The Infection That's Silently Killing Coronavirus Patients
This is what I learned during 10 days of treating Covid pneumonia at Bellevue Hospital.
By Richard Levitan
Dr. Levitan is an emergency doctor.
April 20, 2020
I have been practicing emergency medicine for 30 years. In 1994 I invented an imaging system for teaching intubation, the procedure of inserting breathing tubes. This led me to perform research into this procedure, and subsequently teach airway procedure courses to physicians worldwide for the last two decades.
So at the end of March, as a crush of Covid-19 patients began overwhelming hospitals in New York City, I volunteered to spend 10 days at Bellevue, helping at the hospital where I trained. Over those days, I realized that we are not detecting the deadly pneumonia the virus causes early enough and that we could be doing more to keep patients off ventilators and alive.
On the long drive to New York from my home in New Hampshire, I called my friend Nick Caputo, an emergency physician in the Bronx, who was already in the thick of it. I wanted to know what I was facing, how to stay safe and about his insights into airway management with this disease. Rich, he said, its like nothing Ive ever seen before.
He was right. Pneumonia caused by the coronavirus has had a stunning impact on the citys hospital system. Normally an E.R. has a mix of patients with conditions ranging from the serious, such as heart attacks, strokes and traumatic injuries, to the nonlife-threatening, such as minor lacerations, intoxication, orthopedic injuries and migraine headaches.
https://www.nytimes.com/2020/04/20/opinion/coronavirus-testing-pneumonia.html?action=click&module=Opinion&pgtype=Homepage
pbmus
(12,422 posts)BeckyDem
(8,361 posts)riversedge
(70,033 posts)Recognizing the pneumonia--can keep folks off the vent.
.............There is a way we could identify more patients who have Covid pneumonia sooner and treat them more effectively and it would not require waiting for a coronavirus test at a hospital or doctors office. It requires detecting silent hypoxia early through a common medical device that can be purchased without a prescription at most pharmacies: a pulse oximeter.
Pulse oximetry is no more complicated than using a thermometer. These small devices turn on with one button and are placed on a fingertip. In a few seconds, two numbers are displayed: oxygen saturation and pulse rate. Pulse oximeters are extremely reliable in detecting oxygenation problems and elevated heart rates.
Pulse oximeters helped save the lives of two emergency physicians I know, alerting them early on to the need for treatment. When they noticed their oxygen levels declining, both went to the hospital and recovered (though one waited longer and required more treatment). Detection of hypoxia, early treatment and close monitoring apparently also worked for Boris Johnson, the British prime minister.
Widespread pulse oximetry screening for Covid pneumonia whether people check themselves on home devices or go to clinics or doctors offices could provide an early warning system for the kinds of breathing problems associated with Covid pneumonia.
People using the devices at home would want to consult with their doctors to reduce the number of people who come to the E.R. unnecessarily because they misinterpret their device. There also may be some patients who have unrecognized chronic lung problems and have borderline or slightly low oxygen saturations unrelated to Covid-19.
All patients who have tested positive for the coronavirus should have pulse oximetry monitoring for two weeks, the period during which Covid pneumonia typically develops. All persons with cough, fatigue and fevers should also have pulse oximeter monitoring even if they have not had virus testing, or even if their swab test was negative, because those tests are only about 70 percent accurate. A vast majority of Americans who have been exposed to the virus dont know it.
BeckyDem
(8,361 posts)mopinko
(69,981 posts)i bore the new nurses every time they put that on my finger.
i was a lab aide many decades ago, just as all this automated stuff was taking off. but in those days if you needed a blood O2, it was a big deal. a certified tech had to do an arterial blood draw, and rush it to the lab. they were rare.
days of miracles and wonder.
BeckyDem
(8,361 posts)mopinko
(69,981 posts)BeckyDem
(8,361 posts)Whatthe_Firetruck
(555 posts)...and 10 years ago I was admitted in a va hospital for congestive heart failure and copd... I ended up with a tracheostomy I have to this day (->upside, intubation is a breeze!). While I was there I got lots of arterial blood O2's. Hated them, cuz I'd also get lots of venous blood draws, and I'm a hard stick.
2 years ago I was admitted again for a hernia surgery, and last September for arrhythmia. I didn't get any arterial draws for the more recent admissions, and was grateful for it. Now I know why.
mopinko
(69,981 posts)not to mention bruising.
Nay
(12,051 posts)Rebl2
(13,442 posts)one of those winter of 2019. We have used it a few times recently. I have found if I take a few deep breaths before hand I am around 96, if I dont do that its a bit lower like 94. We bought it after my mother was in the hospital and her oxygen levels were below normal. We thought it might be a good thing to have on hand because we arent youngsters ourselves.
Aristus
(66,273 posts)When I have patients come to the clinic with respiratory issues of any kind, if I have their pulse-ox, the visit is half over before I even walk in the door.
I see real, genuine, actual fever (101F or 38C) maybe three or four times a year in clinic. I get an abnormal pulse-ox (<95%) two or three times a week.
BigmanPigman
(51,560 posts)and they were talking about Chris doing lung and breathing exercises while sick. This article makes it seem that by doing that, he was actually causing more harm...
"Patients compensate for the low oxygen in their blood by breathing faster and deeper and this happens without their realizing it. This silent hypoxia, and the patients physiological response to it, causes even more inflammation and more air sacs to collapse, and the pneumonia worsens until oxygen levels plummet. In effect, patients are injuring their own lungs by breathing harder and harder. Twenty percent of Covid pneumonia patients then go on to a second and deadlier phase of lung injury. Fluid builds up and the lungs become stiff, carbon dioxide rises, and patients develop acute respiratory failure."
I read about the patients lying on their stomachs as opposed to on their backs and partially sitting up. The other article said that this lessons pressure on the lungs and diaphragm from the internal organs. That makes sense to me.
appalachiablue
(41,102 posts)Pulse Oximeter from CVS, $49.99
https://www.cvs.com/shop/cvs-health-pulse-oximeter-prodid-814854?skuid=814854
BeckyDem
(8,361 posts)BigmanPigman
(51,560 posts)Thanks!
TreasonousBastard
(43,049 posts)(mine went down into the 60s for a short time, then stayed too long in the 80s) and someone showed me a $25 gadget that worked just fine. Works the same as the ones attached to the expensive blood pressure machine, but comes in a tiny bag you can hang around your neck. I hear they're used by extreme athletes a lot.
I ended up paying over 30 bucks for one because I couldn't be be bothered ordering it on line. But it works great. Most rethetailers wanted around 50 bucks for the fancy ones, but Walgreens had cheap one. If what this doctor says is true, these little gizmos could be a first line of defense against coronavirus.
BeckyDem
(8,361 posts)RRDrummer
(32 posts)or something close. Just. In. Case. I nearly purchased an in home oxygen concentrator because as luck would have it I am a neurotic over thinker and panicked early. So long before this whole crisis exploded I had extra toilet paper and other essentials stocked up and? A pulse oximeter. Could not pull the trigger on an expensive piece of equipment I'd likely never need but 30 bucks for a pulse oximeter? Sure. Got it. And now thanks to you and this fascinating article I will check my fam and I daily. Just in case. Otherwise I'd have made the mistake of waiting to feel out of breath. Nice post.
Igel
(35,268 posts)the shelves at every pharmacy and store that carries them are being stripped bare, and Amazon is seeing a frightening run on them.
2naSalit
(86,307 posts)So once you see that your blood oxygen is dropping, then what? How else can you deal with it other than eventually ending up in the hospital?
BeckyDem
(8,361 posts)can possibly get admitted asap.
2naSalit
(86,307 posts)I read the article and couldn't find anything past knowing what your blood oxygen is, I would imagine that's helpful but I wonder what remedial action the medical professionals would use.
BeckyDem
(8,361 posts)tool might help you get medical attention quicker. Its scary to read how many people are dying at home, as in NYC.
2naSalit
(86,307 posts)I'm hoping I can stay safe from getting infected until there is a remedy or something. I have the luxury of being retired so I can stay home longer. I worry about the dying at home part too. Since it's now getting nicer out, I would be out in the garden most days so someone would notice if I was not out there and would likely check on me.
I have jitters about the collective living facilities as my very elderly mom is in one. She's about to turn 93. I spoke to her yesterday and she seems to be doing okay so that's a little relief but it with the way this virus is sweeping through those places, it's troubling. At least she's in a state that is paying attention to the problem.
BeckyDem
(8,361 posts)grocery pick up and delivery without direct contact. They call you from the grocery store and let you know the amount. I leave the check on the porch. My senior center has made these arrangements and have done background checks on the volunteers. This way you get help but you're also on their radar? I am sure it is worrisome for your Mom. Glad to hear so far so good!
Blue Owl
(50,234 posts)Thekaspervote
(32,688 posts)This is truly something hopeful
aggiesal
(8,906 posts)And because of this statement
I went out and bought a Pulse Oximeter.
They can cost between $19.99 and $299.99 depending on the features you want.
I bought one that cost $69.99
I have a small cough, but no fatigue or fevers.
I've been taking my temperature and it has ranged from 98.4 to 99.1 consistently,
with the lowest at 98.2 and the highest at 100.0
But I'm not taking any chances.
BeckyDem
(8,361 posts)Be well!
aggiesal
(8,906 posts)Hortensis
(58,785 posts)That seems to be the refrain from everywhere about this virus. Good piece, thanks.
BeckyDem
(8,361 posts)say, like nothing I have seen before. Take them at their word. We have the criminal enterprise, GOP, opening states up, one can only hope that most people will still stay home.
Hortensis
(58,785 posts)I suspect by far most who can will maintain self isolation.
If so, opening will not rescue most small businesses, BUT the big goal of legally shifting much of the economic burden from the wealthy to mostly low-pay service workers and small business owners will have been met. As a GA restauranteur explained in another post, he will be on the legal hook for paying rent and unemployment insurance, and incur other rock-and-hard-place costs, whether anyone walks in the door or not.