All this ranting about ventilators...

[FarPoint]

Maybe we will get 20,000 to 40,000 more ventilators...great....but...lets look at what is needed to operate the ventilator...

A skilled medical professional/ Nurse, Respiratory therapist....this is a small group of individuals who know how to set-up/monitor a ventilator...it is not like plugging in a toaster...It requires ongoing, 1:1 management...maybe 1 Nurse could handle 3 patients...maybe...it's complicated...

The ventilator is attached to a breathing tube that enters the patients lungs/ intubation or a trach ...this requires suctioning with sterile tubing/ suction catheters...patient also will require oral suctioning...the ventilator requires oxygen set at prescribed delivery rate, and pressure of lung inflation...the ventilator tubing, suction catheters, well we will need millions of them...if we don't even have masks, how do we know if we have the ventilator support supplies required for this magnitude of patients?

Another concern....critical management of a ventilator client is needed, cardiac monitors, LABS such as blood gasses wherein the blood is drawn from an artery, a deep sterile stick...ventilator effectiveness and blood Ph is the key data with blood gasses...a must for living stuff. This requires FAST lab results and a lab staff/ equipment to obtain the blood gasses and by the way...drawing a blood gas is typically a very skilled challenge.... radial/brachial or femoral sites...yea it's a little deep. 'OUCH".

So, we don't hear anything about this complex support level for life...staff and equipment... This can go on...realize the patient will have other clinical compromising conditions to balance...hypertension, cardiac, renal, diabetes and "new infections/bacterial...it goes on....

**** Realize...the Nurse/ Therapist are "on-hands" face to face with an active COVID-19 patient...effective PPE is essential....any break in protection barrier opens up an opportunity for the Nurse/Therapist to become infected...effective PPE not home made stuff...the home made gear for 1:1 ventilator patient is not protective...only a cosmetic image...

Just adding a little more visual to the big picture....

[FarPoint]

1. Jeepers....No one commenting???

Maybe this is " just sinking in" as to how far behind the 8-Ball we really are...

[Cousin Dupree]

2. Another point about the breathing tube: there's a cuff around part of the tube that gets air

injected into it. This cuff pushes against the walls of the trachea and holds the tube in place. Over several days, the constant pressure against the trachea limits blood circulation to the area and can cause cell death and necrosis. So people who need prolonged intubation will need tracheotomies, which adds to the complexity of care.

[FarPoint]

4. Absolutely....

I posted this little rant this morning because in general, the impact is intense and the conversation is shallow....The crisis level gets dropped once the ventilator issue is being addressed/ resolved...but the picture is much, much bigger....very complex...

[Cousin Dupree]

7. Indeed.

[FarPoint]

9. I think healthcare workers are in a shock mode....

Healthcare workers need to process their feelings...here is an opportunity...Yea, we face death...maybe doing rounds with the Grim Reaper.

[likesmountains 52]

3. Retired RN here. I've been thinking this for weeks.

Where are they going to get the staff?

[MontanaMama]

5. Yes.

All the ventilators in the world with not enough folks to run them?

[FarPoint]

8. Manage a ventilator and live to tell the story!

I fear that even what added staffing Nurses arrive...where are they going to stay? Say a dorm style housing is set up...after work stripping down, not contaminating one peers is another concern...The COVID virus can live on surfaces, be carried home..live in close quarters...

Plus feeding, doing laundry, oh...so much to think about.

[FarPoint]

6. You know that even on a good summer day....

Getting staff to work with critically ill/ ventilator ICU patients...very challenging.....To go and do it today with COVID-19 patients and not having even effective PPE's to protect the Nurse is almost a death sentence. Plus, the support equipment required for ventilator level patients...I ask, " Do we really have adequate supplies to meet this demand"?

[OhioChick]

13. "Do we really have adequate supplies to meet this demand?"

Absolutely not.

[OhioChick]

12. From what I understand..

States are either graduating a lot of 4th year med students early, or considering it.

A lot of shifting around of physicians and nurses in the hospital. Things are changing by the hour.

One of my kids is ER but will be pulled into the ICU.

[FarPoint]

16. I understand....

This is like taking a butter knife to a gun fight..... (((HUG)))…. This abuse is unnecessary....tRump has blood on his hands...

[OhioChick]

17. Exactly!

He's going to have a lot on his hands by the time the dust settles.

[FarPoint]

18. Question....

The hospitals where your children work....Are they testing employees? If exposed...do they test them? My son in law, he has been exposed at work...hospital with about 20 COVID patients if not more...told, " we don't have any tests, keep working, wear a mask".

[OhioChick]

21. My son that is in quarantine was not tested (FL)

He was told to go home and self quarantine for 14 days and provided he had no symptoms, to return after the 14 days were up.

They're not testing employees anymore there, even if exposed and apparently, he was one of the last to be quarantined.

Things are rapidly changing by the day/hour it seems.

My other son (OH) was notified that if he gets exposed, he's to keep working, just as your son in law. Slap a mask on and keep working.

He intubated a patient 2 weeks ago and was just told the patient is positive.....2 weeks later!

This is just crazy. He thankfully didn't get ill but if he did, how many patients, staff, family members and those he comes in contact with would he have given it to?

This sounds like a catastrophe to me and a dangerous one, at that.

I hope your son in law is fine and doesn't come down with symptoms.

[FarPoint]

23. Sure is rapidly changing!

Same thing here! So, it changes to accommodate the business flow....Is that how you see it?

[OhioChick]

24. I'm sorry I didn't answer you yesterday

I've been so exhausted.

I don't believe that I can answer your question, asked.

All that I know is what my kids are feeding me from their hospitals, colleagues, admin., etc.

They've "taught" me much over the years but I can't honestly answer this particular question.

I'm sorry.

[lostnfound]

10. Is a separate waiver required for the blood gas line?

I remember that it was a separate consent just for that when my bro was on a ventilator (he recovered)

[FarPoint]

11. No....

It's a lab draw into an artery...In/ stab/ ... collect... withdraw, pressure dressing...done...place on ice. Run to lab.

[melm00se]

14. Also don't forget the step down process

to wean the patient off the vent.

[FarPoint]

15. Absolutely!

I
Like I said...it is complicated....every 1:1 caregiver is serious jeopardy; it is a long process...can be weeks! …. We definitely do not have enough staff ...

[hatrack]

19. All of this - and what about lab capacity? What about lab staffing?

This is where the MBA Magic of "Just-In-Time!" falls on its face, breaks teeth, rolls over and suffocates.

[FarPoint]

20. The volume of lab tests...unpresidented!

There ya go...Do we really have the staff, equipment, reagents etc....to do the testing timely? Can they coordinate the right lab test with the right patient????
Probably high incident of errors...


This is deep!

[NNadir]

22. My immediate understanding of the available testing procedure is PCR.

I have, however, not looked into the details of the available tests, so I am speaking from general knowledge.

Assuming the proper isolation procedures have been identified and protocols have been established, these can be conducted using highly automated equipment. This is the type of equipment that was developed in the 1990's for the human genome project.

It has advanced so far that there is even discussion of sequencing the entire genome of the ocean, as discussed in this talk that I attended some years ago, 2014.

Prof. Kay Bidle, Rutgers University: The Invisible World of Marine Microbes: How Earth’s Smallest Living Things Have the Biggest Impact on How Our Ocean Works

I would imagine that the test requires looking for a specific single nucleic acid sequence, which is greatly simplified in comparison to mapping the genome of an entire organism or ecosystem.

The seriousness of the contamination is not to be minimized; however our worldwide scientific community is not totally disarmed. The real problem is not having equipment to run the tests, but the logistics of getting the test materials to the machines and having the machines correctly programmed to obtain results, have the results subject to quality assurance, and reporting the results.

While overall the response in this country has been abysmal, there are many talented people of good will working to respond to this crisis.

[Hermit-The-Prog]

25. Any comments on this thing ...

https://med.umn.edu/covid19Ventilator

[Ghost Dog]

26. Only a minority of those requiring ventilation will need entubation,

I read.