Sunday, January 10, 2021

Live From The Kung Flu Lounge


Not my place, but close enough as makes no difference.


Just FTR, I wanted to give you an idea of what this is like:

Here's the computer monitor Big Board for where I am, within HIPPA constraints (i.e. I will be revealing no specific info identifiable to any specific patient, and have jumbled up order of rooms, etc.):

A) COVID Respiratory failure

B) CVA (stroke), COVID +

C) COVID, SOB(shortness of breath), hypoxia

D) COVID PNA (pneumonia), hypoxia

E) COVID hypoxia

F) Respiratory failure

G) COVID hypoxia

H) COVID PNA

I) COVID hypoxia, respiratory distress

J) COVID PNA

K) something else

L) PNA, respiratory distress

M) COVID PNA, hypoxia, respiratory failure

N) something else

3 of those (you'll never know which) are mine, and I have one empty bed.

There are a couple of other beds empty now, but staffing is also at the lowest for the night, and we have a full cardiac arrest inbound. So it's about to get busy. BusiER, actually. And I'm sneaking this post in, between my hourly tasks for my three relatively stable patients.

 1 of the 3 trauma patients we have is also COVID+, and unlike all the other rooms, we can't isolate them. Not physically possible.

We have furthermore put beds in every foot of hallway in the ED.

They're half-full now, but earlier there were patients in every bed.

We have turned the waiting room lobby into a new ward.

During peak hours, it was 80% occupied with non COVID patients, because it's the only place left to see regular patients..

Our cath lab and our surgery recovery unit are now holding areas for ER overflow, and they're full, which is another 10-15 patients who'd still be in the ER, because the ICU and the rest of the hospital are full, have been for days, and are now all virtually ICU, because when patients get worse, and get intubated, there's no room for them in ICU, so nurses who've never handled patients on a ventilator (normally an automatic ICU admission) are now HOCUS POCUS! POOF! Instant ICU nurses.

Really.

Our only remaining steps after this are to try and turn the hospital cafeteria into a ward, and/or to clear cars out of adjacent parking, and have the county or Notional Guard put in a pop-up hospital, except we have no staff for either plan.

The step after that is the doctors start deciding who comes inside and gets treated, and who stays outside with no treatment and takes their chances. No one wants to talk about that,  but the Christmas/New Year's peak still hasn't hit yet. Probably in a week or two, it will.

You're not dealing with that, wherever you are?

Splendiferous!

But nota bene, your day is probably coming.

Hopefully not, but hope ain't a plan.

Gotta go.

25 comments:

TT03 said...

and what is the typical bed availability excluding the wuhan flu on any other day/evening/night in comparison previously?

red forman said...

Aesop-

Are your folks treating with Ivermectin or Hydroxyquinolone? Just curious.

Red

Aesop said...

Normally at 5:30A, half the ER would be empty.
We only moved two patients to floor beds last night, because 2 patients died up there.
We used to get beds within a few hours.
The current wait in the ER is 2-4 days.
We only have a couple of ICU patients; when I left last Tuesday morning, we were holding 8 ICU patients, IIRC.

Aesop said...

And we're treating with normal pneumonia Abx (Rocephin, azithromycin, vancomycin), plus remdesivir.

dthompson4447 said...

You can't call it anything else than 'criminal incompetence'
Not the guys in the trenches,, the Generals
https://trialsitenews.com/an-unlikely-nation-is-kicking-this-pandemic-guess-which-then-why/

Dan in PA said...

Past 10 months nothing in my little town and section of Westmoreland county PA. Now we’re starting to be where your at with Covid and it’s getting worse. The nurse who used to live up the street got it and a week later died. Her mom died a week later and the rest of the family is sick. Guess who had a family get together at Christmas. Past 10 months I did not know anyone locally with Covid. Now friends and family are testing positive, going to the hospital, and a few dying. I believe this wave will hit the rural areas bad and if it doesn’t wake the deniers up, we’re all in trouble big time. Myself and close family hunkered down, washed are hands, wore masks when needed, and socially distanced since the start and are doing fine. But with whats going on in Washington and the world these days, if your not prepped up by now it’s almost to late, with the big shit storm almost here.

From Norway said...

No vitamin d? Nothing out of label?

Nick Flandrey said...

@aesop, that treatment is (pick one from this group of abx)+ remdesivir, or a combination of abx + rem...?

No Hydroxychloroquine or antivirals?

Single dose injection of rocephin? per the book or oral, or ongoing/repeated? I guess I'm asking are you using the normal drugs in the normal way or are you doing different dosing and stacking meds?

Just treating the pneumonia?

That vancomycin looks like nasty stuff with dangerous side effects, can covid patients at that state still consent?

Just asking for general knowledge sake, not as a guide to prescribing of course. Maybe I have a stock play I'm researching....

nick

Night driver said...

Prayers, Bro.
BTDT in a tertiary facility in Cleveborg. We HATED to have hall beds but we would now and then have a couple dozen when we had a wave of something hit.

Part of my job was getting beds for my ladies (nurses) and I REALLY (though carefully) pushed for our hall population. Not a career choice if ya can't handle rejection.
I got to listen to more than one convo between DON, Chief of Hospital Staff, and ER boss lady as to whether we could go in diversion status in hopes of buying enough time for celestial Check-ins giving us bed availability)

And this was WITHOUT contagion concerns.

Night Driver

Nick Flandrey said...

Still time to prep, although it's gotta be quicker and it's gonna cost more.

Pistols and rifles are still available- albeit at higher prices. Ditto for ammo. Get yourself on some mailing lists. PSA, GrabAGun, etc.

Food, supplies, water treatment and storage, meds, wound care, all still out there.

There is still rural land available, although sales have been brisk and prices are much higher than 6 months ago.

It's always more expensive to do something in a hurry, and your likelihood of making mistakes or oversights is higher, but any preps are better than no preps.

n

Toirdhealbheach Beucail said...

We have been wearing masks, minimizing contact, and washing the hands on a regular basis. To date, we have avoided The Plague so far.

Given what things look like now, I am unhopeful at this point that 2022 will be any different than 2021 or 2020.

Unknown said...

Kung Flu is now too close for comfort. I've had two co-workers at my second job test positive. Guess who is trying to work her day job and got to take the "it's an emergency!" Call from the second job? it's gonna be a long week. So far both co-workers are alright, so that's good, but it's rough on those of us who are left.

I wipe my work station every time I go it and spray Lysol on everything else.

I sure am glad that this plague is scheme concocted by the rest of the world to get rid of Trump, or this would be a nightmare. I'm sure that since this isn't really happening I'll wake up any minute now! (<- for the confused, that's sarcasm.)

~Rhea

Ropro said...

Not allowed to use Hydroxychloroquine
Invermectin is not being used but is not banned

I currently have 40 pts under my care in one hospital Ten have The Rona. This past week I discharged 6 COVID patients. 5 to home, one to an Nursing home Only one need continued oxygen None are/were intubated but one is on BiPAP at night. Definitely an uptick in numbers but not overwhelming Again, my patients are not dying. Different strain in Florida than California? Perhaps that explains our different experiences.
My Plan of Care:
All get high dose D2 50,000 IUs once plus D3 5,000 IUs daily Ascorbic acid 1000 mg 3x/day Zinc sulfate 220 mg 2x daily, Aspirin 162mg daily, Pepcid 2xday, Lovenex/Heparin, MVI one daily Dexamethasone IV or PO one to four times per day depending on degree of illness, and Remdesivir only if hypoxic
Antibiotics only if suspicious of secondary bacterial infection

Robin Datta said...

Some do it right. And if you live in the United States, you may be screwed.

Aesop said...

Rocephin and azithro per protocol for PNA, if seen. If either is a no go, substituting vanco.
Remdesivir for hypoxia with or without PNA.
Also Vit D, multivitamin, decadron (steroid), Aspirin and Lovenox to minimize/prevent clots, Pepcid for antacid/antihistamine.

I just finished doing the daily aspirin, and lovenox shots on my patients camping in the ER, plus the lifegiving multivitamin and Pepcid tabs for the new ones.

2 of my 3 tonight are the same, one new one, and one old one got a bed after 3 days here.
Everyone I have is on supplemental O2, but all 4L/min or less.

The one I finally admitted was on 50L/min, and on 25L by NRB mask, desatted to 88% in the 5 minutes it took to roll him up to the floor.

One of my compadres tonight has 4 ICU patients, which is double a normal assignment.

I've heard anecdotally FL is doing better, and I hope their luck holds.

The next steps for us if/when this gets worse, start getting grim. As noted, we'll start seeing the spike from Christmas/New Year's this week and next, most likely.

One of the nearby hospitals is shipping bodies to us, because they're out of frozen storage space. Time for more conex reefers.

Robin Datta said...

Orally administered. Apple flavored. Advance by one mark on the syringe delivers a dose for a ~70Kg. body weight.

Wayne said...

@Aesop

Is Gruesome Newsome prohibiting use of HCQ/Zn and/or ivermectin? Because they work, particularly if used early.

https://ivmmeta.com/

https://hcqmeta.com/

JJ said...

For your consideration.

Effect of 1% Povidone Iodine Mouthwash/Gargle, Nasal and Eye Drop in COVID-19 patient
http://www.bioresearchcommunications.com/index.php/brc/article/view/176/159

Earlier and much smaller trial, but showing similar results.
EARLY VIRAL CLEARANCE AMONG COVID-19 PATIENTS WHEN GARGLING WITH POVIDONE-IODINE AND ESSENTIAL OILS –A CLINICAL TRIAL
https://www.medrxiv.org/content/10.1101/2020.09.07.20180448v1.full.pdf

Dozens of in vitro studies and expert opinion pieces suggesting PVP-I mouthwash and nasal spray for both Covid-19 prophylaxis and/or treatment have been published over the past year too, almost all to either negative press or no press at all.

JJ said...

For your consideration.

Effect of 1% Povidone Iodine Mouthwash/Gargle, Nasal and Eye Drop in COVID-19 patient
http://www.bioresearchcommunications.com/index.php/brc/article/view/176/159

Earlier and much smaller trial, but showing similar results.
EARLY VIRAL CLEARANCE AMONG COVID-19 PATIENTS WHEN GARGLING WITH POVIDONE-IODINE AND ESSENTIAL OILS –A CLINICAL TRIAL
https://www.medrxiv.org/content/10.1101/2020.09.07.20180448v1.full.pdf

Dozens of in vitro studies and expert opinion pieces suggesting PVP-I mouthwash and nasal spray for both Covid-19 prophylaxis and/or treatment have been published over the past year too, almost all to either negative press or no press at all.

Unknown said...

An outbreak occurred this past fall at one of my customers, a retail distribution warehouse. It was all over the local news. 15 guys got the "rona:. One of them died (he had the usual comorbidities) but the rest of them were sick for 2-3 weeks and then were OK. No one other than the guy who died went to the hospital.

I've the "Rona twice. First was in March. Second was in October. It is nasty and you definitely want to do the social distancing thing to avoid it.

GMay said...

Is the conventional "wisdom" still to advise people wait to go to the hospital until they have trouble breathing?? I can't imagine that being the case. Everything I've seen is that docs are having way more success treating early with some of the stuff already mentioned here.

Marina said...

@ JJ re Povidone: Is it the 10 % Povidone with 1 % free available iodine ?

Allpau1 said...

I feel your pain. I work on pulmonary at my hospital and we've been Covid since April of last year. One bed opens up and is immediately filled. Our hospital is full and trying to find more room for more Covid patients. Our ED is holding people left and right.

JJ said...

@Marina Yes, the OTC 10% povidone iodine prep solution, not the scrub solution. See here as evidence from a reputable source, and for one method of making the PVP-I nasal spray: https://krcrtv.com/news/local/redding-doctor-says-he-may-have-a-solution-to-prevent-transmission-of-covid-19

CJG said...

Aesop,

This sounds just like my ER, where we have seven (7) beds, but routinely treat fifteen (15) patients, in the hallway, in repurposed L&D nursing chairs, in wheelchairs and every other thing we can provide. Psych patients still come in, either by themselves or courtesy the laughable idiots from LA S.M.A.R.T, which means exactly the opposite of that. We have no staff in the BHU, since most of them have called off in protest for the hospital making half of their floor a COVID floor, since it affects 5150's just as well as the rest of us.

We have no beds for MedSurge, since all the RNs from that unit have been tasked to the COVID units, ICU is always full, and we are their overflow (of course).

Of my last 8 shifts, only one was just 12 hours; all the others were over 14, and three were 18+. People are calling off all the time. For New Year's Eve, I was the only RN where we are supposed to have 4, but feel blessed to have 3. It's usually two at this point.

I wish you luck, brother. Thanks for keeping us apprised. Know that our thoughts are with you.

Chris G, RN
Sun Valley, CA