Inside Medicine. What Are You Seeing? [COVID-19 medical news]

Yes, ventilators can cause problems. That is why anyone in medicine views all the recent calls for more ventilators as an ominous development. You do not ever want to be on a ventilator if you can possibly help it. Avoiding the need for ventilators in the first place is of prime importance. Short term mechanical ventilation that is required during a surgery is not in the same ballpark, of course. I am referring to ventilation required because the patient is unable to maintain oxygenation on their own, as well as long term ventilation.

Ventilators are the cause of many problems in premature babies as well. Of course, they may need ventilation in order to survive, but this is not a magic bullet. They pay a price in other ways.

Noninvasive ventilation was always the preferred method for patient safety but it increases risks for providers, so thatā€™s the trade off.

Twice in the last few months my dad was on a ventilator for days. In each case, it took them about three days to wean him off it. The second time, the doctor really thought he was nearing the end. He went home on hospice and signed a DNR order, We thought he would crash again, but he hasnā€™t. Heā€™s not using any oxygen at all at home! Itā€™s so bizarre. But we know it is absolutely critical that he not get this virus.

I think this goes hereā€¦

I had a medical thing yesterday. There was a person in the foyer outside of the actual waiting room. Everyone with an appointment had a series of questions asked of them. Plus temperatures were taken for everyone as well. They had masks for anyone who showed up without one. They were required in the medical practice areaā€¦including waiting room. No exceptions.

During the check in, it was totally hands off. When i needed to use their stylus, they wiped it with sanitizing wipes, and held it up to me by the wire cord. Screen was also wiped off before I needed it.

Chairs in waiting room were very spread apart.

My appointment was at 1:15 and by 1:48 I was in my car heading home. Usually this is an hour plus visit with the waiting.

Very I impressed with their protocol.

What Doctors on the Front Lines Wish Theyā€™d Known a Month Ago
Ironclad emergency medical practices ā€” about when to use ventilators, for example ā€” have dissolved almost overnight.
https://www.nytimes.com/2020/04/14/nyregion/new-york-coronavirus.html

DH cancelled a non-essential appointment today and the office was very surprised by this. They are open and the receptionist said the doctor thinks things are ā€˜perfectly safeā€™. DH politely declined.

Yeah, our allergist was somewhat surprised but respected us when we said we wouldnā€™t be coming in. She offered is a telehealth visit, so we accepted that and the 3 of us participated one at a time. We felt much better staying away from her office which is connected to our major hospital, which has been handling MANY of our stateā€™s COVID-19 cases.

My UCSF lung doc says heā€™s lost 2 family members to this disease already and several good friends. He was upset and astounded that at a Golden Gate Park, folks are playing, picnicking, jogging, and NOT social distancing.

The geriatrician is doing a zoom call with mom tomorrow.

I rescheduled an ortho appointment my mother had for early next week. Itā€™s a follow-up for the broken hip she suffered last fall. They offered a telehealth option but she doesnā€™t have or want internet.

ED census is low, acuity high. They are mandating sending staff home.

My 80 year old dad went for MRI last week. They gave him the first appointment of the day, had him sit in the car until everything was ready, opened every door for him, and he didnā€™t see any other patients and only interacted with the technician. Great job.

Having blood work tomorrow. That canā€™t be done with teletherapy?. But all appointments were available which is very unusual with this lab. I just scheduled this morning. I am guessing they are doing less work because there arenā€™t doctors ordering bloodworkā€¦since most visits that are not essential arenā€™t happening.

The lab also has reserved the first two hours of the open schedule for folks 60 or over.

Was alerted by a colleague about another promising vaccine. Of course, testing must be done before anyone gets too excited.

I am proud that it comes from a University research facility.

https://www.upmc.com/media/news/040220-falo-gambotto-sars-cov2-vaccine

What part of the country?

D2 needs bloodwork too. As this requires pretty close contact, hoping they are accounting for that with PPE or other protective measures.

My 9 month GD needs bloodwork and my daughter said the childrenā€™s lab is not taking appointment; it is still walk in! Hopefully it will not be busy, or both parents can go while one stays in the car until they are ready for her. It is at the Childrenā€™s hospital, so one would think they are taking all precautions necessary, but you never know.

Anecdotally, Iā€™ve heard first hand reports from Washington state, Utah, New Mexico, California and Connecticut.

Some Seattle area EDs cutting doctor shifts dramatically and including a pay cut for the hours that are worked.

I have posted on other threads that I had a very bad accident last summer requiring surgical reconstruction of my ankle. I am scheduled for another surgery in July to have extensive hardware removed.

I had a telemedicine visit with my surgeon today who up is at one of the large teaching hospitals in downtown Boston. He sounded very optimistic saying ā€œI think we will be open for business by the first of Juneā€œ for non emergency surgery.

I sure hope he is right and that our area is about to take a turn for the better.

Local hospitals are doing the same thing.^^^^ Lovelace Hospital and Medical Center (ABQ) has furloughed furloughed 15% of its staff. Christus St Vincent Hospital (Santa Fe) has furloughed 14% of its staff. Memorial Medical Center and Mountain ViewRegional Medical Center ( both in Las Cruces) have furloughed employees. Mountain View put 125 employees on 2 months unpaid leave and reduced all remaining staff salaries by 10% across the board. San Juan Regional Medical Center in Farmington (rural but in the middle to oil country and one of the stateā€™s big CV-19 hot spots) is furloughing all of its staff except emergency and urgent services personnel. All hospital services other than emergency and ICU have closed.

Intermountain Healthcareā€“the largest provider of medical care in Utah and southern Idahoā€“has cut staff salaries across the board and told physicians in out-patient primary care and procedures-heavy surgical specialties that they may be furloughed. . Stewart Healthcareā€“which owns 5 hospitals, 12 outpatient clinics and ARUP (the stateā€™s only coronanvirus testing faciliity) in Utah is furloughing some staff and reducing wages/salaries for those still working.

Neighbor across the streetā€™s daughter is an ER nurse in the state largest hospital and only Level 1 emergency center and she has only been working about 2/3 of the shifts sheā€™s been assigned to. Usually she get a call before her shifts starts and is told not to bother coming in.

We live in TN and our hospital system furloughed a lot of people last week.