Vent settings differ in respect to the patient. Remember we treat a patient and not the vent. Whats documented in those medical books is very different from what you get on the clinicals. Thats where experience and critical thinking comes in. And using SIMV mode was just an example.
Yes, usually from clot formation in the brain…You have to titrate the right amount of anti-clot in the machine. Too little, you form clots whereas too much of it will cause bleeding.
The test for that is called ACT (activated clotting time). You want it in the range of about 180-300 seconds.
Yes, but ARDS is a very distinct entity. That’s why scientists and clinicians meet every so often in Berlin to update on best practices. Lung protective ventilation has survival benefits when compared to regular ventilation. That’s a very key point in this covid pandemic.
Thank you! Thank you very much. There is a stance some people seem to be assuming, ati just throw resources at intensive care end of the corona equation and everything will be ok. Very syupid stance that one.
Trump said exactly that and cancelled 80000 ventilators from production.
Last time I checked one was going for 10 mirrion shillings
I like being mean!
1.Not sure I would mention ECMO in a discussion on covid-19, especially while referencing a Third Wold Country. Poor fellows lack basics!
2. I have not seen any literature claiming that ventilators cure anything, but they prolong lives so that…(red point 4)
3. It is quite easy to lose the plot. Some humans thrive on theory that is regurgitated at the slightest provocation. That is like a rolling stone that gathers no moss.
4. Lest we forget, most viruses cause self limiting ailments. Ventilators enable the critically ill with respiratory compromise to “remain alive” as their body mounts sufficient immune response.
5. Prevention is the Key.
6. It is important that we follow the set guidelines, and since Blacks only ape(copy and paste) let them queue behind others. I think they never invest in research!
7. Keep physical distancing.
8. Be faithful, your one night stand might be full of Covid-19
9. Don’t invite lay-abouts over. They might be infected.
10. Offer assistance/donations to those who can’t afford a meal during this period. Then keep off useless talk like ECMO!
Ni jinger gani ilikuwa inasema @Purple hapana daktari? I hope this thread settles that.
Your point #4. Once you get to the point of needing a ventilator, it’s very very hard to recover. I’ve had the chance to see daily, twice daily x-ray results of covid-19 patients. The assault to the lungs is out of this world. Total white-out! It’s scary what it does to the lungs. It’s relentless and rarely gets better.
X-ray in a covid patient
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Normal chest xray (black areas are good, that’s air/oxygen)
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Great effort. They say that Covid-19 causes inflammation, edema, and fibrosis, and all these eventually play apart in survival rates. I look at it as a pneumonitis that severely affects ventilation perfusion ratio. Recovery might be slow, at times stretching into weeks. And the longer they are on a ventilator the worse the prognosis; of course there are parameters that influence outcome; like age, co-morbidities, and immunity. Some are even thinking that gender has a role to play. Anyway, we are all learning about it. We hate to see folks on ventilators, and that is why the emphasis is on prevention, prevention, and prevention. Thanks.
Based on your observation, do you support the ‘do not resuscitate’ policy? Some hospitals have been quietly floating the idea because of the scarcity of resources. If you strongly believe that someone is going to die no matter what, would you rather let them pass on and use the ventilator on someone else with better chances of survival?
That’s an important ethical consideration you bring up. DNR/DNI (do not resuscitate/do not intubate) is something I think everyone, regardless of age or comorbidity, should have in the form of a health care directive or living will document. In the face of this pandemic, I have read about 80-90 year olds with serious or terminal conditions becoming more vocal about not wanting to be put on a ventilator or receive any invasive/excessive attempts at keeping them alive. Some are outrightly saying if it comes to a question of who doesn’t get treated, “choose me.” I think it’s a personal decision and there shouldn’t be any coercion yet. America has not exhausted their capacity to render treatment (not by a long shot). But even if it comes to that, from a point of equity and fairness, should vaccines and other treatments be skewed towards one group or should the burden be evenly distributed? In Italy, the doctors made a decision to let the elderly pass on while giving their best efforts to the younger population. It’s a tough call.
I actually read an article a couple of days ago (will try to remember the source) that indicated that some American doctors have been considering (or have already done it) applying the policy, even in cases where the patients have a DNR order in place. The argument was about the risks doctors take while performing CPR without proper protective gear. In some hospitals, doctors/nurses are reportedly reusing masks for a whole day.
If there’s a DNR order in place there’s no question it must be followed. The only time it’s suspended is if that patient must have a procedure in the operating room, then it can be tweaked. For example, the patient can say I don’t want chest compressions but I wouldn’t mind epinephrine if my BP goes down or shock therapy if my heart goes into a bad rhythm. With respect to covid 19, I think CPR is a very futile exercise because even if you bring someone back, it’s useless if the underlying condition can’t be addressed.
Most people around the world except maybe China (coz they hoarded everything) are reusing their N95 masks. My aunt is a doc in Germany and they’re also reusing N95s. On top of that N95, we are being asked to wear regular surgical masks that can be discarded after each patient encounter, to make them a bit safer by reducing the number viral particles on the precious N95s.
Following
I wish you guys in health sector all the best as you work hard to save our lives, we shall keep you in our prayers. Let us hope something to cure it will be found soon!