Posted on 03/27/2020 4:49:42 AM PDT by Kaslin
Do you believe him?
The “Case Fatality Rate” in New York state is 1.2%.
The CFR in New York City is 1.6%.
The CFR for the entire USA is 1.5%. That rate has been steady or slightly falling for three straight weeks.
To put someone on a vent you have t intubate them. I certainly have never seen anyone try something else and i imagine if you tried there would be so many leaks you wouldn’t even be ventilating the patient. You. Would be ventilating the room.
The best stat I saw for was the one showing 21 million fewer cell phone subscribers. Where did they go? Hmmmmmm....
Look at the # new deaths in NYC. I imagine they are getting a lot of practice at intubation.
Whereas patients put on ventilators who did not require intubation had a slightly higher survival rate, with only 92% dying.
THAT's a relief!!
But really; how long do they LIVE before they finally die?
indeed, the city is going to be banking on tax sales. by the way their profit should be given back to families... imagine mortgage insurers doingthat
I ran ICUs for 5 months of my surgical internship. Not quite on the “DeBake model” but close. 15 beds and at times almost all of them on vents. In my younger days I was quite good at it because when you are managing a child with a brain tumor on a vent if you don’t know what the hell. You are doing you will kill them quickly.
They switched carriers to get a pair of new Iphones and got scammed outta their old ones.
People are frightened. They don’t understand what is happening and they want answers. That’s no reason to be rude.
To put someone on a vent you have t intubate them. I certainly have never seen anyone try something else and i imagine if you tried there would be so many leaks you wouldn’t even be ventilating the patient. You. Would be ventilating the room.
I'm a complete layman, but this is an elaboration of what I've read about non-invasive ventilation:
Mechanical ventilation is the most widely used supportive technique in intensive care units. Several forms of external support for respiration have long been described to assist the failing ventilatory pump, and access to lower airways through tracheostomy or endotracheal tubes had constituted a major advance in the management of patients with respiratory distress. More recently, however, new “noninvasive” ventilation (NIV) techniques, using patient/ventilator interfaces in the form of facial masks, have been designed.
The reasons for promoting NIV include a better understanding of the role of ventilatory pump failure in the indications for mechanical ventilation, the development of ventilatory modalities able to work in synchrony with the patient, and the extensive recognition of complications associated with endotracheal intubation and standard mechanical ventilation.
NIV has been used primarily for patients with acute hypercapnic ventilatory failure, and especially for acute exacerbation of chronic obstructive pulmonary disease. In this population, the use of NIV is associated with a marked reduction in the need for endotracheal intubation, a decrease in complication rate, a reduced duration of hospital stay and a substantial reduction in hospital mortality. Similar benefits have also been demonstrated in patients with asphyxic forms of acute cardiogenic pulmonary oedema. In patients with primarily hypoxemic forms of respiratory failure, the level of success of NIV is more variable, but major benefits have also been demonstrated in selected populations with no contraindications such as multiple organ failure, loss of consciousness or haemodynamic instability.
One important factor in success seems to be the early delivery of noninvasive ventilation during the course of respiratory failure. Noninvasive ventilation allows many of the complications associated with mechanical ventilation to be avoided, especially the occurrence of nosocomial infections. The current use of noninvasive ventilation is growing up, and is becoming a major therapeutic tool in the intensive care unit.
Without mechanical support for respiration, many patients would die within hours to days due to acute hypoxaemic and hypercapnic respiratory failure. Observational, physiological and case/control studies form a large body of evidence demonstrating that noninvasive ventilation (NIV) can be used in many situations to decrease a patient's dyspnoea and work of breathing, improve gas exchange and ultimately avoid the need for endotracheal intubation (ETI) 1–3. Randomised controlled trials have confirmed this and helped delineate when NIV should be used as a first-line treatment. Studies conducted outside the context of clinical trials are also of great importance in ensuring that the results of these trials can be obtained in real life 4–6. Indeed, the success of NIV may follow a learning curve, and early results may not be as good as those obtained later. In addition, it must be clear to clinicians that NIV is a complementary technique and cannot replace ETI in all instances.
In theory, the modes and settings for the delivery of NIV could be very similar to those for traditional mechanical ventilation through an endotracheal tube or tracheotomy cannula. In practice, because the circumstances of ventilation are different, the population of patients more selected and the equipment available sometimes more limited, this is not the case. In addition, leaks are a quasiconstant feature of NIV 7, 8. NIV is usually delivered in the form of assisted ventilation, in which every breath is supported by the ventilator. Rarely, controlled mechanical ventilation is used.
[To put someone on a vent you have t intubate them. I certainly have never seen anyone try something else and i imagine if you tried there would be so many leaks you wouldn’t even be ventilating the patient. You. Would be ventilating the room.]
This is going to get technical. If you subject tissue to more than ten # PSI you stop the capillary blood flow. If you try to use a mask to stop the leaks you have to inflate the seal to 10 lbs PSI because to keep the alveoli open you need 5 cm of Positive End Expiratory Pressure or PEEP. Which is about 5 lbs. to prevent leaks. This is not a new idea. It was tried 30 years ago. Occluding the capillaries under the seal for a day or two causes necrosis of parts of the face and then the seal is lost anyway. Sorry to rain on your parade.
I haven’t seen a copy of The Lancet study. All I have is an IPad and a router. I will say this, Lancet has an excellent reputation and if they published it you can generally take it to the bank. Unlike that ridiculous email that some (adjective deleted) was spamming everywhere a couple days ago. When I can stumble across it, believe me I will be reading it.
Here is what I have been saying. It is probably too late to start blue people on meds. It is probably over treating to put everybody who tests positive on drugs. So who do we put on drugs, even if they work to some extent? Everyone admitted to the hospital? Maybe. It would be logical. But first I still want to know that there were no or few people on Plaquenil prior who are among the Dead and seriously ill. Putting people who are critically ill on a drug we don’t have a real good idea works clinically could be a real mistake.
And any. Body who says they took it for months in Viet Nam, you were 18 and healthy as a horse. You probably could have taken small doses of cyanide.
Lancet is one of those Journals you don’t have to look for the red flags first. They have good editors.
[This is going to get technical. If you subject tissue to more than ten # PSI you stop the capillary blood flow. If you try to use a mask to stop the leaks you have to inflate the seal to 10 lbs PSI because to keep the alveoli open you need 5 cm of Positive End Expiratory Pressure or PEEP. Which is about 5 lbs. to prevent leaks. This is not a new idea. It was tried 30 years ago. Occluding the capillaries under the seal for a day or two causes necrosis of parts of the face and then the seal is lost anyway. Sorry to rain on your parade.]
People are being absolutely buried in bull shit. Which is why I have been here every day trying to help.
Experience. It is why you want to keep a few old people around.
[Putting people who are critically ill on a drug we don’t have a real good idea works clinically could be a real mistake.]
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