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Cowboyardee's Latest Activity

  1. Cowboyardee

    Take the Shutdown Skeptics Seriously

    Good article. I tend to reflexively get defensive when people advocate reopening because that camp so often either buys into crackpot theories or seriously downplays the loss of life caused by covid-19 and/or the damage it does to acute care and critical care infrastructure across the board. However an honest discussion of the risks of continued economic shutdown that doesn't rely on falsehoods is a welcome change.
  2. Cowboyardee

    Kern County ER Docs C-19

    1. Wait, what? I only got involved in this conversation when you claimed (entirely without evidence) that healthcare is not overwhelmed in NYC or anywhere in particular, implying that hospitals are fine and handling the crisis well. I then presented you with a first-hand account of what "not overwhelmed" and "fine" actually mean to those trying to fight this disease... You then have the nerve to tell me I have no evidence as though seeing patients suffer and/or die of inadequate care first-hand and talking friends and relatives suffering from inadequate medical resources in NYC through their ordeal couldn't possibly compete with 'facts' you pulled out of thin air, about a real life crisis and tragedy you haven't seen or taken part in, to make blustery, tone-deaf arguments on the internet. Seriously, check yourself. This is real life, not some keyboard warrior pissing contest. As for numbers 2-7: Completely, 100% irrelevent to anything I actually said. If the rest of your argument hinges on your fantasyland head-in-the-sand nonsense about hospitals coping perfectly well with the crisis and patients not suffering at all for the chaos, then you should definitely reconsider your entire case. But I haven't particularly taken a side on economic shutdowns and mass quarantines and I don't know why you're wasting most of your post lecturing me about it. It's still early on. The peer reviewed meta-analyses will come later. For now, best you can do is actually listen to accounts from the front lines rather than pretending you know what's going on when you clearly don't at all.
  3. Cowboyardee

    Kern County ER Docs C-19

    For whatever it's worth, I'm not particularly arguing about whether the country should open back up. There are far too many considerations to that kind of decision for me to pretend I know what's best. But on the subject of NYC or any other hot spot... Nope. You're just plain wrong. Why are you just reiterating the same incorrect talking points I responded to in your last post? You clearly aren't on the front lines and clearly don't understand the challenges we face. You clearly have little idea of what's gone on in NYC or any other hot spot. Please have a little humility. Read my post again if you need to. The problem wasn't and isn't the number of beds. It's the need for trained personnel. Critical care has been overwhelmed in many areas and still is, and many patients are dying not only of the disease but of inadequate medical care for that reason. You may not read about it in political op-ed pieces, but that doesn't make it any less true. If you want to learn whats going on with critically ill patients, talk to people who work in the field rather than searching out whichever talking heads most closely agree with the conclusions you've already made.
  4. The first video linked is about reasonable topics, but seems to be disappointingly devoid of actual clinical evidence. Of course, at this point, clinical evidence is hard to come by, since this is a new phenomenon. But I dont think they should take it as a given that early intubation wprsens outcomes. That is pure conjecture at this point. Likewise, it seems they are underestimating the severity of the consequences of a genuine lack of well trained critical care personnel. You can't apply protocols developed and tested in an environment with plenty of staff (e.g. proning by a 1:1 ICU trained nurse) and expect the benefits of that therapy to hold up when enacted in a completely different environment (5:1 ratio, nurses minimally trained in ICU care, etc.) They seem to lack the perspective of people involved first hand in the crisis. The second video linked is sensationalized garbage posted by a nurse who lacks even a cursory knowledge of critical care and who should not be informing anyone. Virtually nothing she said is useful or reliable. There are plenty of good, important conversations to be had about hospitals pushing suboptimal protocols, or the ethical issues involved in providing medical care without our normal ratios of skilled staff. This kind of trash doesn't lead to those conversations.
  5. Your wife has exited the realm of rural and/or conservative individuals who are honestly engaged with the world and has drifted into a kind of right wingnut culture cult. Normal people can realise that CNN is occasionally full of **** without buying into worldwide conspiracy theories. Whenever someone tells you that everyone else - the whole world - is lying to you and that the only people who will speak the truth is themselves and their narrow band of likeminded individuals... there's a word for that. It's called brainwashing. Sounds like your wife has been listening to some brainwashers. Good luck de-programming her.
  6. Cowboyardee

    COVID-19 and extinction of human species

    I'm suspecting there's a bit of an echo chamber ongoing where people are repeating the (comforting) thought that since there are surely way more cases than we know of, the case fatality rate must be much lower than reported. What that line of thinking leaves out is the very likely possibility that the number of deaths attributed to covid19 is lower than the actual number. For one, many patients die without getting tested, either due to code status or disease progression. For another, it would not have been uncommon even up to a few weeks ago for patients presenting with covid along with some other illness not to be worked up or even suspected. And of course a substantial number of the patients currently positive for covid19 will in fact die from it but merely haven't yet. Lets a assume a 1% case fatality rate, for the sake of argument. That would mean every covid19 fatality missed from the official count would balance off 100 undiagnosed cases. The problem with assuming that the case fatality rate is actually 10 times lower than what has been measured so far is that to make that assumption, we have to estimate not only that theres 10 times more cases than we know about (which isn't entirely unlikely) but also that the numerator of the case fatality equation is accurate as reported. Unfortunately, it isn't.
  7. Hi all. I'm wondering how covid testing is being performed in your area currently. Where I am (hospital, ICU, mid atlantic state), I'm seeing tests being ordered from either the state health dept or quest diagnostics. Cases are being tested on the basis of severe (critical) illness with symptoms consistent with covid19. 1st order exposures are also being tested I think (like, spouse of someone covid +). I think that likely exposures with likely symptoms are being tested too. I'm not sure beyond that. We are doing a single nasal pharyngeal swabs sent for PCR in most cases, I believe. There is some reason to worry about the possibility of false negatives with nasal pharyngeal PCR swabs - best data I can find is that the sensitivity of the test is only 75% (emcrit's covid19 page discusses this and cites the study they used to estimate this figure), though I would welcome better or updated data if anyone can offer any. So I'm wondering if other states are routinely sending 2 swabs to double check or have some other procedure. As is, it appears there could be could be one covid + patient whose test was erroneously negative for every 3 patients who actually test positive, which potentially has some very concerning consequences. However, I'd love to hear that my thinking is wrong on this matter or be directed to better information. What are you seeing?
  8. Cowboyardee

    COVID-19 and extinction of human species

    I'm probably more pessimistic than many epidemiologists seem to be about the effects of covid19 - I doubt the real case fatality rate is below 1%, though many seem to be banking on this; I doubt a vaccine will be ready soon or possibly even that an effective one can be developed at all given difficulties vaccinating against the most similar known corona viruses; I hope we develop some kind of effective treatment that severely mitigates the illness soon, but I dont see any of the ones being touted so far as that miracle RX; I personally believe that the 100k-300k figures being thrown around as a likely death toll in the US are probably a best case scenario right now. But with all that said, you would have to make certain assumptions to conclude this could be a serious threat to our species, and I doubt those assumptions as well. Namely you'd have to believe that people can readily be reinfected after illness and repeated illness, and that doesnt appear to be true from what we see so far. Theres probably at least temporary immunity, and lasting immunity is unknown, but reasonably likely. Youd have to assume that no effective treatment will be discovered for several or many years while this rages - I dont know about a quick fix, but given time, we do pretty well against infectious diseases. Youd probably have to assume that the virus gets worse in terms of case fatality either as time passes or as people get it repeatedly, and there's no good reason to think that AFAIK. And you'd have to assume that changing conditions among our virus-ravaged society won't be enough to bring the infectious rate below 1 spread per new case. Given the success of China and Korea in controlling spread, that's probably unlikely. All of these things would have to be true for this to be as apocalyptic as you're worried. Probably none of them are true. Still, its going to be plenty bad, best I can tell.
  9. Cowboyardee

    Am I a coward for going on FMLA due to COVID?

    Ill offer a dissenting opinion, but its not really directed at the OP, who has risk factors that I dont share - I'm in no position to judge such a hard decision about someone else's life. Here goes You don't owe this to your employer or the administrators at your hospital. You don't even owe this to those of your coworkers who are sticking in there. You did not sign up for this. Disaster nursing, sure maybe. Pandemic without PPE? Not so much. Many levels of society, political leadership, and healthcare administration have failed leading up to this. Forget about owing anyone anything. But... Here's the thing. I'm following projections of this virus and I'm watching the ICU I work in slowly get overrun, even in an area thats not yet considered a hot spot. And I'm pretty sure there will come a time (and soon) when every patient I treat, more or less, will be one more patient that wouldn't get treated if I wasnt there. It's not about what I signed up for. Instead, I have a skill set that is desperately needed right now. Eventually, every day I'm working at risk to myself and my family is also a chance to save lives in a system that will save that many fewer without me. And each of us has to decide how much risk to ourselves is too much to bear for that opportunity, not worth the lives of our neighbors. The risk to yourself is real and substantial. I can't make that decision for anyone else. But please don't make it casually or bitterly or to spite those who have failed us. This virus has proven many of our bean counters and administrators wrong - youre not just a cog in a system, replaceable by a fresh new recruit in the same color scrubs for a small cost and a little orientation. But of course, the problem with being irreplaceable is that you won't be replaced. Best wishes to everyone making hard decisions, and not taking them lightly.
  10. Courage isn't the absence of fear; it's doing the best you can even though you're afraid. I think a lot of us are about to find out we're braver than we thought and stronger than we realized. You're not alone in your thoughts and fears, OP. Best wishes to you and yours.
  11. Cowboyardee

    Why is BSN required for CRNA?

    Assuming I'm understanding you correctly and you're comparing the BSN curriculum to the ADN or diploma RN curricula, that's not really true. There's no additional pathophysiology at all, and additional education in either assessment or research (statistics class notwithstanding) tends to be incredibly basic. If the BSN offered substantially improved education in these areas over the ADN and diploma, I'd be much happier with it and the push to make it the entry-level degree for RNs.
  12. This. Take the job if it suits you. Or not. But don't let their pressure worry you that you're losing a once-in-lifetime opportunity if you don't act now. Keep looking and applying with confidence that this particular opportunity will still be open to you in another week, or month, or 6 months. And frankly, if one LTC in your area is that desperate to hire, chances are that the other LTCs in your area have plenty of job openings regularly as well. Take all the time you need, regardless of what they say.
  13. Cowboyardee

    CMA playing "Nurse Manager?" CMA boundaries? NPD?

    If the person interviewing you hadn't made such a big deal out of it, I would say that you are making too many assumptions about the CMA and also putting far too much weight on her education level and how you think that should determine her status rather than her skill set, work ethic, and ability to navigate power hierarchies in the real world, which don't stack up nicely according to how impressive one's education and resume might look on paper. (In fairness, you might be making this error anyway). But your interviewer did go out of his way to belabor this particular point, and that would raise my eyebrows too. If the arrangement wasn't already a source of contention, he probably wouldn't have bothered. Ask for a day or two shadowing on the job before making a decision. Try your best to see and evaluate this new workplace on its own terms and as it is, its own unique (and possibly disasterous) environment, rather than as a retread of your past. Best wishes.
  14. Im not a huge fan of sin taxes as a way to raise revenue either. But if you raise taxes on cigarettes high enough, the amount of revenue raised will actually decline as fewer people smoke. The ideal tax level to raise the most revenue and the ideal tax level to curb smoking aren't the same figure, and you don't just raise more revenue by setting taxes higher endlessly. Plus, if anyone wants to pass legislation mandating that cigarette tax revenue goes entirely to fund lung cancer research or low cost health solutions for the poor or the struggling foster care system, then please sign me up.
  15. Cowboyardee

    Why is BSN required for CRNA?

    I'm right there with you. However, I'm pretty sure the main reason those two classes are difficult is because they are usually terrible classes that add nothing much to our overall education. Could both sides of this debate agree that perhaps 'easy' is the wrong word (too subjective, for one), but nonetheless, we'd all get more out of our BSNs if nursing schools cleaned up their curricula a little bit?
  16. Cowboyardee

    New dialysis nurse - blood collection question

    Dialysis ports are called 'venous' and 'arterial' by dialysis techs and nurses, but in reality both lumens are actually venous. At least for TDCs and Quinton caths. I have no particular experience accessing AV fistulas. I'm not a dialysis nurse, but I don't think there's any significant difference in drawing from one port versus the other if dialysis is not currently running. Of course, you're right about infection risk.

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