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Old 03-28-2020, 06:47 PM   #1161
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You forgot
SARS (Severe Acute Respiratory Syndrome) - SARS virus is from a group known as coronaviruses, which also cause the common cold.
SARS wasn't named after a place a country or even a convention. All the named ones were.
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Old 03-28-2020, 06:51 PM   #1162
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What is this about someone vowing to disregard, not comply, with specific articles of the emergency funding bill? The someone who signed the bill into law, and articles specifying oversight and accountability procedures for the $500,000,000,000 of corporate relief?
This bill is socialist and has broad support. You commies!
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Old 03-28-2020, 08:59 PM   #1163
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I lost a good friend Thursday evening from this damn virus, he was only 55.

https://www.popfuneralhome.com/obituary/mark-wittkamper

His wife died from cancer a year ago March 8th, they leave behind a 17 year old son and 14 year old daughter.
He hadn't been in the best of health since his wife died, lots of stress but nothing I would have thought could have led to his death.
He ended up having 7 tests and 6 came back negative for the virus but his doctors said he had crystalizing in his lungs and were sure it was corona, then the 7th test came back positive the day before they took him off the ventilator and he passed.
He wasn't a bike guy but we shared a passion for trap shooting and guns.
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Old 03-28-2020, 09:13 PM   #1164
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I'm very sorry to hear that Mike. May he rest in peace and I hope for the best for his kids.
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Old 03-28-2020, 10:39 PM   #1165
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I watched a video from a doctor who repeated much of what I had heard before but presented it in a way that came through. This doctor was confident he would not contract the disease because he was especially mindful of how it is transmitted.

1% of the infected would get it simply from being in a small closed environment like a room with doors closed or in a car with an infected person for about 15-20 minutes.

But 99% would get it from touching an infected person or object and then touching their face with that hand where it enters through the eyes, nose, or mouth.

This doctor had trained himself not to respond to the unconscious and reflexive reasons we all touch our faces, scratching an itch, adjusting eyeglasses, wiping watery eyes, cleaning perspiration, etc.

It may be tough to do but we should all try to do the same and consciously avoid this predominant method of infection when we are out in locations of risk.

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Old 03-28-2020, 11:30 PM   #1166
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Originally Posted by okaugust View Post
None of us wants to lose our own loved ones. But doing it kike this is going to be the worst.
This virus means instant pneumonia for the vulnerable, as it moves quickly, goes straight for the lungs, and even damages the heart.

People like my wife will likely die if they get this virus—even if—and that’s a big if—she can get health care in an overwhelmed system. She has asthma and an immune deficiency. She’s an impressive, hard-working women who for a time traveled to the UN in Geneva twice a year to help draft international treaties that supported and protected American democratic values. We don’t need to lose her.

People are showing up at ERs with a dislocated shoulder and after a chest x-ray found to have bilateral pneumonia (which can quickly kill you) and COVID but are asympomatic so don’t know they have the disease and should self-isolate, meaning many people unknowingly infecting other people as the virus hangs around aerosolized in a room for three hours and survives on some ideal surfaces for days.

If you want to know more about how shockingly bizarre and evil this virus is, then read this account from a verified ER doc in New Orleans:

https://texags.com/forums/84/topics/3102444/1
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Old 03-29-2020, 06:24 AM   #1167
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I’m just curious. Are we getting into politics? If so, may someone from the deplorable masses participate?
Agreed I choose not to declare Mutiny on the Lifeboat.

20/20 hindsight from those that missed it completely in Dec, Jan and Feb is comforting during a disaster.
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Old 03-29-2020, 06:39 AM   #1168
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One thing I do not worry about much is the economy especially that of the US. People need to consume and there never has been a system more adaptable to shocks and more consistent in creating wealth than the US economy (we are so integrated that economically I include Canada in this) In fact it I believe it will come back stronger than ever after this pruning. All you have to do is nothing.
We should focus on is the pandemic for now and do everything minimize its impact. It will run its course, all viruses do and we will be off to the races.
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Old 03-29-2020, 06:43 AM   #1169
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Agreed I choose not to declare Mutiny on the Lifeboat.

20/20 hindsight from those that missed it completely in Dec, Jan and Feb is comforting during a disaster.
It isn't just hindsight though. There was lots of foresight ignored too, everywhere. I agree though it is irrelevant now and all of the second guessing, however valid, can wait.
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Old 03-29-2020, 08:19 AM   #1170
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Where do vegetables send their children when school is out during the summer? John cougar Mellencamp.

Who would have thought old John cougar would have one of the most memorable lines in all of music? Oh yeah, life goes on, long after the thrill of living is gone!

That should cheer everybody up
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Old 03-29-2020, 08:28 AM   #1171
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My wife's uncle has it, in California. He has anywhere from a couple days to a week to live. None of us can see him. I'm at a loss for words right now. Crushed.
Quote:
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I lost a good friend Thursday evening from this damn virus, he was only 55.
So sorry to hear of both of these. No matter the what, why, or how, life and love matter, especially when we lose them.


Quote:
Originally Posted by Harry1976 View Post
we shared a passion for trap shooting and guns.
Hang on to the good times.
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Old 03-29-2020, 08:34 AM   #1172
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Doc says, "Joe, I got some bad news for you. You've got six months to live." Joe says, "Six months? Doc, I can't pay your bill in six months, I can't do it!" Doc says, "OK, I give you a year..."
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Old 03-29-2020, 11:17 AM   #1173
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It isn't just hindsight though. There was lots of foresight ignored too, everywhere. I agree though it is irrelevant now and all of the second guessing, however valid, can wait.
Well I beg to differ. It's vital that we do NOT wait.

As far as I know, there is no vaccine for stupidity. If you were stupid enough to ignore widespread scientific consensus about the danger of this virus, then you have a TERMINAL case of stupidity. You should be quarantined from the rest of us until the danger has passed.

It's tough love. But we need to save the planet from the morons. ESPECIALLY the ones who hold news conferences.
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Old 03-29-2020, 11:20 AM   #1174
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Doctor says "Fred I have some good news and some bad news."
Fred: "Give me the bad news".
Doctor: "You don't have long to live".
Fred: "What's the good news?"
Doctor: "You already paid for this visit".
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Old 03-29-2020, 11:53 AM   #1175
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The first thing you feel from most infections is your immune response. I'm a little sniffly and sickly right now because of my pollen allergies, no infection at all. Sometimes, I even get fever. So this thing doesn't do that. No one has an immediate immune response. This ER Dr from NOLA says that one of the features is bilateral pneumonia severe enough to cause hypoxia, with no elevation of WBCs.

Here's what he said a couple of days ago.
Quote:

"I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know:

• Clinical course is predictable.

• 2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.
• Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.
• Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours.
81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.
• Patient presentation is varied. Patients are coming in hypoxic (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT's of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it.
• Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.
• China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.

Diagnostic
• CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.
• Labs- WBC low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
• CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
• Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal failure and on the vent sooner.
• Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.
• A ratio of absolute neutrophil count to absolute lymphocyte count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.
• An elevated Interleukin-6 (IL6) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.
• Other factors that appear to be predictive of poor outcomes are thrombocytopenia and LFTs 5x upper limit of normal.

Disposition
• I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won't make it back.

We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.

Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the "lockdown", our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.

Treatment
• Supportive worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.
• Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post.
• We are also using Azithromycin, but are intermittently running out of IV.
• Do not give these patient's standard sepsis fluid resuscitation. • • Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.
• Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps.
• Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed.
• Do not use Bipap- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours.
• The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI. Use only if wheezing which isn't often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room.
• Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI/bronchitis.
• We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads.

One of my colleagues who is a 31 yo old female who graduated residency last May with no health problems and normal BMI is out with the symptoms and an SaO2 of 92%. She will be the first of many.

I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg.

The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all."












.





James C Brown






James C Brown Mark Long “More transmissible and fatal than seasonal influenza, the new coronavirus
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Old 03-29-2020, 11:58 AM   #1176
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This:
Quote:
Even after a cough or sneeze this virus can aerosolize up to 3 hours.
And this: Dude doesn't remove his PPE even to drink water for the whole shift, 12 hrs.

Quote:
PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg.
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Old 03-29-2020, 01:49 PM   #1177
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Damn, that sounds like something from a war zone!
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Old 03-29-2020, 01:55 PM   #1178
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Just lost a guy in my moms neighborhood. 40 years old. Healthy. Went into the ER last week, dead 5 days later from CV19. Wife and kids are quarantined at home still.
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Old 03-29-2020, 02:15 PM   #1179
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Oh fvck. That is awful. This is getting really ugly.
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Old 03-29-2020, 03:23 PM   #1180
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Damn!
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