China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails."
Thanks for posting.
Yup. That’s the flu.
Explain it to us like we're ten year olds.
Later
How many elderly or with compromise immune or respiratory issues?
Gonna need Google MD translate
I wonder why the cytokine storm ?
Would be interesting to see the percentage that don’t present to hospital.
In MN we’re being told that we are in day 4 of a 150 day outbreak. Which will peek in the final week in June.
Question: How many undiagnosed have gotten it and stayed home until they were better and only had mild to moderate symptoms?
This virus is no flu. This stuff is nasty.
Good post. Thanks
Yikes. Lungs, brain, heart, kidneys. Heard a few days ago it is damaging testes. What a bad virus. Have any other viruses attacked so many organs?
Geezus, I think everyone here is on the internet. Do we not know how to look up the meaning of a word on said internet?
Looks like another doc ?? chimed in, in the replies, along with a reply by orig doc....
I agree that it is striking how fast they crash when they do. It happens right in front of you in very short order.
The rate of superimposed bacterial PNA is very low, less than 1% based on Chinese data, and so I really don’t feel there is any benefit to azithromycin. Especially given even strep pneumo in major population centers laughs at azithro these days.
CXR findings in general have little correlation with disease severity in pneumonia, and that goes for COVID as well. A patient <65 who isn’t hypoxic or hypotensive with a RR <30 essentially never needs to be admitted for pneumonia outside of unique circumstances (regardless of imaging), and even then it’s usually “just in case”. I will say this disease does make one hesitate because of its unique course, but there are predictors other decompensation as you said that can guide you.
I don’t love the Plaquenil option and the data sucks to be honest, but I have used it some. Remdesivir really seems to work well in the severe cases from my anecdotal perch.
Also, some of these patients have incredible IL-6 levels. I’ve never seen numbers this high even in my AIDS patients with KICS. One guy had a level above assay which were pretty sure has never been reported by our lab before.
Obviously we dont know what they were for Spanish flu patients 100 years ago but the cytokine storm was the hallmark of that disease. We’re seeing something similar here.
Patients requiring supplemental oxygen beyond regular nasal cannula, which in COVID usually ends up being a ventilator. We don’t really try NIPPV as the OP said because it doesn’t help much and risks aerosolizing the virus. I’ve had one patient saved from a vent by high flow nasal cannula, which in terms of pure oxygen delivery is the most we can provide prior to intubation, but generally these people are either on NC or getting intubated because the hypoxia becomes so profound so quickly if they crash.
That is correct. Once on the vent if they survive expect them to be on 10-11 days.
sheesh...why did I read that
next time I feel the urge to go out I think I will just read that again.
Sounds like you better find a way to nip this in the bud at home PDQ because you have no idea where the Wuhan Roulette ball will fall
I am going with that Zinc Picowhatever.
Quercetin for the transporter
Vitamin C
Tumeric, Zicam, Copper and some other stuff
New Orleans not getting much attention but the numbers aren’t good down there.
Being an ER MD on the front lines, do you have a medical opinion regarding the use of Hydroxychloroquine in combination with Azithromycin as documented in the recently published peer reviewed study out of France? Is it being prescribed in your hospital for certain Covid patients ?
Who wrote this? Is it real? What hospital?
Nobody knows.
It’s the second anonymous, different yet similar letter alleged to be from a doctor in a hospital in NOLA.