Acute COVID, What We're Seeing

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  • Specializes in Critical Care. Has 10 years experience.

You are reading page 3 of Acute COVID, What We're Seeing

Specializes in ED, psych. Has 6 years experience.
55 minutes ago, Kitiger said:

He did not say that the virus is 5 microns. He said the definition of aerosol means that the droplet that suspends the virus has to be about 5 microns.

Should’ve been more specific, I guess ... was typing on a quick break. The virus is 0.125 microns from what I read. Flu is similar. Both in droplet form, 2-3 hrs? But with our lack of immunity, scary.

The ARB/ACE inhibitor potential is fascinating. Something I didn’t realize could play a role ...

toomuchbaloney

9,748 Posts

Specializes in NICU, PICU, Transport, L&D, Hospice. Has 44 years experience.
33 minutes ago, pixierose said:

Should’ve been more specific, I guess ... was typing on a quick break. The virus is 0.125 microns from what I read. Flu is similar. Both in droplet form, 2-3 hrs? But with our lack of immunity, scary.

The ARB/ACE inhibitor potential is fascinating. Something I didn’t realize could play a role ...

Yes. Lack of immunity and lack of vaccine means that we will suffer through this pandemic and then have smaller outbreaks regularly until we achieve widespread herd immunity or a vaccine or both.

Right?

jobellestarr

328 Posts

On 3/18/2020 at 4:56 PM, MunoRN said:

About 12% of those with COVID require hospitalization but not critical care, most commonly it's because of the need for supplemental oxygen and I would say we're already maximizing that as a way of avoiding the need for a ventilator.

We basically took over an ambulatory surgery center and are using their space and their anesthesia machines as vents. Bagging is actually an option, it's how we've been dealing the non-COVID patients that require short term ventilation for procedures, anesthesia recovery, etc.

MunoRN, where are you located? Thank you for you excellent nursing skills and explanations.

Guest1142305

507 Posts

MunoRN, thank you for what you do for society. Very inspirational. Stay safe.

adventure_rn, BSN

1 Article; 1,544 Posts

Specializes in NICU, PICU.
On 3/20/2020 at 9:40 AM, AJPV said:

How to share 1 vent with 2 or 4 patients:

God, that's terrifying. I'm glad this information exists, but I hope we don't actually reach that point...

ShirleyMc

29 Posts

Has 10 years experience.

I have a question regarding elderly and COVID-19....

Do people over, say 70 or 75 years old, generally develop a fever with COVID?

The reason I ask is because in nursing school they drilled into our heads over and over that elderly often do not present with a fever with infection.

Does anyone have any experience related to this?

Anonymous666

135 Posts

Regarding the ACE thing, Fauci acted like it’s a given that COVID hooks up with ACE receptors.

I didn’t realize this was common knowledge.

A little worrying selfishly as I just started taking Lisinopril for HTN

Katillac, RN

370 Posts

Has 18 years experience.

ICU One Pager:

ICU_one_pager_COVID_v2.6.png

LovingLife123

1,579 Posts

We have really seen an influx of critical COVIDs in the last week. I think the next two weeks will be worse. When these patients go bad, they seem to go bad quickly.

We’ve had a couple that have seemed to be getting better then all the sudden they go into cardiac arrest. I’ve been reading up on this.

We are ending up probing most of ours. I think we are starting to manually prone this week. We’ve had some on vents for weeks now and we haven’t even seen the height of this in my area yet.


DesertSky, BSN

121 Posts

Specializes in BSN, RN, CCRN - ICU & ER. Has 10 years experience.
On 3/16/2020 at 12:47 AM, MunoRN said:

COVID-19 has been in my area long enough that we're getting an idea of how it plays out, curious what others are seeing.

The most surprising thing has been the duration of acute illness, I sort of figured it would be like other respiratory viruses just more severe, but with acute symptoms lasting up to 7 days or so.

We've seen timelines similar to what China was reporting; about 10 days from symptom onset to needing ICU care, then critically ill for weeks, the shortest recovery we've seen is 3 weeks of aggressive life support. Time from symptoms onset to death has ranged from 2 to 8 weeks in China. So it's not just the number of patients that will require vents and other equipment, it's the length of time they will need them for.

The first week or so on the vent is similar to a bad influenza; lots of vent support, maybe proning, maybe flolan, not typically requiring inotropes or vasopressors, then they seem to have turned the corner and are out of the woods.

Then they crump, big time. From nothing to max pressors and inotropes and an EF that drops from normal to 10-15% in as little as 12 hours. Sudden onset renal and liver failure, with impressively severe liver failure in such a short amount of time.

Deaths appear more cardiogenic than respiratory, lethal rhythms have varied the full gamut; VT, VF, PEA, and asystole.

We've had enough ventilators so far, but what likely lies ahead will be the need to figure out a process for taking ventilators and other life support equipment away from patients less likely to survive to make them available to patients more likely to survive. Things seem dicey now, but that's a whole 'nuther level of dicey.

MunoRN - Thanks for sharing your findings thus far. I had read similar information coming out of Italy regarding patients having severe cardiac issues with low EF's resulting in cardiac arrest after some of the COVID-19 patients started to improve. In Italy, I know some hospitals are not performing codes on these patients d/t there being nothing more than can really be done. Has this been discussed in your institution?

choughlesRN

24 Posts

Holy cow do they crump fast. I'm in stepdown, rather than critical care, but the patients that we upgrade, we upgrade FAST. To the point where we have standing protocols to notify the COVID/ID team immediately with any changes in respiratory requirements. Have you all noticed the young (40s) guys being hit pretty hard, too? We've sent 2 to the unit in a week. Our COVID team is calling it the real man flu ?

toomuchbaloney

9,748 Posts

Specializes in NICU, PICU, Transport, L&D, Hospice. Has 44 years experience.

Well worth a listen.