This page is for discussion among EM residents, faculty, staff.
Do not post anything inappropriate. It should only be for serious discussion.
Room9er ["Room Niner"]:
The sickest patients, who receive world-class care in the trauma/critical care bay of University of Louisville Department of Emergency Medicine
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TLDR- are we still gonna avoid NIV for suspected covid and go straight from relatively low fio2 –> tube? See links at the bottom.
I know early on we (and everybody else) had been planning to avoid NIV and HFNC for fear of aerosolisation and concerns regarding likely failure. I was all about this cos I don’t wanna get covid.
Initially there was a lot of talk about how this was classic ARDS that needed high PEEPS (or APRV) and oxygen alone wasn’t going to cut it.
I’m reading more and more foamed sources from NYC/NJ saying that this isn’t classic ARDS and these patients have completely normal compliance but very low o2 SATs. People comparing it more to HAPE (very low SATs in patients who look comfortable), pulmonary hypertension (very high mortality, >50%, in mechanically ventilated patients) or even a hemoglobinopathy given the clinical picture doesn’t really fit the SATs (people sitting up texting with sats in 50s).
There seems to be a lot of positive talk about the New Orleans data but seems to me that so far even they’ve only been able to extubate 40-50%. Though I guess that number could change as many are still alive and intubated. I imagine Dr Baker might know how things are looking there.
Just wondered if we were planning on sticking to a no NIV/HFNC plan or not? If not do we have NIV machines with dual circuits or would we have to use vents in NIV mode/some of the Jerry rigged stuff people are trying in NYC/California? Seems to me closed circuit CPAP/PEEP may be the best combination of high fio2, little bit of positive pressure and hopefully low aerosolisation.
I included a couple sources below which are interesting. One is a Salim Rezaie article summarising his thoughts on aerosolisation based on some exhaled smoke dispersion stuff. The other is a more concerning article from Nebraska basically saying they found COVID on everyone and everything including the air even when patients were wearing only regular low flow nasal cannula (though to be fair they weren’t sure if the viral particles found in the air were enough to spread infection)
Foam stop intubating advice-
https://emcrit.org/emcrit/stop-kneejerk-intubation/
https://thinkingcriticalcare.com/fbclid=IwAR364j6uuFRdAzIJL_1KvUXvm2h3PFbdyeeUlHFYsJgxlc2hEodY_dS-de8
https://youtu.be/GLbKyc31XhM (EMRAP LIVE- all interesting but skip to Swaminathan for their experience with early tubes)
Rebel em article re aerosolisation –
https://rebelem.com/covid-19-hypoxemia-a-better-and-still-safe-way/?utm_source=rss&utm_medium=rss&utm_campaign=covid-19-hypoxemia-a-better-and-still-safe-way
Nebraska study re aerosolisation-
https://www.medrxiv.org/content/10.1101/2020.03.23.20039446v2
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How to Get and Use E-Mail Addresses for Viral Advertising Viral marketing has an array of possibilities and ways to achieve your overall goals. However, just like everything else, preplanning and the right setup to create success are the things you will need [read more..]
Arrays Of Bank Accounts Living without our bank accounts would be a major problem. They help us save money. They provide a sense of safety and security. We do not need to fear that we will be robbed of all our money in a sin [read more..]
The Best Way To Develop A Customer We continually search for the correct blend of ingredients that will prompt internet visitors to become paying customers for our home business. If we create an award winning website, add a good produc [read more..]
Problems with Windows Vista The newest version of the Windows operating system family is Windows Vista. Just as with other versions of Windows, Windows Vista operating system is not without its share of problems. Some of them [read more..]
Excellent Menu for a Great Fourth Outdoors The Fourth of July is America's Independence Day. It is a special day in the minds and hearts of patriotic citizens of this country and there are many ways we celebrate that patriotism. If you ar [read more..]
The Flags are Waving in Daytona Beach Gentlemen, start your engines and ladies, grab your beach bag. It's NASCAR time in Daytona Beach, Florida. 2006 is already wooing a track full of die-hard race car drivers and fans are pulling up [read more..]
How To Repair Credit – A Brief Report Are you looking for a way to dig yourself out of mounting debt that just seems to keep getting worse? You're first instinct may be to hire someone to fix the problem, but if you've already g [read more..]
The Killer Squeeze Page Strategies In the world of Internet Marketing, the subscriber email list is considered the most important part of the business and even more important than the sales itself. As a result, marketers dedicate a la [read more..]
How To Save Money When You Apply For A Mortgage So, youre about to get a mortgage? Take a deep breath. Prepare to spend a little bit of time doing your homework. Three or four hours of effort may end up saving you thousands of dollars now, and tens [read more..]
The World Wide Web For Absolute Beginners, Part 1 The World Wide Web is not as overwhelming as it sounds. Simply put, it is an effective way of exchanging information much the same way as the global telephone network. Just like a spider web, the web [read more..]
Systems On Option Trading Explained Stock option trading has always given the traders additional work of not just predicting correctly the securitys price. They also must choose the best option for trading strategies. But most stock tra [read more..]
Dealing With The Best Credit Card Offer Credit cards are considered the most widely used modes of paying different types of bills. Payments may range from small to big amounts.When it comes to obtaining a credit card, there's always a [read more..]
Adwords Miracle With job security as a thing of the past, people have started to look at the internet as a way to provide additional or full time income for themselves. Many people have looked to Adwords as a source [read more..]
Muiltimeters or Test Lights I have been to a lot of car audio shops that use test lights, and not as many that use digital multimeters. Is one really "better" than the other for finding power sources?Absolutely! A test [read more..]
Sex And The City (Season 2) DVD Review Based on Candace Bushnell's best-selling book, Sex And The City became one of the most successful and widely lauded original HBO series ever. Premiering in the summer of 1998, it follows the live [read more..]
Forex Technical Indicators Revealed The forex market is said to be one of the largest places known to the business people. Trading has become a part of man's life since time immemorial. Needless to say, it is an opportunity that pr [read more..]
Recumbent Stationary Bikes The world of stationary bikes and exercise equipment in general is on the verge of major revolution. This may be due in part to the overwhelming success of such interactive video games as Dance Dance [read more..]
Internet Banking Means Fewer Hassles for Students College freshmen face a long list of hassles when they leave home for the first time and move into a dorm or their own apartment. Today, thanks to the growth of Internet-based banks, setting up a chec [read more..]
Loans for Unemployed It is one of lifes small cruelties that the times when you need credit most badly, are also the times when lenders are least willing to give it to you. When you are finding it hard to meet your obliga [read more..]
How To Get Started Writing Articles If you are a new or budding writer, then you may be wondering how to get started writing articles. The first and most important rule of writing is simply to write what you know. That is not to say tha [read more..]
What Would You Prefer To Eat Weve entered the Twilight Zone when it comes to the multitude of diets being promoted today. Starting with the Atkins Diet, then the South Beach Diet, now the Hamptons Diet and more. All higher in pro [read more..]
Bathroom Remodeling: Should You Change Your Bathroom Theme Are you a homeowner who has recently decided that you would like to have your bathroom remodeled? If so, why would you like to have it remodeled? One of the most common reasons for bathroom remodelin [read more..]
Film Graduate Ranking School The filmmaking business is becoming more and more competitive With the number of other aspiring filmmakers like you increasing every year, one would expect such degree of competition in the business. So give yourself an edge by attending a film graduate ranking [read more..]
Battery Life – Expectations The life of a battery bloc can vary dramatically especially when used in a UPS System , the manufacturer will always state the expected life of a battery bloc on the proviso that it has a pure dc floa [read more..]
Free Rent Online Movie Have you been late in video movie store? Most of us prefer to rent a movie from movie stores but sometime when we return, we couldn't tell whether we are angry, disappointed, or just having abou [read more..]