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Discussion

Three Nurses Discuss Problems With Intubation and Related Issues in NYC Hospitals

3 nurses discuss how Intubation is routinely being used early instead of CPAP and hyflow options in certain NY hospitals, reason given because they are a closed system less likely to spread infection however therapeutic medications and other treatments are often not being employed. Majority of patients in unnamed hospital dying. Family members kept out of rooms reduces accountability. Poles being extended outside of rooms. Various problems discussed

( disregard the exaggerated click bait video title, couldn't find original source with proper title). You may or may not agree but this is a reasonable discussion

In this earlier 10 minute video one of these nurses expresses a more urgent tone speaking of negligence in certain hospitals in NY

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April 21, 2020

By using ventilators more sparingly on Covid-19 patients, physicians could reduce the more-than-50% death rate for those put on the machines, according to an analysis published Tuesday in the American Journal of Tropical Medicine and Hygiene.

The authors argue that physicians need a new playbook for when to use ventilators for Covid-19 patients — a message consistent with new treatment guidelines issued Tuesday by the National Institutes of Health, which advocates a phased approach to breathing support that would defer the use of ventilators if possible.

Read in its entirety: New analysis recommends less reliance on ventilators to treat coronavirus patients

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The ongoing novel coronavirus disease (COVID-19) pandemic is threatening the global human population, including in countries with resource-limited health facilities. Severe bilateral pneumonia is the main feature of severe COVID-19, and adequate ventilatory support is crucial for patient survival ...

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Key messages include that supplemental oxygen is a first essential step for the treatment of severe COVID-19 patients with hypoxemia ...

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Oxygen delivery can be increased by using a non-rebreathing mask and prone positioning. The presence of only hypoxemia should in general not trigger intubation because hypoxemia is often remarkably well tolerated. Patients with fatigue and at risk for exhaustion, because of respiratory distress, will require invasive ventilation. In these patients, lung protective ventilation is essential.

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Severe pneumonia in COVID-19 differs in some important aspects from other causes of severe pneumonia or acute respiratory distress syndrome ...

Read in its entirety: Respiratory Support in Novel Coronavirus Disease (COVID-19) Patients, with a Focus on Resource-Limited Settings

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    • Featured Replies

    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.

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    • Experts
    2 hours ago, Cowboyardee said:

    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. 

    Thank you. I wondered.

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    I posted this already. I called them "Youtube doctors" because nobody ever shows credentials.

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