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Notes from 24 hours on the front lines #COVID19
- Hypoxemia common but, doesn't always correlate w/ symptoms
- Seeing comfortable pts, speaking full sentences w/ sat 75%.
- Others in clear resp distress w/ similar hypoxemia
- Sat no longer appears reliable correlate w/ symptoms
Lots of intubations
- Upper airway edema - despite absence of stridor/signs upper airway compromise - common
- Due to edema, troubles w/ gum elastic bougie. Using more rigid stylet with better success
- Asynchrony + extubation common: sedate heavily, add pressor if necessary
At some point, every patient in ED has #COVID19 despite symptoms
- Saw beta blocker OD w/ COVID19
- Saw ischemic leg w/ COVID19
- Saw DKA w/ COVID19
- Saw trauma, PTX w/ COVID19
Assume all pts COVID +
Wearing #PPE all shift is tough but doable
- Hard to breath, challenging to communicate
- Take breaks in "clean" area
- Get into open air
- Hydrate during breaks
Look out for your team
- Others will have lapses in #PPE, if you see it, point it out
- Make sure others take breaks and hydrate
- Check in to see how people are feeling. Shifts are physically + emotionally taxing
Negative Pressure Rooms
- clearly ideal for aerosolizing procedures like intubation
- Take pt out of neg pressure once ETT in place
- Eventually, every pt in ED COVID (+) and no neg pressure left
- Clinicians just wear airborne #PPE all shift
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Lawrence Gostin
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