Posted on 04/09/2020 1:04:34 PM PDT by Kaslin
You up the ante based not just on numbers but by symptoms. A lot of folks show low sats on a finger monitor because of circulatory issues or have a long running stable COPD that keeps their sats in the 85 to 90 percent range but are as oriented as you and me(I presume the best for you...I might be a bit crazy...ya never know).
If you have low numbers but are not overly dyspnic and are alert and oriented...just careful monitoring and minimal o2 to keep sats at the 88 to 92 percent range for copd’ers is often enough. PH between 7.3 to 7.5 is the key. Numbers above and below cause issues but there are lots of tricks that can be done to maintain them.
So the key is to look at the arousal and orientation of your patients...not just the “raw numbers”. A declining level of responsiveness despite a “good” o2 sat is a bad sign as the patient’s co2 levels may be rising and his abg ph is dropping. If Ph is dropping(and the patient has become drowsy and confused) but the gas levels look good(or the co2 is low in the blood) but the metabolic bicarb is low...then the patient may have a metabolic or kidney or hydration issue.
Always look at what the patient is doing...not just the numbers.
We ran a comparison test on those finger tip sensors here at our local hospital using the main, very expensive hospital unit as the base.
Results were amazing: Left hands always gave higher readings on BP. O2 levels could be off by 5%; HB’s were pretty consistent. And if your hands were cold, you could be dead.
re: “I love Rush....but there is a lot of marginal and bad info in that piece.......”
Address it. Let’s see if you’re right ...
If the odds aren’t “slim”, then what are the odds?
You made the assertion that the odds of survival were not slim, so let us know exactly what are the odds.
Good luck getting a response.
Article: Is protocol-driven COVID-19 respiratory therapy doing more harm than good?
Publish date: April 6, 2020
https://www.the-hospitalist.org/hospitalist/article/220301/coronavirus-updates/protocol-driven-covid-19-respiratory-therapy-doing
Wiki: Ventilator-associated lung injury
https://en.wikipedia.org/wiki/Ventilator-associated_lung_injury
re: “response”
Ya - doesn’t look like one is forthcoming.
Meanwhile, there is a lot of good info on “ventilation” and the effects on lungs in this on-going discussion for those interested (the post is about Elon and his CPAP machines etc, but the discussion in comments addresses ventilators et al):
Title: “Bombshell Plea From NYC ICU Doctor: COVID-19 A Condition of Oxygen Deprivation, Not Pneumonia”
VENTILATORS may be causing the lung damage, not the virus
Opening excerpt:
A NYC physician named Cameron Kyle-Sidell has posted two videos on YouTube, pleading for health practitioners to recognize that COVID-19 is not a pneumonia-like disease at all. It’s an oxygen deprivation condition, and the use of ventilators may be doing more harm than good with some patients. The ventilators themselves, due to the high-pressure methods they are running, may be damaging the lungs and leading to widespread harm of patients.
Dr. Cameron Kyle-Sidell describes himself as an “ER and critical care doctor” for NYC. “In these nine days I have seen things I have never seen before,” he says. Before publishing his video, we confirmed that Dr. Kyle-Sidell is an emergency medicine physician in Brooklyn and is affiliated with the Maimonides Medical Center located in Brooklyn.
In his video (see below), he goes on to warn the world that the entire approach to treating COVID-19 may be incorrect, and that the disease is something completely different from what the dogmatic medical establishment is claiming.
“In treating these patients, I have witnessed medical phenomena that just don’t make sense in the context of treating a disease that is supposed to be a viral pneumonia,” he explains.
Rush is at his most embarrassing when he tries to play medical expert.
If you are put on a ventilator for ANY REASON.., the odds that you are going to walk out of the hospital are slim at best.
THAT is what I replied to...and your statement was very wrong. Do you not understand?
You apparently don't understand or want to understand what I've have tried to tell you...
I'm telling you, you are wrong...plenty of people come off vents just fine..I've extubated and decannulated people on vents..many times.....
You don't seem to understand...that many times people are on Vent's post surgery...You don't seem to understand many people are tubed...and we fix them and extubate them.
I've intubated probably 100 kids...Preemies..and they got extubated and lived...
So how long are you going to argue with me??
Which I've tried now more than once...to explain to you?
I responded to one sentence that you uttered. PERIOD.
Hopefully I was informative....and that is all you needed.
I do not know why...Some circulation study I suppose...
Or you could just say thanks, "I didn't know what I was talking about"...
Or you could just ignore me...and continue to be uneducated on the subject...
The choice is yours...
Gee thanks!!!!!
What are the odds of leaving the hospital alive if you are admitted with severe respiratory distress and you have to be intubated?
What if you are over 70, have diabetes and hypertension and severe respiratory distress? What are the odds then?
Nor do you read well...
And your don't argue well....
You give FR a bad name....
Lol!
Why do you believe I wouldn't understand it? I work in healthcare and drug development; while I'm not a HCW myself, I routinely work with doctors and clinical researchers. I also have an aging parent with COPD, so I'm quite familiar with the process.
I was asking you to back up your original comments; my request was not in any way mean-spirited.
Hopefully I was informative....and that is all you needed.
I had no comment yesterday, because I don't monitor FR in real time. Don't ever mistake a non-response on these forums as a concession.
The majority of the article posted, I thought, was very true, very accurate about hospitals being underwhelmed.
You obviously took issue with some specifics about the use of ventilators, and I'll defer to you on that as a specialist in that profession. I won't argue with you about that. While I know it's challenging for some patients to come off a ventilator, I assume you employ all the best practices in doing so, and the majority of patients resume normal breathing.
I still think your initial comment is akin to throwing a baby out with the bathwater.
You on the other hand prolly would understand it....with your background.
Sorry I assumed...
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