Thread by @MRamzyDO

More of our #COVID19 experience here in #NYC:

Most if not all ICUs are full & the ED is quickly becoming an ICU. There's been a push away from early intubation for those that may not need it

1/9 #COVIDfoam #FOAMed @cameronks @srrezaie @ThinkingCC @emcrit @19criticalcare

As a result, theres a very large number of “Happy Hypoxic” patients who have been tolerating HFNC for hours & sometimes for days. SpO2 continues to remain unreliable (as do certain "traditional" exam findings of respiratory distress). PaO2s continue to correlate

2/9 #COVIDfoam

The oxygen requirement these patients need is very high. Hospitals w/lower volumes of #COVID19 patients should start from now in securing the appropriate resources and have contingency plans to accommodate for this

3/9 #COVIDfoam

https://twitter.com/cameronks/status/1248571039073873921?s=20

Although logistically challenging due to limited space/resources, we’re quickly learning that admitted #COVID patients should NOT go unmonitored or behind closed doors as they require frequent re-evaluation & can very rapidly deteriorate.

4/9 #COVIDfoam

Those requiring more respiratory assistance based on their overall clinical picture (ie mental status, WOB & rising pCO2), end up on mechanical ventilation, however the decision to intubate is extremely difficult & should not be made by a single healthcare provider alone.

5/9

More patients are coming in and These portable LTV ventilators have become more common. Many healthcare providers appear to not be as familiar with them and as a result mislabel them as inferior or inefficient.

6/9 #COVIDfoam #FOAMed

Below is the first of two, step-by-step guide for healthcare providers on setting up two commonly used modes on these LTV Ventilators, please provide feedback.

7/9 #COVIDfoam #FOAMed

Here is the second step-by-step guide for healthcare providers, describing how to set up CPAP on these LTV ventilators, again feedback is appreciated.

8/9 #COVIDfoam #FOAMed

As we continue to learn more about #COVID19 we must be prepared to utilize & ration the resources we have in regard to everything from PPE to ventilators. Also wanted to thank all the amazing nurses/support staff who have helped keep the hospital running!

9/9 #COVIDFoam #FOAMed