Category: Misc.

Special episode: The Intensive Care Academy

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We share our grand new project, the Intensive Care Academy, an online, video-based, subscriber-only educational platform. Check it out at icu101.com!

Special episode: Surviving COVID-19 with Eve Leckie

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The COVID-19 pandemic will hopefully wind down this year. What happens next with these patients? A powerful discussion with Eve Leckie (@browofjustice), RN, CCRN, formerly of the CVCC at Dartmouth-Hitchcock and now disabled after contracting COVID. Learn about their acute course of illness, the challenges of navigating the healthcare system with this new disease, and their persistent, poorly-understood symptoms.

Takeaway lessons

  1. For Eve, orthostasis, heart rate and blood pressure abnormalities (e.g. POTS), and severe persistent fatigue, weakness, and “brain fog” are hallmarks of their chronic symptomatology. Shortness of breath, nerve-type symptoms (paresthesias, twitching), and intermittent fevers also continue to occur without a clear cause. Steroid courses seem to bring relief from some symptoms.
  2. Ground glass opacities and moderate airway thickening persists on imaging. In Eve’s case, their baseline asthma no longer responds to bronchodilators.
  3. Some “long haulers” have developed a criterion that most patients will have improvement in symptoms by 4 months post-infection, but there is a subset who does not fit that model.
  4. Patients who were advised to avoid healthcare, presume positivity, and defer testing now may face difficulty “proving” they had a definite infection for purposes like continued care or disability claims.
  5. Lack of understanding of this disease leads to a lack of diagnostic “boxes” to categorize symptoms, which often leads to dismissal and “non-diagnoses” of functional disorders or conversion syndrome. Until the scientific model is understood and diagnostic criteria have been validated, all that’s available is patient experiences, which should be trusted.
  6. Practical challenges like fatigue and cognitive issues can make dealing with healthcare, insurance, and supporting one’s self and family almost impossible without substantial assistance.

Links

Special episode: Initial vent settings for COVID-19

A 5-minute episode describing three hyper-simple, generally safe recipes for the initial strategy of mechanical ventilation after intubating a COVID-19 patient.

Caveat: this is intended for trained clinicians, such as emergency medicine providers, who already have a general understanding of safe and sound life support practices. It glosses over a great deal and is not meant as a primer for trainees.

Resources

ardsnet-tableDownload

Full ARDSnet protocol

Special episode: COVID-19 brief

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A fast-tracked update: what we know about the active pandemic of the novel coronavirus (SARS-CoV-2) and its resulting respiratory syndrome, COVID-19.

Takeaway lessons

  • Treat like viral pneumonia/ARDS. High PEEP. Prone early. Keep fluid balance dry.
  • Probably avoid CPAP/BiPAP except perhaps for very short trials. Unclear role for HFNC.
  • Watch out for myocarditis-type picture with cardiogenic shock and arrhythmias.
  • Take isolation extremely seriously.
  • Think about innovative ways to optimize patient flow.
  • Take care of yourself and each other, and try to stay sane.

Resources

References