You're highly fixated on research. Did you know the vast majority of medical decisions are not based on research? — frank

Yes. I'm not sure what difference that makes to an evaluation of whether incentives are a good thing or not.

Yes. I'm not sure what difference that makes to an evaluation of whether incentives are a good thing or not. — Isaac

Smh

Internet friend who lives at the border, fully vaccinated, son is 13 w/ CF who cannot be vaccinated and is in the hospital at least a week out of every month, has typed out a string of letters that I am sure meant something to her.
She has been hospitalized since 8/25 with COVID-19. Difficulty breathing required intubation, collapsed lung, able to be reinflated and off the vehnilator as of yesterday, hence the string of letters as she got her phone back.
ICU Psychosis is what she is working on now. Getting her brain back online without corruption.
Rough times for her family and especially scary for her son who cares for his Mom and is terrified of losing her.
Remain humble my friends :sparkle:

[...] Honestly, I couldn't care less if the clearly insane conspiracy theorists are given a slot on Farcebook or not. Any restriction on actual scientific research is a hundred times more worrying than the media circus platforms of a few tinfoil hats. — Isaac

Right. Such ulterior motives for (not) publishing ain't cool.

There's a separate problem involved, let's call it tunnel vision.
Say, if 90 studies show the veracity of a vaccine, and 10 show downsides, then weighing all available evidence is equally warranted. That's not always what happens, though, since skeptics/deniers/clowns might just see risks, where subject matter experts acquire a better, more relevant overview.
Sure, "doing your own research" is fine, as long as you know what that means. No tunnel vision, context, bigger picture, overview, histories of similar events, don't just dismiss subject matter experts and turn to deniers. Especially in quarrels/preaching.

Say, if 90 studies show the veracity of a vaccine, and 10 show downsides, then weighing all available evidence is equally warranted. That's not always what happens, though, since skeptics/deniers/clowns might just see risks, where subject matter experts acquire a better, more relevant overview. — jorndoe

Indeed.

Sure, "doing your own research" is fine, as long as you know what that means. No tunnel vision, context, bigger picture, overview, histories of similar events, don't just dismiss subject matter experts and turn to deniers. Especially in quarrels/preaching. — jorndoe

I'm not sure if this is directed at anything I've said here, but the journals I've cited are mainly the JME, which is one of the world's most respected journals of medical ethics. I don't think any of the authors there are 'doing their own research' in the manner you suggest.

Anti-Vax Radio Host Who Called Anthony Fauci a ‘Power Tripping Lying Freak’ Dies of COVID

I’m sure vaccination helps. From what the news tells me, those who are hospitalized with the disease are largely unvaccinated. What they never mentioned was how quickly the virus can circulate among the vaccinated. In any case I much rather assume the risk of living than let governments, all of which failed to contain the virus, continue to contain human beings. — NOS4A2

If the vaccines are 90% effective as claimed, and 100% of your population is vaccinated then 100% of the people in hospital and ICU will be vaccinated. Moving towards that situation is probably why we see in some areas more vaccinated people in hospital than unvaccinated. In New South Wales 100 % of people in hospital are unvaccinated according to the official figures I last saw (a couple days ago)

I live next to a city of about 100,000 souls in Massachusetts, USA. The city from the start has posted daily Covid statistics for the city.

https://veoci.com/v/p/dashboard/u54vqwxq9z

In early July the rolling ten-day average had decreased to and was just over four cases per day. On 7 Aug, 2021 it's now 19 per day, with the ten day trend strongly increasing.

The gestapo checking your vaccine papers while you eat. France has fallen.

@frank
Do you have any idea of how addicts are being treated for Covid-19 in the hospital?
I ask because my internet friend who is typing out babble from within the hospital, has a long history of Migraines and likely had an addiction to the pain meds she has been on, is not progressing the way that the are expecting.
The only thing that makes me ask this is because the family is trying to get the pharmacy to talk to the hospital care team.
I realize I am likely asking a question that may not have an answer....
But I know the thinking when NicK was in the ICU, intubated and started having DTs was that they ride them out. Where 15 years ago the thinking was ICU is not the place to go through Detox.
Any ideas?

I expected better from you.

Her level of safety remains the same. Whatever viral load that is taken up by the newcomer is countered by whatever additional load brought in by him, net effect: nothing changed.

I can not speak directly to the treatment of only addicts in ICU with Covid. However (and this will raise a ton of naysayers who will refuse to believe me) the treatment protocols for Covid in the ICU for ventilated patients are designed primarily to reduce the number of viral particles expelled by the patient while ventilated. This is the first time I have ever seen a protocol for patient care that is based on fear of the infectious agent, rather than focused on patient recovery.

When infected with Covid the inside of the lungs develop a relatively thick secretion which makes it more difficult to process oxygen and maintain reasonable tidal volumes, hence the shortness of breath associated with Covid. Ventilated patients are given medication treatments to dry up these secretions, thereby reducing the dampness, and viral load, of the exhaled breath. Initially it sounds like a reasonable step, until you consider what effect this will have on the lung tissue: We dry out the slightly thick secretion...and still need it to be permeable, and flexible, to allow for oxygen exchange and proper lung inflation. No wonder only 3% of ventilated patients survived initially. There have been some improvements since then ,but still based on reducing exhaled virus, not patient care.

Changes to the resuscitation process are the same. Old approach: Patient down in cardiac arrest. Call for help, begin chest compressions, help arrives, attach defib pads, continue compressions, shock, etc. New Covid approach: Patient down with cardiac arrest. Leave room, go get isolation cart and place it at the door of patients room, call for help, get dressed in appropriate isolation gear, enter room, begin chest compressions, await other staff (who also must dress for isolation prior to entering room), when staff arrive and are dressed, run code as usual. Please remember, brain death begins at 4 minutes with no circulation. The old way wasn't that successful as the patient had usually been down a few minutes before someone noticed, but it had successes. The new way, which opens with LEAVE THE ROOM, means that the patient will have no one even attempting CPR for at least five minutes, likely closer to eight. So essentially the Covid resuscitation technique is: Patient in cardiac arrest, leave room, go for coffee, notify doctor that family needs to be made aware that patient died due to Covid.

And no, I would not recommend treating the DT's in ICU. Not that ICU can't handle it, just that it is an inappropriate use of resources. Also, to avoid DT's the patient just needs the proper medications, all of which can be administered via IV, in the ICU, or any other floor. As far as "letting them ride them out", your buddy got a nasty ass care team. There is no reason to do that, not best practice, not even inconvenient to treat, just plain old mean.

I cannot tell you how much I appreciate your reply.
I was recently in the Regional burn center and I witnessed exactly what you described about everyone leaving the room, the cart in front of the door because the patient that was medivcaed in from a remote town was Covid-19 positive. They moved me to the hall (I burned my eye with a curling iron) and I was able to hear the conversation with the staff and they announced the incoming patient's ETA with the pilots over the ER speaker system.
A male, 65 yrs old had a burn down his throat and mouth (suspected meth consumption.
When he arrived they were questioning him about drinking, he said yes, have you gone through DTs, yes and you know you are Covid-19 positive, yes, any symptoms, yes tightening of his chest and throat. They asked him for family they could call to let them know where you are and that you are going to be intubated, he gave his daughter's name and number.
They got back to me and I don't know what happened to that man but I have a feeling it didn't have a positive outcome.

I am sorry that I didn't explain that NicK who was in ICU for 23 days and intubated/tracheostomy and had the DTs was at the hospital because he had an Aortic dissection both ascending and descending May 2020.

Aortic dissections are a rough go. He is lucky he made it through the corrective surgery. And yep ICU is where he would have been for a while to be kept in a "medically relaxed state" while his initial healing took place. Still, someone should have explained that, while he was sedated during intubation, the sedative would also help him avoid the DT's. The right IV meds and they wouldn't be a problem, since he was already out, no idea why they wouldn't give them, or inform family that he is being managed properly, not that "ride it out" crap.

Not that I haven't heard and seen patient's get crappy treatment, I saw it all the time in the emergency department, and still do, but I never really understand why. I am able to still treat my patient properly, even if he is an asshole, although I won't stick around to chat if he is.

However (and this will raise a ton of naysayers who will refuse to believe me) the treatment protocols for Covid in the ICU for ventilated patients are designed primarily to reduce the number of viral particles expelled by the patient while ventilated. — Book273

I'm a naysayer. The exit path for virus leaving the lung of an intubated patient would be into the ventilator circuit and splat onto the viral filter the protects the exhalation valve. The other path would be around the ETT cuff into the room and then out the window because it's a negative pressure room.

The ventilation strategy they use is tailored to the patient's condition. Lung protection is the most important factor because the patient's lungs are being shredded by the virus.

Do you have any idea of how addicts are being treated for Covid-19 in the hospital?
I ask because my internet friend who is typing out babble from within the hospital, has a long history of Migraines and likely had an addiction to the pain meds she has been on, is not progressing the way that the are expecting.
The only thing that makes me ask this is because the family is trying to get the pharmacy to talk to the hospital care team.
I realize I am likely asking a question that may not have an answer.... — ArguingWAristotleTiff

My first thought is that your friend's brain was affected by the virus. I'm guessing they've already done a head CT to see if she's had a stroke. If it's not that, there's a condition we call covid-brain, and I don't really know what causes it. It's characterized by happy confusion. It should get better eventually.

Hospitals deal with addiction issues every day. An acute setting us not the best place to help a withdrawing patient. So they just give them narcotics to put withdrawal off until the patient is out of danger.

I'm assuming your friend's family has expressed their concerns to the doctors?

The ventilation strategy they use is tailored to the patient's condition. Lung protection is the most important factor because the patient's lungs are being shredded by the virus — frank

Nice thought, and wrong. Ordinarily I would say absolutely correct, but not for Covid. Your position presupposes that the patient is still the most important factor; it isn't. Controlling spread is. Which brings up your earlier points...

The exit path for virus leaving the lung of an intubated patient would be into the ventilator circuit and splat onto the viral filter the protects the exhalation valve.



Accurate, except for when we have to suction secretions to clear the airway for the patient and when the vent circuit opens accidentally, which does happen, hence circuit alarms. and when we have to change the circuit, or something goes sideways and we have to bag the patient while the vent gets fixed. Next point...


— frank

because it's a negative pressure room. — frank

Maybe your ICU has negative pressure rooms. Mine generally have one, which isn't useful when the ICU is full of vented Covid patients. so no negative pressure rooms, although that would be nice. Also, ICU windows here don't open, controlled environment and all that. Perhaps your ICU's are different, I can't speak to your region.

I did not write the algorithm for Vented Covid patients but it seems about as effective as the Covid Resuscitation algorithm for maintaining life.

The advantage to telling what you have seen/done is that it is easy to recall and one can brush off anyone that says "I don't think so".

Nice thought, and wrong. Ordinarily I would say absolutely correct, but not for Covid. Your position presupposes that the patient is still the most important factor; it isn't. Controlling spread is. — Book273

It's what I do for a living. Yes, measures are taken to limit the spread of the virus,. but that has to do with PPE and blocking off the ICU to through traffic. It's not a factor in ventilator strategy.

Maybe your ICU has negative pressure rooms — Book273

During the blitz, every ICU room in our hospital was negative pressure. Like overnight they installed HEPA filter blowers and modified the windows with plexiglass. Out hospital was spewing coronavirus out the windows 24/7 :grin:

I can not speak directly to the treatment of only addicts in ICU with Covid. However (and this will raise a ton of naysayers who will refuse to believe me) the treatment protocols for Covid in the ICU for ventilated patients are designed primarily to reduce the number of viral particles expelled by the patient while ventilated. This is the first time I have ever seen a protocol for patient care that is based on fear of the infectious agent, rather than focused on patient recovery. — Book273

My neighbour is an anesthesist and he's calling this bullshit.

@Book273 @frank @Benkei
I'm truly grateful for each of you, even if you differ in approaches to the details of a shot in the dark, for even I am only able to view this from a distance.
With her son having access to her FB account, they may not be sharing all the details as one would expect.
At the beginning of this shit show called a pandemic, I was very concerned that President Trump would not be able to cut enough red tape, around the world, to actually make Operation Warp Speed happen as he suggested he could.
I believe it was in April of 2021 when I was eligible for a COVID 19 Vaccination and did so.
I knew we would need boosters as it evolves but I truly expected to be sending kids to school without mandatory masks but that is not the case.

I'm slowly losing faith in my fellow man my friends and I am starting to understand why.

"So make the best of the test and don't ask why
It's not a question but a lesson learned in time"
Good Riddance by Green Day

I knew we would need boosters as it evolves but I truly expected to be sending kids to school without mandatory masks but that is not the case. — ArguingWAristotleTiff

One doctor who I know said something that I agree with, unfortunately.

"Likely we will start getting annual vaccinations for COVID as we get annual vaccinations for the flu. Some will take them, some will not (just as with flu vaccines)."

Masks will asked to be used for a while... until people don't wear them anymore. Some likely will and some places limitations and regulations will continue. Likely in few more years we are back in the ordinary. The scare of dying to Covid will last for just so long until it's the new normal.

(Influenza regulations back during the Spanish Flu)

Good for your neighbour. Clearly he doesn't work in my health region or he would be saying "Holy shit, someone is talking outside of work! That person might get fired!" I am glad that he works in a better place than I do. Although I am surprised that he would have such a narrow perspective as to instantly call bullshit, rather than saying that it is ridiculous practice. But hey, whatever helps you sleep at night eh!

Good for you. Your hospital seems to have had leadership move forward to do those things; must be nice. Ours did none of them, which is inline with our leadership. Every health region I have worked in cares very deeply about maintaining the image of caring very deeply. Actual patient care though, not so much.

Notice that I did not jump up and call all the naysayers full of shit? I have no idea how accurate their information is. I assume, as they have said they work in the business, that their data is as accurate as mine as we all do it for a living.

I also notice that no one has said anything about the Covid Resuscitation procedure...

...I guess that's another thing we aren't supposed to talk about?

They have military policing the streets in Sydney, Australia, stopping people from doing things like going to their beach houses. Nanny-state gonna nanny.

https://7news.com.au/lifestyle/health-wellbeing/another-500-australian-defence-force-personnel-to-hit-sydney-streets-as-part-of-nsw-covid-19-compliance-crackdown-c-3656569

They have military policing the streets in Sydney, Australia, stopping people from doing things like going to their beach houses. Nanny-state gonna nanny. — NOS4A2

Do they ever let you out, or are you just on ward privileges?

I love knowing I upset you more than the jackboot.

Careful, there are more "jackboots" around you than you can reasonably imagine.

Careful, there are more "jackboots" around you than you can reasonably imagine. — tim wood

What's a jackboot?

You are not referring to number 2 on this website are you? Here