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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 9:23 am to Diamondawg
Posted on 4/10/20 at 9:23 am to Diamondawg
When I rotated through our multiplace chamber in residency, we routinely dived 2.5 ATA at 100% x 90-120mins, depending on treatment protocol.
2
Posted on 4/10/20 at 9:25 am to Apollyon
quote:
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....
We're actually going to start using non-invasive BiPaps to vent pt's. Problem was, since this was an air born disease, bipap's expiratory valves are open with no filtration.. A new company just released a closed circuit with a filtered valve...
Posted on 4/10/20 at 9:27 am to Hangover Haven
And most of our patients were dived for treatment of non-healing wounds.
It was more rare to get a call for emergency hyperbarics for decompression sickness, CO poisoning, or met-hemoglobinemia, but we did plenty of those as well.
It was more rare to get a call for emergency hyperbarics for decompression sickness, CO poisoning, or met-hemoglobinemia, but we did plenty of those as well.
This post was edited on 4/10/20 at 9:34 am
Posted on 4/10/20 at 9:28 am to Apollyon
quote:We had a monoplace. I am probably too claustrophobic to pile up into a multiplace unit.
When I rotated through our multiplace chamber in residency, we routinely dived 2.5 ATA at 100% x 90-120mins, depending on treatment protocol.
Posted on 4/10/20 at 9:28 am to Hangover Haven
Yeah, we aren't doing NIPPV because of risk to staff from aerosols.
In europe they have those space helmet bipaps, which would be awesome of course
In europe they have those space helmet bipaps, which would be awesome of course
Posted on 4/10/20 at 9:31 am to Diamondawg
Our multiplace unit at Duke was huge. You can stand up inside, looks like a massive propane tank. Can fit up to a dozen patients and 1-2 staff. We usually dove with around 6-8 patients + 1 resident. Not claustrophobic, was actually very interesting rotation for me back then.
Posted on 4/10/20 at 9:32 am to Apollyon
quote:We were too far inland to see much decompression sickness but we did co poisoning, non healing woulds, radiation soft tissue injury, chronic osteo, occasional necrotizing fasciitis if we could get the surgeons to turn them loose long enough.
And most of our patients were dived for treatment of non-healing wounds.
It was more rare to get a call for emergency hyperbarics for decompression sickness, CO2 poisoning, or met-hemoglobinemia, but we did plenty of those as well.
Posted on 4/10/20 at 9:33 am to Diamondawg
Yeah, same. My deco sickness pt at the time was life-choppered in from wilmington bc their mono-unit was out of commission
Posted on 4/10/20 at 9:37 am to Apollyon
quote:Holy crap. I don't think they had those when I did this but I am thinking we adopted some of the Duke tables in addition to the Undersea Medical Society's tables.
We usually dove with around 6-8 patients + 1 resident.
Posted on 4/10/20 at 9:37 am to Diamondawg
I haven't seen hyperbarics proposed for covid.
I don't think increasing the dissolved fraction of O2 in the blood would be all that beneficial in increasing actual PAO2 in these patients.
#AlveolarGasEquation....
Lol, I will stop being an anesthesia nerd now, carry on
I don't think increasing the dissolved fraction of O2 in the blood would be all that beneficial in increasing actual PAO2 in these patients.
#AlveolarGasEquation....
Lol, I will stop being an anesthesia nerd now, carry on
Posted on 4/10/20 at 9:39 am to Apollyon
quote:
When I rotated through our multiplace chamber in residency, we routinely dived 2.5 ATA at 100% x 90-120mins, depending on treatment protocol.
Partially my mistake; I ignored the last "a" in ATA and was thinking 100 FSW. 50-ish, yeah, I can see that. There also may be a difference in a healthy diver and someone with compromised lungs you're trying to push oxygen to; the med part isn't my world.
Posted on 4/10/20 at 9:39 am to Apollyon
quote:
In europe they have those space helmet bipaps, which would be awesome of course
Is that bipaps? I thought it was some type of O2 system... I/E adult Oxyhood...
You not talking about that full face mask huh...?
This post was edited on 4/10/20 at 9:43 am
Posted on 4/10/20 at 9:42 am to Hangover Haven
quote:
Is that bipaps?
Yep, apperently they use a helmet that seals at the neckline and can deliver positive pressure. Very cool way to do NIPPV actually, wish we had it in the States
Posted on 4/10/20 at 9:44 am to Little Trump
quote:
Because Hydroxychloroquine can’t be the answer because Trump came up with it
Everything is political to democrats and they want people dead!
THIS!
The Ventilator Issue is not about ventilators. The Democrats know that the Ventilator Issue is another Propaganda Attack Vector to use against Trump.
To the Dems, the relative effectiveness of Ventilators is irrelevant. They know that the AVAILABILITY of the things is where the weak spot resides. As such, they will attack the weak spot until all Democrat Governors publicly announce that FedGov has supplied all of the necessary Ventilators. Of course, no Dem Governor will ever do that.
This issue is merely an attack vector against Trump.
Posted on 4/10/20 at 9:46 am to Hangover Haven
And apparently the helmet BIPAP is more effective than the mask in reducing instances of progression to intubation in ARDS patients:
Article in JAMA
Article in JAMA
Posted on 4/10/20 at 9:47 am to Apollyon
quote:
Yep, apperently they use a helmet that seals at the neckline and can deliver positive pressure. Very cool way to do NIPPV actually, wish we had it in the States
I see they have a peep valve on this one.
Looks pretty "mid-evil" I wonder how they measure delivered tidal volumes and minute volumes...?
This post was edited on 4/10/20 at 9:49 am
Posted on 4/10/20 at 2:56 pm to Hangover Haven
quote:
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”..
You can’t get O2 in without CO2 leaving. That is respiration. Again, unless the CO2 leaves O2 can’t enter or enter as efficiently as before. So the patient goes hypoxic. The respiration cycle must be completed for life. Forced ventilation under higher than normal pressure in infected, swollen, fluid filled aveoli is just not working well. Of course ventilation works fine for other conditions where the aveoli are not swollen and fluid filled.
Posted on 4/10/20 at 3:17 pm to GumboPot
quote:You are really testing my memory here but I am not sure what you are saying. I guarentee you can increase PO2 and CO2 at the same time. You can decrease the minute volume by 1/2 and place the person on high oxygen and both the CO2 and PO2 will rise.
You can’t get O2 in without CO2 leaving. That is respiration. Again, unless the CO2 leaves O2 can’t enter or enter as efficiently as before. So the patient goes hypoxic.
If you are talking in a diseased or damaged lung then maybe what you are saying is that if you are having a difficult time removing CO2 then you will likely have a more difficult time getting oxygen into the blood because CO2 is 20 times as diffusible as O2. Also, what you might be seeing is the damaged hemoglobin and its inability to transport oxygen would also have a inability to get CO2 back to the lungs as carbominohemoglobin. I don't remember what percentage is transported that way but it's signicant.
Posted on 4/10/20 at 3:35 pm to thejudge
quote:
Kung tissue
I hate it when my Kungs are messed up
Posted on 4/10/20 at 9:20 pm to Apollyon
(no message)
This post was edited on 6/23/20 at 5:40 am
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