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Post by Deleted on Mar 26, 2020 13:00:43 GMT -5
This is on the official government news channel (Faux) and is pretty amazing if it's true. "As hospitals across the country face shortages of personal protective equipment due to surges of coronavirus patients, health care professionals are reportedly privately discussing the possibility of a blanket do-not-resuscitate policy for infected patients to mitigate the risks for those responding to a code blue. “If we risk their well-being in service of one patient, we detract from the care of future patients, which is unfair,” bioethicist Scott Halpern at the University of Pennsylvania wrote in a circulated model guideline, according to The Washington Post. Still, he said a blanket do-not-resuscitate policy for all COVID-19 patients is too ”draconian.” He suggested the patient’s doctor and another should sign off on case-by-case do-not-resuscitate orders for coronavirus patients, giving the reason to the family – although they don’t have to agree with it." www.foxnews.com/health/hospitals-weigh-blanket-dnr-orders-amid-coronavirus-protective-equipment-shortages
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pulmonarymd
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Post by pulmonarymd on Mar 26, 2020 13:21:23 GMT -5
This is on the official government news channel (Faux) and is pretty amazing if it's true. "As hospitals across the country face shortages of personal protective equipment due to surges of coronavirus patients, health care professionals are reportedly privately discussing the possibility of a blanket do-not-resuscitate policy for infected patients to mitigate the risks for those responding to a code blue. “If we risk their well-being in service of one patient, we detract from the care of future patients, which is unfair,” bioethicist Scott Halpern at the University of Pennsylvania wrote in a circulated model guideline, according to The Washington Post. Still, he said a blanket do-not-resuscitate policy for all COVID-19 patients is too ”draconian.” He suggested the patient’s doctor and another should sign off on case-by-case do-not-resuscitate orders for coronavirus patients, giving the reason to the family – although they don’t have to agree with it." www.foxnews.com/health/hospitals-weigh-blanket-dnr-orders-amid-coronavirus-protective-equipment-shortagesWelcome to American medicine 2020. We tried to tell people, but the ones who needed to listen didn't. Hospitals are responsible for the safety of their employees like any other employer, and if you literally cannot get the needed equipment, something has to give.
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thyme4change
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Post by thyme4change on Mar 26, 2020 13:25:24 GMT -5
Check their voter registration before putting them in a DNR situation.
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jerseygirl
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Post by jerseygirl on Mar 26, 2020 13:26:02 GMT -5
Actually if there are guidelines or orders then the physician might have less torment or stress when making the decision MAYBE less but I’m sure it will be difficult
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jerseygirl
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Post by jerseygirl on Mar 26, 2020 13:28:36 GMT -5
Actually if there are guidelines or orders then the physician might have less torment or stress when making the decision MAYBE less but I’m sure it will be difficult
Triage also occurs in mass accidents etc 3 categories- one of which is the person has no or little hope of surviving so medical efforts go to those with better chances
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chiver78
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Post by chiver78 on Mar 26, 2020 13:28:39 GMT -5
Actually if there are guidelines or orders then the physician might have less torment or stress when making the decision MAYBE less but I’m sure it will be difficult AYFKM? Editing to add that I quoted the post in its entirety when I quoted it. the added content doesnt make anything better, but I quoted ALL of what was there when I quoted.
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grumpyhermit
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Post by grumpyhermit on Mar 26, 2020 13:28:52 GMT -5
This doesn't surprise me, at all. I honestly figured this was kind of a forgone conclusion? I was discussing this with my mother just yesterday regarding my grandmother. She's 88, has dementia, and recently had a fall, and also developed pneumonia. If she has to go back to the hospital for ANY reason, I just presume it's a one-way trip, and that she will be, if not requested DNR, de facto DNR.
When resources are scare and the system is overloaded, you aren't going to be prioritizing the old and infirm.
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pulmonarymd
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Post by pulmonarymd on Mar 26, 2020 13:33:48 GMT -5
Actually if there are guidelines or orders then the physician might have less torment or stress when making the decision MAYBE less but I’m sure it will be difficult Triage also occurs in mass accidents etc 3 categories- one of which is the person has no or little hope of surviving so medical efforts go to those with better chances This is a slow motion, long duration crisis, the likes of which we have not seen, and we are woefully unprepared for. We are just seeing the beginnings of the decisions that will need to be made in NYC. Per projections, they have not yet peaked, and they are already out of ICU beds, and I saw a story about NY Presbyterian using one ventilator for 2 patients, but I am unsure if it is true. The moral nightmare has just begun. And if you believe that any of this will be less distressing to healthcare professionals, you don't know many who do critical care for a living very well.
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Miss Tequila
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Post by Miss Tequila on Mar 26, 2020 13:40:29 GMT -5
Actually if there are guidelines or orders then the physician might have less torment or stress when making the decision MAYBE less but I’m sure it will be difficult Triage also occurs in mass accidents etc 3 categories- one of which is the person has no or little hope of surviving so medical efforts go to those with better chances This is a slow motion, long duration crisis, the likes of which we have not seen, and we are woefully unprepared for. We are just seeing the beginnings of the decisions that will need to be made in NYC. Per projections, they have not yet peaked, and they are already out of ICU beds, and I saw a story about NY Presbyterian using one ventilator for 2 patients, but I am unsure if it is true. The moral nightmare has just begun. And if you believe that any of this will be less distressing to healthcare professionals, you don't know many who do critical care for a living very well. Which is why we need to get stricter with not allowing travel from hot zones, really pairing down what is considered “life-sustaining” business (here’s a hint...it isn’t a beer distributor!), etc.
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pulmonarymd
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Post by pulmonarymd on Mar 26, 2020 13:42:12 GMT -5
This is a slow motion, long duration crisis, the likes of which we have not seen, and we are woefully unprepared for. We are just seeing the beginnings of the decisions that will need to be made in NYC. Per projections, they have not yet peaked, and they are already out of ICU beds, and I saw a story about NY Presbyterian using one ventilator for 2 patients, but I am unsure if it is true. The moral nightmare has just begun. And if you believe that any of this will be less distressing to healthcare professionals, you don't know many who do critical care for a living very well. Which is why we need to get stricter with not allowing travel from hot zones, really pairing down what is considered “life-sustaining” business (here’s a hint...it isn’t a beer distributor!), etc. If we want to do that, that requires a national response, state by state won't work, because you will continue to risk infections from the ones not doing it, even if you are OK now. Problem will be longer lasting then.
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Post by The Walk of the Penguin Mich on Mar 26, 2020 13:50:02 GMT -5
Actually if there are guidelines or orders then the physician might have less torment or stress when making the decision MAYBE less but I’m sure it will be difficult Triage also occurs in mass accidents etc 3 categories- one of which is the person has no or little hope of surviving so medical efforts go to those with better chances This is a slow motion, long duration crisis, the likes of which we have not seen, and we are woefully unprepared for. We are just seeing the beginnings of the decisions that will need to be made in NYC. Per projections, they have not yet peaked, and they are already out of ICU beds, and I saw a story about NY Presbyterian using one ventilator for 2 patients, but I am unsure if it is true. The moral nightmare has just begun. And if you believe that any of this will be less distressing to healthcare professionals, you don't know many who do critical care for a living very well. Supposedly, and engineering medical doctor was jerry rigging ventilators like this in Italy. So not the first time I’ve heard of this.....and if it is possible, they need to figure out how to do this quickly everywhere.
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Post by Deleted on Mar 26, 2020 13:52:31 GMT -5
Cuomo talks daily about how part of NY's plan is they will be splitting ALL ventilators between at least 2 patients and even using CPAP machines that aren't as effective.
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Post by The Walk of the Penguin Mich on Mar 26, 2020 13:58:23 GMT -5
Cuomo talks daily about how part of NY's plan is they will be splitting ALL ventilators between at least 2 patients and even using CPAP machines that aren't as effective. Better than nothing and it does force air into the lungs.
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swamp
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Post by swamp on Mar 26, 2020 14:02:14 GMT -5
NYC people are fleeing the city to their summer homes in northern NY and the adirondacks.
The local hospital has 4, yes 4, vents, and 10 ICU beds, 5 of which are generally occupied by patients. This area is fucked if they are contagious, or if they become sick.
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justme
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Post by justme on Mar 26, 2020 14:10:11 GMT -5
NYC people are fleeing the city to their summer homes in northern NY and the adirondacks. The local hospital has 4, yes 4, vents, and 10 ICU beds, 5 of which are generally occupied by patients. This area is fucked if they are contagious, or if they become sick. It seems very short sighted to run there if you have any chance of having gotten the virus.
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swamp
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Post by swamp on Mar 26, 2020 14:12:53 GMT -5
NYC people are fleeing the city to their summer homes in northern NY and the adirondacks. The local hospital has 4, yes 4, vents, and 10 ICU beds, 5 of which are generally occupied by patients. This area is fucked if they are contagious, or if they become sick. It seems very short sighted to run there if you have any chance of having gotten the virus. I agree. I don't think they thought this through all the way.
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Post by billisonboard on Mar 26, 2020 14:13:47 GMT -5
... I was discussing this with my mother just yesterday regarding my grandmother. She's 88, has dementia, and recently had a fall, and also developed pneumonia. If she has to go back to the hospital for ANY reason, I just presume it's a one-way trip, and that she will be, if not requested DNR, de facto DNR. Years ago MIL was released to a facility for care when she didn't really need to be hospitalized any longer but couldn't survive at home. She was there for a few days. At one point, both her daughters (and I) were there and she was obviously struggling. The nurse said something like "We could call an ambulance and have them isolate her in the hospital or we could just let it play out here with you all beside her." No call was made and she peacefully slipped away.
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swamp
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Post by swamp on Mar 26, 2020 14:15:27 GMT -5
NYC people are fleeing the city to their summer homes in northern NY and the adirondacks. The local hospital has 4, yes 4, vents, and 10 ICU beds, 5 of which are generally occupied by patients. This area is fucked if they are contagious, or if they become sick. It seems very short sighted to run there if you have any chance of having gotten the virus. Even better, the area where most of the vacation homes are located has one small hospital that is more like a bandaid station. All their ICU cases are shipped to my city with the 10 ICU beds. The other closest hospital isn't much bigger, and the next closest also doesn't have an ICU and ships to a different hospital in the county that has probably 8 to 10 ICU beds.
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chiver78
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Post by chiver78 on Mar 26, 2020 14:16:25 GMT -5
NYC people are fleeing the city to their summer homes in northern NY and the adirondacks. The local hospital has 4, yes 4, vents, and 10 ICU beds, 5 of which are generally occupied by patients. This area is fucked if they are contagious, or if they become sick. and Cape Cod, which is still at winter staffing levels. stay the fuck home!!
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pulmonarymd
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Post by pulmonarymd on Mar 26, 2020 14:29:38 GMT -5
This is a slow motion, long duration crisis, the likes of which we have not seen, and we are woefully unprepared for. We are just seeing the beginnings of the decisions that will need to be made in NYC. Per projections, they have not yet peaked, and they are already out of ICU beds, and I saw a story about NY Presbyterian using one ventilator for 2 patients, but I am unsure if it is true. The moral nightmare has just begun. And if you believe that any of this will be less distressing to healthcare professionals, you don't know many who do critical care for a living very well. Supposedly, and engineering medical doctor was jerry rigging ventilators like this in Italy. So not the first time I’ve heard of this.....and if it is possible, they need to figure out how to do this quickly everywhere. Saw a video, doesn't appear to be technically difficult. But, what if both patient's don't have same illness. What if it turns out one has corona and one has the flu. What do you do if one worsens significantly, how do you adjust the vent. If one is improving, how are we getting that one off. Where are these patients being cared for, most ICU rooms don't have room for 2 patients, as most ICUs no longer are open wards. Just the beginning of the issue involved.
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swamp
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Post by swamp on Mar 26, 2020 14:53:06 GMT -5
Supposedly, and engineering medical doctor was jerry rigging ventilators like this in Italy. So not the first time I’ve heard of this.....and if it is possible, they need to figure out how to do this quickly everywhere. Saw a video, doesn't appear to be technically difficult. But, what if both patient's don't have same illness. What if it turns out one has corona and one has the flu. What do you do if one worsens significantly, how do you adjust the vent. If one is improving, how are we getting that one off. Where are these patients being cared for, most ICU rooms don't have room for 2 patients, as most ICUs no longer are open wards. Just the beginning of the issue involved. I just want to say that I really appreciate your input on the coronavirus issue. Stay safe.
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chiver78
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Post by chiver78 on Mar 26, 2020 14:53:40 GMT -5
Supposedly, and engineering medical doctor was jerry rigging ventilators like this in Italy. So not the first time I’ve heard of this.....and if it is possible, they need to figure out how to do this quickly everywhere. Saw a video, doesn't appear to be technically difficult. But, what if both patient's don't have same illness. What if it turns out one has corona and one has the flu. What do you do if one worsens significantly, how do you adjust the vent. If one is improving, how are we getting that one off. Where are these patients being cared for, most ICU rooms don't have room for 2 patients, as most ICUs no longer are open wards. Just the beginning of the issue involved. I had the same questions watching a hospital executive explaining it at a very high level last night, I think NYC. there are ways of preventing fluid flow through valves, like check valves, but pressurized air flow is a lot different than the liquids that typically are controlled by check valves. I'm curious of the mechanics of how this actually works. ETA: I forget you're pretty new here. I'm a pharma engineer, with a lot of years designing utility systems for pharmaceutical production. I'm in QA now
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NastyWoman
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Post by NastyWoman on Mar 26, 2020 15:00:28 GMT -5
Check their voter registration before putting them in a DNR situation. Since you cannot die from a democrat induced Hoax disease, I would say check voter registration before any suspected COVID19 case is even allowed in the door. We can't have attention seekers waste precious resources now, can we? (Yes that is sarcasm, but barely since there are still so many in denial and spouting that shit)
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jerseygirl
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Post by jerseygirl on Mar 26, 2020 15:03:22 GMT -5
Anesthesia machines are being converted to ventilators. With elective surgeries cancelled many of these will be freed up probably sooner than the 2/1 ventilators are tried in ICUs This will be very terrible situation for hospital staffs
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pulmonarymd
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Post by pulmonarymd on Mar 26, 2020 15:13:59 GMT -5
Thanks for the good wishes everybody. We are in uncharted waters. Doing nonstandard things in a period of high stress is a recipe for disaster. Mistakes will be made. When we start using machines we are unfamiliar with, well just say it makes my chief self very nervous. I don not like to set my staff up to fail, and it feels like that is what we will be doing. But, their safety has to be our priority right now.
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pulmonarymd
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Post by pulmonarymd on Mar 26, 2020 15:16:17 GMT -5
Saw a video, doesn't appear to be technically difficult. But, what if both patient's don't have same illness. What if it turns out one has corona and one has the flu. What do you do if one worsens significantly, how do you adjust the vent. If one is improving, how are we getting that one off. Where are these patients being cared for, most ICU rooms don't have room for 2 patients, as most ICUs no longer are open wards. Just the beginning of the issue involved. I had the same questions watching a hospital executive explaining it at a very high level last night, I think NYC. there are ways of preventing fluid flow through valves, like check valves, but pressurized air flow is a lot different than the liquids that typically are controlled by check valves. I'm curious of the mechanics of how this actually works. ETA: I forget you're pretty new here. I'm a pharma engineer, with a lot of years designing utility systems for pharmaceutical production. I'm in QA now Yes, this causes about as many problems as it solves, the biggest one is what do we do if one of the patient's decompensates. Ventilator needs to be adjusted, but that could harm the patient who is stable. Fun times.
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azucena
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Post by azucena on Mar 26, 2020 15:44:09 GMT -5
This is a slow motion, long duration crisis, the likes of which we have not seen, and we are woefully unprepared for. We are just seeing the beginnings of the decisions that will need to be made in NYC. Per projections, they have not yet peaked, and they are already out of ICU beds, and I saw a story about NY Presbyterian using one ventilator for 2 patients, but I am unsure if it is true. The moral nightmare has just begun. And if you believe that any of this will be less distressing to healthcare professionals, you don't know many who do critical care for a living very well. Which is why we need to get stricter with not allowing travel from hot zones, really pairing down what is considered “life-sustaining” business (here’s a hint...it isn’t a beer distributor!), etc. MissT - I'm not picking on you in particular. Continuing to consider some places hot zones that warrant more caution than others is the crux of the problem. We should all be acting as if we are infected and isolating as much as possible.
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Gardening Grandma
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Post by Gardening Grandma on Mar 26, 2020 16:07:05 GMT -5
Which is why we need to get stricter with not allowing travel from hot zones, really pairing down what is considered “life-sustaining” business (here’s a hint...it isn’t a beer distributor!), etc. MissT - I'm not picking on you in particular. Continuing to consider some places hot zones that warrant more caution than others is the crux of the problem. We should all be acting as if we are infected and isolating as much as possible. This. It's already in EVERY state. If not every county, it will be. It's ALREADY HERE, FFS! For every positive test, there are 5-10 that are out there and undiagnosed. One study I read said that in China, the asymptomatic carriers caused 86% of the cases. Pretending that it's only a problem in certain areas is shortsighted. That's why the US will probably end up having the most cases and resulting deaths. People will die because they got into an auto accident but the hospital was full of COVID cases. People will die because they had a heart attack but the hospital was full. The areas that don't have a lot of cases, right now, have an opportunity to prepare. Just like the US had two months to prepare instead of pretending it was not a problem.
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pulmonarymd
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Post by pulmonarymd on Mar 26, 2020 16:08:42 GMT -5
This is a slow motion, long duration crisis, the likes of which we have not seen, and we are woefully unprepared for. We are just seeing the beginnings of the decisions that will need to be made in NYC. Per projections, they have not yet peaked, and they are already out of ICU beds, and I saw a story about NY Presbyterian using one ventilator for 2 patients, but I am unsure if it is true. The moral nightmare has just begun. And if you believe that any of this will be less distressing to healthcare professionals, you don't know many who do critical care for a living very well. Which is why we need to get stricter with not allowing travel from hot zones, really pairing down what is considered “life-sustaining” business (here’s a hint...it isn’t a beer distributor!), etc. You would think so, but on the topic of unimagined consequences, if you cut off alcohol sales, and alcoholics run out of liquor, they either drink things they should't, or wind up with the DTs. Both of which will require hospitalization, burdening hospitals with patients they don't need. So although it might not seem to be needed, alcohol sales may indeed be necessary. Crazy, I know.
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Post by The Walk of the Penguin Mich on Mar 26, 2020 16:10:09 GMT -5
Which is why we need to get stricter with not allowing travel from hot zones, really pairing down what is considered “life-sustaining” business (here’s a hint...it isn’t a beer distributor!), etc. MissT - I'm not picking on you in particular. Continuing to consider some places hot zones that warrant more caution than others is the crux of the problem. We should all be acting as if we are infected and isolating as much as possible.Exactly....in the lab, all samples we dealt with were treated as if they had Hep B, even if they were samples from lab staff (who had all been immunized). It is just better to assume everyone is a carrier, and act appropriately.
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