link.

Increased risk of clotting isn’t unknown in large infections or immobility from bed rest. We have almost all of our COVID patients on heparin in some form, but typically our dosing is just consistent with DVT or line prophylaxis.
 
Last edited:

rescue1

Forum Asst. Chief
587
136
43
Today, I heard for the first time about blood clots anecdotally linked to COVID-19. I'm wondering if any of you have information to share on that; specifically:
1. Are we talking about, say, DIC, or isolated clots?
2. Could cytokine storms be responsible? The literature sounds like that could go either way.
3. What about NSAIDs like ibuprofen and naproxen?

I wasn't able to find studies on this yet, probably because there aren't any.

Thoughts?


A lot of the website is a bit excessive for EMS, but Josh Farkas at the Internet Book of Critical Care has a section on COVID where he discusses the prothrombotic state that patients seem to be in.

Obviously it's based on very flimsy evidence but that's about as good as it gets right now.
 

mgr22

Forum Deputy Chief
1,393
581
113
A lot of the website is a bit excessive for EMS, but Josh Farkas at the Internet Book of Critical Care has a section on COVID where he discusses the prothrombotic state that patients seem to be in.

Obviously it's based on very flimsy evidence but that's about as good as it gets right now.

Thanks. This looks like an important part of what you linked:

  • COVID produces a form of disseminated intravascular coagulation (DIC) which is usually marked by hypercoagulability.
  • The exact causes of this are unclear and likely numerous. They could include the following:
    • (1) Inflammation (e.g. IL-6) stimulates up-regulation of fibrinogen synthesis by the liver (Carty 2010).
    • (2) Virus may bind directly to endothelial cells.
  • There is likely a bi-directional, synergistic relationship between DIC and cytokine storm (wherein each exacerbates the other).
  • DIC appears to be a driver of disease severity. As might be expected, it is a strong prognostic factor for poor outcome (Tang et al. 2020).
    • Microthrombi have been reported as autopsy findings in patients with COVID-19 (Luo et al.)
 

silver

Forum Asst. Chief
892
100
43
I know that an elevated dimer seems to be present in almost every critically ill patient we have seen. Most have had negative vascular ultrasounds and I haven’t seen a remarkable number of PEs. Dimers can certainly be elevated for a variety of reasons beyond clotting, and I’m not entirely sure we fully understand the link.

Increased risk of clotting isn’t unknown in large infections or immobility from bed rest. We have almost all of our COVID patients on heparin in some form, but typically our dosing is just consistent with DVT or line prophylaxis.

As you mention its not uncommon to be coagulopathic with infections. With a relative increase severe sepsis from COVID presenting to hospitals across the world, its hard to say if there is an increased rate of sepsis induced coagulopathy vs. we are just seeing so much of the same disease and don't have a treatment. I often don't check D-dimers, so not surprised that I see more elevated numbers than normal.

That being said, I anecdotally feel like I am seeing a ton of high dimers, some DVTs, dialysis lines clotting and also RV dysfunction suggestive of PE. However will reference back to my original statement. Some academic systems are full dose anticoagulating high D-dimers without evidence of clinically significant clots while others are just promoting aggressive prophylaxis. Only the data will tell us.


A lot of the website is a bit excessive for EMS, but Josh Farkas at the Internet Book of Critical Care has a section on COVID where he discusses the prothrombotic state that patients seem to be in.

Obviously it's based on very flimsy evidence but that's about as good as it gets right now.

Some of his recommendations in there appear to not be completely consistent with what other people are experiencing, however overall its a great primer.
 

rescue1

Forum Asst. Chief
587
136
43
Some of his recommendations in there appear to not be completely consistent with what other people are experiencing, however overall its a great primer.

Yeah I've noticed that too. I don't think there's any one source that we can individually rely on right now for COVID, but his is definitely the most comprehensive all in one place.
 

Carlos Danger

Forum Deputy Chief
Premium Member
4,322
3,011
113
Yeah I've noticed that too. I don't think there's any one source that we can individually rely on right now for COVID, but his is definitely the most comprehensive all in one place.
I would agree. Of all the resources out there, PulmCrit is probably my favorite.

This one is not strictly clinical, but is also good: Brief19
 

Peak

ED/Prehospital Registered Nurse
1,023
603
113
That being said, I anecdotally feel like I am seeing a ton of high dimers, some DVTs, dialysis lines clotting and also RV dysfunction suggestive of PE. However will reference back to my original statement.

What are you treating your patients with? We haven’t seen PEs but have a seen a significant amount of pulmonary hypertension and have gotten decent (although typically temporary) improvement with nitric.
 

silver

Forum Asst. Chief
892
100
43
What are you treating your patients with? We haven’t seen PEs but have a seen a significant amount of pulmonary hypertension and have gotten decent (although typically temporary) improvement with nitric.

We haven't really been scanning people. Ive had 2 patients in new refractory shock w/ severe RV dysfunction on POCUS (no hx) and known DVTs with markers suggestive of hyper-coagulable state. Started on iNO and epi and have done ok for now. We aren't really lysing much either, just riding out therapeutic AC. Its a different world when you have >150 covid ICU patients in house.
 

Peak

ED/Prehospital Registered Nurse
1,023
603
113
We haven't really been scanning people. Ive had 2 patients in new refractory shock w/ severe RV dysfunction on POCUS (no hx) and known DVTs with markers suggestive of hyper-coagulable state. Started on iNO and epi and have done ok for now. We aren't really lysing much either, just riding out therapeutic AC. Its a different world when you have >150 covid ICU patients in house.

For sure. When we scan we have to shut down the room for an hour before we can even start the terminal clean. We are pretty resource rich and since we have canceled a lot of electives we have been able to use the IR/Hybrid CTs without affecting our main CTs.
 

mgr22

Forum Deputy Chief
1,393
581
113
Apparently, CORONA-19 associated coagulopathy, or CAC, is now a thing. Here's an article that compares and contrasts it to DIC and suggests treatment:


To me, this seems like an underreported reason for continued caution among even the young and healthy.
 

Top