Years ago there was some testing on “internal” vitamin C creation in goats.
You do know that most animals on the planet actually don’t need vitamin C, because they make their own?
Humans (and all great apes) lack one of the genes (out of three) to make their own vitamin C.
Anyways, they took some goats and put them on a shock pad where a few times a day they were given a jolt.
After a few days, these goats (whose normal production of Vitamin C was in the 6,000-10,000 mg range SKYROCKETED to about 100,000 milligrams per day!
Tells you something about goats, eh?
Fauci would probably say it doesn’t mean anything for humans at all...
What the HELL has the FBI got to do with healthcare OMG!!
Page 5 of 11 | EVMS Critical Care COVID-19 Management Protocol 04-20-2020 |
evms.edu/covidcare
11.Escalation of respiratory support (steps); Try to avoid intubation if at all possible, (see Figure 3)
•Accept “permissive hypoxemia” (keep O2 Saturation > 84%) •N/C 1-6 L/min•High Flow Nasal canula (HFNC) up to 60-80 L/min
•Trial of inhaled Flolan (epoprostenol)•Attempt proning (cooperative repositioning-proning; see Figure)
•Intubation ... by Expert intubator; Rapid sequence. No Bagging; Full PPE. Crash/emergency intubations should be avoided.
•Volume protective ventilation; Lowest driving pressure and lowest PEEP as possible. Keep driving pressures < 15 cmH2O. •Moderate sedation to prevent self-extubation
•Trial of inhaled Flolan (epoprostenol)•Prone positioning•?? ECMO < 60 yrs. and no severe commodities/organ failure.
There is widespread concern that using HFNC could increase the risk of viral transmission. There is however, no evidence to support this fear.
HFNC is a better option for the patient and the health care system than intubation and mechanical ventilation.
CPAP/BiPAP may be used in select patients, notably those with COPD exacerbation or heart failure.
A sub-group of patients with COVID-19 deteriorates very rapidly. Intubation and mechanical ventilation may be required in these patients.
12. Treatment of secondary HLH (increasing Ferritin, CRP and transaminases)
•“High dose corticosteroids.” Methylprednisolone 120 mg q 8 hourly for at least 3 days, then wean accruing to CRP, IL-6, Ferritin etc (see Figure 4).
•Tocilizumab (IL-6 inhibitor) as per dosing guideline. •Consider plasma exchange 13.Monitoring•Daily: PCT, CRP, IL-6, BNP, Troponins, Ferritin, Neutrophil-Lymphocyte ratio, D-dimer and Mg.
CRP, IL-6 and Ferritin track disease severity closely.
Thromboelastogram (TEG) on admission and repeated as indicated.
•In patients receiving IV vitamin C, the Accu-Chek™ POC glucose monitor will result in spuriously high blood glucose values. Therefore, a laboratory glucose is recommended to confirm the blood glucose levels.
•Monitor QTc interval if using chloroquine/hydrochloroquine and azithromycin and monitor Mg++ (torsades is uncommon in monitored ICU patients)
•No routine CT scans, follow CXR and chest ultrasound.
•Follow ECHO closely; Pts develop a severe cardiomyopathy.
Page 6 of 11 | EVMS Critical Care COVID-19 Management Protocol 04-20-2020 | evms.edu/covidcare
14.Post ICU managementa.Enoxaparin 40-60 mg s/c dailyb.
Methylprednisone 40 mg day, the wean slowlyc.
Vitamin C 500 mg PO BIDd.
Melatonin 3-6 mg at nig