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Started By
Message
re: Ventilators have been a shitty, 20th century "solution" for a long time.....
Posted on 4/10/20 at 8:22 am to RoyalAir
Posted on 4/10/20 at 8:22 am to RoyalAir
quote:
I appreciate the clarification. Like I said, it was part of my understanding. Happy to be incorrect.
Sorry to sound snarky...
I know the average lay-person doesn’t understand how critical care medicine works, nor should they..
This post was edited on 4/10/20 at 8:23 am
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Posted on 4/10/20 at 8:22 am to DMAN1968
quote:Hyperbaric probably wouldn't help much in this situation. Unlike carbon monoxide poisoning where hyperbaric treatment causes the hemoglobin to release the CO more quickly, my understanding with this disease is that the Hemoglobin is permanently damaged rendering it incapable of transporting oxygen. Hyperbarics would increase the amount of oxygen dissolved in the plasma but only for the time that you are in the chamber. Most monoplace chambers use 100% oxygen and the time is limited to 90 minutes or so at 3 ATA. Multiplace chambers use a face mask and you can do air breaks and lengthen the time you can stay in there but few places have a multi place chamber and if they do, there is likely a 4 person chamber in addition to attendants.
Hyperbarics is not my thing but seems like someone would have tried it by now, at least on some of the less (less being not just now needing a vent) critical patients. I know some of these hospitals have chambers.
Posted on 4/10/20 at 8:25 am to shrevetigertom
quote:
How many more times are you gonna say this?
Until there stops being threads about it. It’s a legitimate question to ask any press member doctor governor etc whether or not they would take hydroxychloroquine if they were admitted to the hospital with covid and it’s a legitimate question to people who make negative threads about the vent if they wouldn’t get intubated. I don’t think anyone with legitimate understanding of the issue thinks that the vent is actively healing anyone. The only thing it does is prevent someone from dying due to respiratory failure. So it’s a choice of essentially 100% death or 80% death. Sure it’s not great odds but it’s very important to that 20%. People are very easy to make that decision for others but when it’s themselves in that place then things look a little bit different (and this applies to both the vent and hydroxychloroquine)
This post was edited on 4/10/20 at 8:26 am
Posted on 4/10/20 at 8:29 am to Diamondawg
You know it’s weird...
This disease is mimicking co poisoning. Higher SPO2s with lower Po2, but the blood is really dark like with metahemoglobinemia. There’s this weird blood separation going on. When I do gasses, the bloods separates really fast with a definite line like it was actually spun down..
This disease is mimicking co poisoning. Higher SPO2s with lower Po2, but the blood is really dark like with metahemoglobinemia. There’s this weird blood separation going on. When I do gasses, the bloods separates really fast with a definite line like it was actually spun down..
Posted on 4/10/20 at 8:31 am to tiger1014
quote:
Contrary to your Q research, you can’t give them a blood transfusion and cure their breathing problems
The problem with ventilation while infected with COVID is CO2 respiration through flooded aveoli. It’s just not happening. So people are dying from CO2 poisoning. If you hook up the patient to a Hemolung device while on ventilation then use the Hemolung device to strip CO2 from the blood while ventilators pump in O2 to complete the respiration cycle then you will see MUCH higher success rates. But Hemolungs are not readily available. Ventilation alone is incomplete when aveoli are filled with fluid. Doctors need to figure out a way to more successfully complete the patients respiratory cycle while the patient is under ventilation.
Posted on 4/10/20 at 8:35 am to GumboPot
quote:
CO2 poisoning.
Interesting, I’ve only seen 1 or 2 patients with ventilation issues, most are having issues with oxygenation..
Most have no issue with CO2 “blowoff”...
This post was edited on 4/10/20 at 8:36 am
Posted on 4/10/20 at 8:36 am to Hangover Haven
quote:
Problem is in the blood... You can give them all the Oxygen with different pressures, if o2 no longer has an affinity to the hemoglobin, it won’t be affective. I’m hearing some are being treated with blood transfusions..
Hyperbarics increases the amount of oxygen in the bloods plasma...by as much as 10-15 times. Which then flows around the body and helps oxygenate when and where blood cells cannot. It is used in cases of carbon monoxide poisoning.
It was just a thought...seems someone would have tried it.
Posted on 4/10/20 at 8:40 am to Adam Banks
Amateur question here, but curious nonetheless: Could plasmapheresis play a beneficial role in any way?
Posted on 4/10/20 at 8:41 am to Adam Banks
Here’s some anecdotal evidence for the thread:
Friend of a friend has been on a vent for 24 days. He’s had dialysis for more of those days than not. He was transferred to a large teaching hospital last week. Yesterday, they did one last trial wean before performing a tracheostomy. And, almost miraculously, he passed with flying colors. He’s breathing on his own this morning. The goal is extubation in the near future now.
So, yeah, the numbers are shitty for survival with a vent. But it probably means a lot to this family.
Friend of a friend has been on a vent for 24 days. He’s had dialysis for more of those days than not. He was transferred to a large teaching hospital last week. Yesterday, they did one last trial wean before performing a tracheostomy. And, almost miraculously, he passed with flying colors. He’s breathing on his own this morning. The goal is extubation in the near future now.
So, yeah, the numbers are shitty for survival with a vent. But it probably means a lot to this family.
Posted on 4/10/20 at 8:46 am to Adam Banks
quote:
It’s crazy how this anti Obamacare board is trying to ration the care and advocating possibly getting into a situation where care would have to be rationed and arbitrarily pulling granny off a vent
Huh? The main thing I've read is, due to the nature of covid, vents are much less of a lifeline for cv patients than they are for ordinary ARDS/pneumonia patients.
This isn't an R v D issue.
The discussion has taken off in med community, and it isn't just because of that one NYC doctor.
I can't believe I'm linking Talking Points Memo here, but since you apparently only speak TDS, maybe it will help:
LINK
quote:
Yesterday I noted an emerging debate within the critical care community of whether at least some critical COVID-19 cases are significantly different from standard Acute Respiratory Distress Syndrome (ARDS) and require a different treatment protocol. Since posting that piece I’ve found more evidence that this is a rapidly emerging discussion among critical care doctors and perhaps even some emerging consensus about how critical COVID-19 cases are different from ARDS.
This post was edited on 4/10/20 at 8:56 am
Posted on 4/10/20 at 8:53 am to Diamondawg
quote:
Diamondawg
I kind of thought the times would not be long enough...thanks for the info.
Posted on 4/10/20 at 8:55 am to the808bass
quote:
Friend of a friend has been on a vent for 24 days. He’s had dialysis for more of those days than not.
They’ve been doing what’s called Continuous Renal Replacement Therapies or CRRT, which is a little different from regular HD, amazing what that therapy does. It’s a life saver..
This post was edited on 4/10/20 at 8:56 am
Posted on 4/10/20 at 8:56 am to Adam Banks
quote:
The result is the opposition to cuomo now us going to the opposite of him and arguing against the vent. Just like the press with trump, if someone on the far left says jumping off a cliff is bad then we will get topics on this board extolling the virtues of cliff diving.
I'm not seeing that as a general trend - Of course there are some fanatics on both sides of any political issue - no "side" can claim to be "pure" - but usually one side is less 'purely evil' than the other.
I was responding to your 'death panel comment' - nothing else. perhaps I read too much into it.
I try really hard to understand the 'other' side point of view - and appreciate any rational discussion that results from that. Sadly, I do not see much rationality from the DEM side of the aisle on this board - or any other, to be frank.
quote:
The absolute right thing would be to move the vent to the younger person who had a higher chance of survival. I just don’t think it’s a situation that anyone wants to be put in. The doctor, the hospital, and yes the governors and ultimately the president.
agree totally - sadly that level of rationality rarely gets consideration in these heated political days - and that is what upsets me more than anything else - the total absence of rational thought in any of the recent political differences.
And yes - I recognize that there is a small "trump cult' in existence here - some refuse to acknowledge when he steps on his dick. But I think the vast majority of conservative on here merely think that he is far far better than anything the DEMs could have put forward in '16, and that he has performed far far better than most of us "anybody but Hillary" Trump voters ever expected.
I expect perfection from no man. I do expect good faith. So far, Trump has not let me down on that critical issue. I do believe he has only the best interest of the USA in mind, and is not shilling for any purely 'political' side.
Sadly, I cannot make that statement about the DEMs - ALL they are motivated by is the 'great leap forward" where all our founding principles have been abandoned and the new age of perfect 'socialism' has taken lasting root.
Posted on 4/10/20 at 8:57 am to the808bass
quote:
they did one last trial wean before performing a tracheostomy.
The sink-or-swim method of vent weaning. Sometimes weaning by the book just doesn't work for some. It's surprising how often it works. Wish him the best of luck.
Posted on 4/10/20 at 8:57 am to Hangover Haven
The guy’s son is a spine surgeon and he’s had nothing but amazing compliments for the staff at this particular hospital.
We don’t realize how lucky we are here in the USA to have access to the technology and expertise that we have.
We don’t realize how lucky we are here in the USA to have access to the technology and expertise that we have.
Posted on 4/10/20 at 8:59 am to DMAN1968
quote:Since the amount of oxygen is only 0.3 ml/100 ml of blood at room air, increasing it by 10-15 times (don't remember if that is true or not), you would only increase the amount of dissolved oxygen to 3 to 4.5 ml/100 ml of blood. With functioning lungs and hemoglobin that number is close to 20 ml/100 ml of blood.
Hyperbarics increases the amount of oxygen in the bloods plasma...by as much as 10-15 times
That's assuming you have good lungs, perfusion and relatively normal shunt fraction, which is quite unlikely given the situation.
Posted on 4/10/20 at 8:59 am to Diamondawg
quote:
Most monoplace chambers use 100% oxygen and the time is limited to 90 minutes or so at 3 ATA
Are you sure about those numbers? That looks like O2 poisoning.
Posted on 4/10/20 at 9:09 am to Rip N Lip
It is not as simple as ventilator vs no ventilator, we think it is how you use them and when to use them and who to use them on....
And what other therapies to use in addition.
And what other therapies to use in addition.
Posted on 4/10/20 at 9:20 am to Diamondawg
quote:
Diamondawg
What do you do?
Nice to hear someone talk the talk...
This post was edited on 4/10/20 at 9:37 am
Posted on 4/10/20 at 9:21 am to Flats
quote:Are talking about seizures from oxygen toxicity? It's been many, many years but I think 90 minutes is right for 3ATA depending on what's being treated.
Are you sure about those numbers? That looks like O2 poisoning.
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