Most of you following the COVID threads know I work as a PA in critical care. Smallish community hospital on the border of DC/MD. Today the floodgates opened and we’ve been overrun with COVID patients. Here’s the quick snapshot of what that looks like.
COVID patients in the ICU have doubled each of the last two days. It was a slow trickle at first, over the last two weeks. That phase is over. Game on.
Most admitted to ICU end up on the vent. Our entire neuro/surgical ICU (16 beds) is full with COVID and suspected COVID patients. They are now overflowing to the main ICU, as expected, as well as isolation rooms on the above floors. I don’t know the total number, as it changes by the minute. We’re treating suspected as infected, for obvious reasons. The drain on resources is tremendous. Time, personnel, logistics, PPE, everything. It’s like operating in a completely different environment now, versus two days ago.
WE DO NOT HAVE ADEQUATE TESTING. We’re still looking at 5-7 day turnaround for results, which clogs up the system with patients who could be ruled out and moved out, making room for more COVID positive patients. We were told we’d have in-house testing on the 28th. Problem is the reagent won’t be available to us for another TWO WEEKS, which roughly correlates with the anticipated peak for this area, according to a few resources. We are not alone in this problem. When Trump or anyone says that testing is adequate, bullshit. We’re so far behind the curve, it’s embarrassing and causing so many downstream problems, I can’t begin to list them all.
Also contrary to what the administration is saying, we are taking measures to make certain patients DNR/DNI on arrival. I know this because I just made this happen. I responded to a rapid response on the main floor for a nursing home patient with advanced dementia and a host of problems came in Full Resuscitation, then developed worsening respiratory symptoms, to the point where an oxygen mask is barely adequate. I called my critical care colleague, and the managing Hospitalist, and gave my recommendation. The CC colleague called the top administrator in charge of these decisions, and within minutes the code status was changed to Do Not Resuscitate, Do Not Intubate. Neither the patient nor the next of kin have a say in this now. There is no recourse. And I guarantee you this is happening across the country where the numbers of admissions are spiking. If you have a family member nearing the end of life, you should expect to encounter this in high COVID rate areas.
The staff, nursing and respiratory therapists in particular, are CONSTANTLY exposed to these patients, far more than the PAs or MDs. And they’re terrified. These are critical care nurses who’ve been there and done that. When COVID patients on vents—presuming they’re available—start hitting the other units, the nurses will be overwhelmed. This is coming, and it’s going to be ugly. I’m staying here overnight again to help out, and working the noon shift tomorrow. I’ll probably stay tomorrow night as well, and will sleep when I can. It’s an all hands on deck situation now, and if one hand goes down, boy are we screwed. It will decimate our capacity to manage all these patients. I’m supposed to be off for 7 days starting...whatever two days from today is, but I fully expect to be here almost every day. Some of my colleagues are immunocompromised and they need to limit their exposure time.
We are reusing PPE that should be one-time use, and “sterilizing” as best we can. I don’t know what the supply line looks like now, but we’re not the only ones with increasing demand, so I’m not holding my breath.
We have had two COVID patients improve. Neither of them required ventilators. Zero deaths so far. Roughly half of our COVID patients are on vents. None have come off yet or showed much improvement. Their chest X-rays are atrocious. This thing is no joke. Keep yourself and especially your sick or elderly friends and family as far from this virus as possible.
The devil made me do it the first time, second time I done it on my own - W
COVID patients in the ICU have doubled each of the last two days. It was a slow trickle at first, over the last two weeks. That phase is over. Game on.
Most admitted to ICU end up on the vent. Our entire neuro/surgical ICU (16 beds) is full with COVID and suspected COVID patients. They are now overflowing to the main ICU, as expected, as well as isolation rooms on the above floors. I don’t know the total number, as it changes by the minute. We’re treating suspected as infected, for obvious reasons. The drain on resources is tremendous. Time, personnel, logistics, PPE, everything. It’s like operating in a completely different environment now, versus two days ago.
WE DO NOT HAVE ADEQUATE TESTING. We’re still looking at 5-7 day turnaround for results, which clogs up the system with patients who could be ruled out and moved out, making room for more COVID positive patients. We were told we’d have in-house testing on the 28th. Problem is the reagent won’t be available to us for another TWO WEEKS, which roughly correlates with the anticipated peak for this area, according to a few resources. We are not alone in this problem. When Trump or anyone says that testing is adequate, bullshit. We’re so far behind the curve, it’s embarrassing and causing so many downstream problems, I can’t begin to list them all.
Also contrary to what the administration is saying, we are taking measures to make certain patients DNR/DNI on arrival. I know this because I just made this happen. I responded to a rapid response on the main floor for a nursing home patient with advanced dementia and a host of problems came in Full Resuscitation, then developed worsening respiratory symptoms, to the point where an oxygen mask is barely adequate. I called my critical care colleague, and the managing Hospitalist, and gave my recommendation. The CC colleague called the top administrator in charge of these decisions, and within minutes the code status was changed to Do Not Resuscitate, Do Not Intubate. Neither the patient nor the next of kin have a say in this now. There is no recourse. And I guarantee you this is happening across the country where the numbers of admissions are spiking. If you have a family member nearing the end of life, you should expect to encounter this in high COVID rate areas.
The staff, nursing and respiratory therapists in particular, are CONSTANTLY exposed to these patients, far more than the PAs or MDs. And they’re terrified. These are critical care nurses who’ve been there and done that. When COVID patients on vents—presuming they’re available—start hitting the other units, the nurses will be overwhelmed. This is coming, and it’s going to be ugly. I’m staying here overnight again to help out, and working the noon shift tomorrow. I’ll probably stay tomorrow night as well, and will sleep when I can. It’s an all hands on deck situation now, and if one hand goes down, boy are we screwed. It will decimate our capacity to manage all these patients. I’m supposed to be off for 7 days starting...whatever two days from today is, but I fully expect to be here almost every day. Some of my colleagues are immunocompromised and they need to limit their exposure time.
We are reusing PPE that should be one-time use, and “sterilizing” as best we can. I don’t know what the supply line looks like now, but we’re not the only ones with increasing demand, so I’m not holding my breath.
We have had two COVID patients improve. Neither of them required ventilators. Zero deaths so far. Roughly half of our COVID patients are on vents. None have come off yet or showed much improvement. Their chest X-rays are atrocious. This thing is no joke. Keep yourself and especially your sick or elderly friends and family as far from this virus as possible.
The devil made me do it the first time, second time I done it on my own - W