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..]
Getting a Loan When You’re a Tenant Wherever we go these days we're bombarded with offers of credit, whether loans, credit cards, remortgages – there seems to be no end to the number of companies asking us to consider applying for [read more..]
Copper Canyon Sierra Tarahumara, popularly known as Copper Canyon is situated in Mexico. The area is a favorite destination among those seeking an adventurous vacation. Copper Canyon is one of the six gorges in the [read more..]
Summary: The basic facts about and why it is one of the most famous travel destination is s Valley Isle and its second largest island. Its 729 square miles of land area is home to about 117,644 human population, made up mostly of Caucasians. Some other ethnicities that comprise popula [read more..]
Which RC Car Is Right For You RC Cars offer all the excitement of motor racing at a fraction of the cost. They also offer a safe form of motor sport and allow youngsters to begin to understand car control at a very young age.There [read more..]
Realize What No Other Can We have thousands of choices we can explore in order to reach our ultimate destination. Some of these pathways appear safe, so many of us prefer to try this route. And while this path can be blissfull [read more..]
Birdwatching Binoculars If you have been scouting for birdwatching binoculars, all you have to do is to purchase the best You may find the advice very ambiguous because what is best for you may not be best for others. That in itself is a very good point. A great suggestion then is to search over the internet on what the [read more..]
ZAP that zit I would be fairly safe saying that acne is amongst the most hated skin afflictions. It's certainly one of the most prominent ones, if not the most. Once you hit those puberty years, all bets are [read more..]
Small Business Success Small business is again in transition. Many employees, now working from home, are no longer tied to a geographic office and the woes of commuting. This is a relatively new phenomenon with hints of exp [read more..]
Sugar Substitutes What if you could drink all the soda you wanted and never get fat? To some peoplecomputer programmers, harried editors, every ten year old in the worldthis sounds like heaven, while others shudder at [read more..]
Dressage Competitions and Riding Copyright 2006 Rob DanielsAt the lowest levels, dressage tests are very simple, with the emphasis on basic training. At its basic level, if you make your horse move forward, or stop, you have performe [read more..]
Family Travel Tip Kid: 7 Ways To Make Traveling With Your Kids Easier Its family vacation time and while its great to get away and have a wonderful time together, these trips can also be a nightmare for adults when children become restless and bored.Kids see the world d [read more..]
What Does It Take To Make Chocolate Chocolate has been around for many years. This was first used by the Native American civilizations as a refreshment but soon, this was developed into chocolate bars which we all eat today. But what do [read more..]
Titanic (DVD) Review Nominated for 14 Academy Awards and winner of 11 including Best Picture, Titanic became a worldwide phenomenon upon its release in 1997. Written and directed by James Cameron, the producer behind such [read more..]
Traditional Futon Beds Futon is Japanese traditional furniture, basically a mattress that makes up a bed which is still commonly used today. Futons first appeared as weed-made rags in ancient Japan. A traditional futon set [read more..]
Contributing Factors and Subsequent Snoring Remedies Snoring is the noise produced through vibrating throat components. This occurs only during sleep since this is when our muscles are most relaxed. Relaxation of the muscles can inhibit the passage of n [read more..]
Grosfillex-Quality Brand, Quality Melamine Tables Grosfillex is the number one brand name in outdoor resin patio furniture. Famous for its resort and food service grade quality patio furniture, it is also ideal for residential patio furniture. Grosfi [read more..]
Website Performance And Load Testing Your company is rolling out its new web application. This web application is well designed and attractive. It has been well tested by your quality assurance group. You have spent a lot of money market [read more..]
Avoid Home Foreclosure – Facing Foreclosure If you are facing a foreclosure, there may be options to negotiate a workout program with your lender. To get help with a foreclosure you have to start by talking to your lender. Help is available if [read more..]
Ash herbal KWD: 13516 2.51 Ash herbalAsh is a tree that grows between 33 ft to 99 ft. It has hairless and grayish-green branches. Flowers are bisexual and have no petals. You can see reddish stamens before th [read more..]
Skin Care: From an Inner Radiance to an Outer Glow When we were young, our mothers may have told us to take care of our skin, but did we listen? Or did we spend our summers baking in the sun and our winters bracing against the cold and frost with nary [read more..]
Mixing Of The Breeds You might know of them as 'mongrels', 'mutts' or have heard some more colorful descriptions like designer breeds. Whatever you call them they are the result of either deliberate or [read more..]
Mudras Hand Symbolism: Mudras of the Esoteric Christian Tradition Part 2 The Channeling HandsThere are times when we need to direct healing energy to a person. This may be done with the Channeling Hands. Although there are many techniques and methodologies for channeling e [read more..]
Sun Will Only Burn For 5 Billion More Years; Humans Express Concern We are often reminded that the sun will only shine in a way that can support life way out here on the earth for only about another five billion years. Sensing the eventuality of the cataclysm, were ea [read more..]
Why You Should Stay At A Kailua Kona Hotel Are you in the mist of planning a Kailua Kona vacation? If so, did you know that you are planning to vacation in one of the most popular areas of Hawaiis Big Island? At a destination as popular as Kai [read more..]
Flower Tattoos Back in the late 18th century, the queue for flower tattoos was made up mostly of the upper classes. Now, celebs lead the tattoo trends, with some even changing tattoos as quickly as they change cloth [read more..]
Discount Hardwood Floors Hardwood floors do not come cheap. In fact, compared to concrete and synthetic materials, pure hardwood floors are more expensive, primarily because it comes from an exhaustible resource. It takes yea [read more..]
Mothers Daughters, Sells Buyers Who said language doesn't matter in making relationships work?In an interview with Deborah Tannen, whose new book, You're Wearing That?Understanding Mothers and Daughters in Conversation, ha [read more..]
1 Million Gsa Backlinks, the term that has been buzzing around the search engine optimization area,
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Here is my blog – Tiered link building with GSA SER
Emergency Payday Advance Myths Debunked Need instant cash? Apply for a payday loan. Quite a simple solution, isn't it? While the popularity of pay day advances is growing, so are the myths surrounding them. If you are applying for payd [read more..]
List of Brokerage Firms Bolsa Mexicana de Valores is the main stock exchange of that can be located in the glamorous area of Paseo de la Reforma. It is an exclusive corporation with the trades that comprised of legal broker [read more..]
Jigsaw Puzzles: Food For The Mind, Heart, And Soul Jigsaw puzzles are normally viewed as learning toys. They are said to do wonders for one's mood and mind. Yet which assumption is right and which one is not?What Educators SayJigsaw puzzles are s [read more..]
Currency Trading Course Experiences A currency trading course may analyze the details of currency trading in a different perspective. It is similar to a Forex Trading course in many ways. Let us see what is the difference between the tw [read more..]
Organic Vegetable Gardening Information Organic vegetable gardening is making a comeback. This is because people are more health conscious about the food they eat and in some places, there is already a food shortage so some have decided to [read more..]
Writing SEO Copy – 8 Steps to Success We all know that the lion's share of web traffic comes through the search engines. We also know that keywords and links to your site are the two things that affect your ranking in the search engi [read more..]
The Anti-Social Mobile Effect Traveling with any type of public transportation vehicle today in a metropolitan city, one could easily assert that the common mobile use has embraced different societies and penetrated the communicat [read more..]
Golf Swing The golf swing is probably one of the most frustrating parts of the game of golf. People are constantly modifying their swing to get more distance or to correct problems like a slice or a hook. Real [read more..]
Keyword : Benefit of Ginkgo Biloba KWD : 14431 3.24Benefit of Ginkgo BilobaUsing ginkgo biloba could redound to a number of benefits. Ginkgo biloba being an herb with medicinal components is used to treat various ailments. For c [read more..]
Impressions of Russia Whenever you travel to a country, it is important to avoid the tourist traps and get to know the locals. Here are my impressions of Russia.Created in the 12th century, Russia was originally a much sma [read more..]
Bad Credit Loan Bad Credit Loans are specially designed for individuals who are facing problems with their credit history. Bad credit loans help to cater the monetary requirements of borrowers who are having a bad cr [read more..]
How Safe Is Your Credibility Records Fond of purchasing on credit using your different Credit Cards account? If you are one, you pay more in interests than getting a personal or character loan from a lending bank categorized as having to [read more..]
Acquiring And Using Testimonials For Your Product, Service Or Website One of the most effective ways of persuading potential customers is by providing social proof of the value of your product. This proof is usually in the form of a testimonial from a satisfied customer [read more..]
Business Idea With Your Own Home Computer Since the invention of Home Computer in the 1980s, even the inventors did not prejudge, that this technology is born to help millions of people throughout the globe to earn substantial money from thei [read more..]
The Benefits Of Pagers The use of pagers was once limited to medical professionals (as in, Paging Dr. So-and-so, paging Dr. So-and-so!); however, there are many people who currently use pagers and love the way that pagers a [read more..]
Real Estate Golf Courses at Myrtle Beach Summary:Real estate couldnt get anymore classic. With gorgeous houses located over the green such as that on Crow Creek Golf Course, even non golfers would be hard pressed into acquiring real estate o [read more..]
Facts and Figures about the Presidents of the USA The first president of the united States was not George Washington. Washington was the first president under the Constitution of June 21, 1788, ratified by 1790.The first constitution of the USA was t [read more..]
The Front Page On World Of Warcraft First came computer games. Then came DSL, and broadband online access, followed very closely by computer games where you can play with other real people sitting in front of other real computers, somew [read more..]
Assumption, Assuming a Mortgage An assumption is the agreement between the buyer and the seller where the buyer takes over the payments on an existing mortgage from the seller. Assuming a mortgage can usually save the buyer money si [read more..]
Identity Theft – Straightening Out Your Credit In The Aftermath FBI statistics reveal that identity theft is one of the fastest-growing crimes in the United States, with about 1 in 5 families in the U.S. being a victim of identity theft. Identity theft is obtaini [read more..]
A Trustworthy Loan by More Gross As a Secured Loans UK, your faith and trust is what we value most. Hence when you take a personal loan from us, Secured Loans UK promise to make your experience a pleasant one- from the first time you [read more..]
Where to Find Full Length Fur Coats Got a taste for full length fur coats Several stores have been selling it and its nice to know that many of these products are accessible online with a number of fashion boutiques and stores out there in the cyberspace featuring full leng [read more..]
Americans with Disabilities Act The Americans with Disabilities Act, which is signed into law on the 26th of July 1990, is a comprehensive legislation intended to make the American Society more accessible to people with disabilities It is divided into five titles such as: 1. Title I Employment. Businesses must provide reasonable accommodations to protect the rights of individuals with disabilities in all phases of employment. Po [read more..]
IS Clinical Active Serum – Repair Damaged Skin IS Clinical Active Serum can be considered one of the best skin medications. IS Clinical Active Serum is formulated to rapidly reduce and fight the signs of aging and to repair damaged skin by exfoli [read more..]
An Easy Way To Make Your Small Business More Visible-For Free No two small businesses are alike, but most want to be like their larger counterparts in some key respects. For example, even if you own a company with only a few really great customers, you want to b [read more..]
Window Trim For any window to really look beautiful and attractive, a window trim is needed Window trim is a wooden design that is fitted at the outer frame of the windows. Its purpose is both aesthetic and functional. It protects the windows from falling through the support that it lends an [read more..]
Ensuring Safety Around The Helicopter What you know and you dont know about safety around helicopter could make a big difference.Here are some important information you must know in order to be safe around the helicopter at all times:Appr [read more..]
Tips for Entrepreneurs Opening a Restaurant As entrepreneurial enterprises are concerned, opening a restaurant is by far one of the hardest endeavors to undertake. While the rate of restaurant failure isn't nearly as bad as it's purp [read more..]
Indie Music Indie music is a type of alternative rock which exists in the independent music world. The word is periodically used to refer to all underground music, and is the opposite of indie pop music. Indie ro [read more..]
A Quitter Never Wins And A Winner Never Quits Bottom line that8217;s the difference in the mindset between a champion and just another fighter. The difference between winning and losing. This is the attitude you must have to overcome all the obst [read more..]
Plumbing If you have ever gone camping for a weekend, you know it doesn't take long to miss running water, flushing toilets, clean clothes, and hot showers. These modern conveniences are the benefits of p [read more..]
SEO Leveraging Your Content On The Way to Google Heaven The Search Engine Optimization Quality guidelines have a direct impact on how search engines rank your website in search results and your websites page rank. While they are listed as suggestions wise [read more..]
Shopping For Cheap Musical Instruments Shopping for musical instruments could be a costly affair if quality and performance are the main criterias. The best quality electric guitar costs above 2000 and good keyboards are priced anywhere be [read more..]
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