Never however have I seen patients as sick as those with COVID-19
By: Wzendo Snkt
Tags: News, Social Media, Sports, Covid 19

Asa critical care medicine specialist, I am used to seeing the sickest of the sick. I am used to seeing patients with respiratory failure. I am used to seeing patients in shock. I am used to seeing patients gasping for air, with dangerously low oxygen levels. I am used to seeing patients in kidney failure. Never, however, have I seen patients as sick as those with COVID-19.

Frightening Hypoxemia (low oxygen levels)

https://www.reddit.com/live/167s4jgu8c59s

https://www.reddit.com/live/167s4qaf8o8kr

https://www.reddit.com/live/167s4xa201fqo

https://www.reddit.com/live/167s58vu1e6vh

https://www.reddit.com/live/167s4kruzz4ff

https://www.reddit.com/live/167s4rfeg6gut

https://www.reddit.com/live/167s4zfg0x7ic

https://www.reddit.com/live/167s5dn7t2qbz

https://www.reddit.com/live/167s4lzx69073

https://www.reddit.com/live/167s4si18k6dz

https://www.reddit.com/live/167s51vvze3qm

https://www.reddit.com/live/167s5ftw4n1r0

https://www.reddit.com/live/167s4myc9iwl3

https://www.reddit.com/live/167s4ucfgncix

https://www.reddit.com/live/167s56628wi93

https://www.reddit.com/live/167s5h9k8cy4p

https://www.reddit.com/live/167s4oo1flpgf

https://www.reddit.com/live/167s4vohclem2

https://www.reddit.com/live/167s57fr1mkww

https://www.reddit.com/live/167s5iofustq5

https://www.reddit.com/live/167s4jgu8c59s

https://www.reddit.com/live/167s4qaf8o8kr

https://www.reddit.com/live/167s4xa201fqo

https://www.reddit.com/live/167s58vu1e6vh

https://www.reddit.com/live/167s4kruzz4ff

https://www.reddit.com/live/167s4rfeg6gut

https://www.reddit.com/live/167s4zfg0x7ic

https://www.reddit.com/live/167s5dn7t2qbz

https://www.reddit.com/live/167s4lzx69073

https://www.reddit.com/live/167s4si18k6dz

https://www.reddit.com/live/167s51vvze3qm

https://www.reddit.com/live/167s5ftw4n1r0

https://www.reddit.com/live/167s4myc9iwl3

https://www.reddit.com/live/167s4ucfgncix

https://www.reddit.com/live/167s56628wi93

https://www.reddit.com/live/167s5h9k8cy4p

https://www.reddit.com/live/167s4oo1flpgf

https://www.reddit.com/live/167s4vohclem2

https://www.reddit.com/live/167s57fr1mkww

https://www.reddit.com/live/167s5iofustq5

https://247sports.com/high-school/mississippi/board/football-102607/contents/nfl-snf-seahawks-vs-rams-crackstreams-live-stream-reddit-watch-157897248/

https://247sports.com/high-school/mississippi/board/football-102607/contents/reddit-rams-vs-seahawks-live-stream-reddit-online-nfl-free-157897246/

https://247sports.com/high-school/mississippi/board/football-102607/contents/los-angeles-rams-vs-seattle-seahawks-free-live-stream-122720-157897247/

https://247sports.com/high-school/mississippi/board/football-102607/contents/stream-rams-vs-seahawks-live-stream-nfl-week16-match-on-tv-157897251/

https://247sports.com/high-school/mississippi/board/football-102607/contents/nflstreamswatch-seahawks-vs-rams-live-stream-reddit-free-o-157897250/

https://247sports.com/high-school/mississippi/board/football-102607/contents/seahawks-vs-rams-crackstreams-live-stream-free-on-reddit-nfl-157897252/

https://247sports.com/high-school/mississippi/board/football-102607/contents/nfl-streams-reddit-watch-rams-vs-seahawks-live-stream-free-157897253/

https://247sports.com/high-school/mississippi/board/football-102607/contents/seahawks-vs-rams-free-live-stream-122720-nfl-week16-157897256/

https://247sports.com/high-school/mississippi/board/football-102607/contents/hd-seahawks-vs-rams-live-stream-reddit-free-crackstreams-157897257/

https://247sports.com/high-school/mississippi/board/football-102607/contents/full-nflseahawks-vs-rams-nfl-live-stream-free-reddit-online-157897259/

https://247sports.com/high-school/mississippi/board/football-102607/contents/livestreamofficial-seahawks-vs-rams-live-stream-free-157897263/

https://247sports.com/high-school/mississippi/board/football-102607/contents/nfl-streams-reddit-watch-rams-vs-seahawks-live-stream-reddit-157897265/

https://www.reddit.com/live/167s7het5b1dj

https://www.reddit.com/live/167s7sna72248

https://www.reddit.com/live/167s837nphvfv

https://www.reddit.com/live/167s8a00ie9sr

https://www.reddit.com/live/167s8g4m1i5tz

https://www.reddit.com/live/167s7x5dqndwi

https://www.reddit.com/live/167s7paz4ur0v

https://www.reddit.com/live/167s83pgmp9f4

https://www.reddit.com/live/167s8acw3glyl

https://www.reddit.com/live/167s8hf3ed23q

https://www.reddit.com/live/167s7rsrt54v1

https://www.reddit.com/live/167s819z3bhzp

https://www.reddit.com/live/167s87fexaxc4

https://www.reddit.com/live/167s8dttwstg2

https://www.reddit.com/live/167s7jpnxb3iw

https://www.reddit.com/live/167s7r50etb9g

https://www.reddit.com/live/167s80w1wdsqx

https://www.reddit.com/live/167s873y0q0lm

https://www.reddit.com/live/167s8ery7fy1i

https://www.reddit.com/live/167s8nwtnggpl

https://www.reddit.com/live/167s7j7aaegpn

https://www.freitag.de/autoren/gedfvsdf/tdyhth-tyh-rt5-h

https://www.era-leader.com/node/57497

https://www.era-leader.com/node/57510

https://www.era-leader.com/node/57511

https://www.era-leader.com/node/57512

https://www.era-leader.com/node/57513

https://www.era-leader.com/node/57514

https://www.era-leader.com/node/57515

https://www.era-leader.com/node/57516

https://www.era-leader.com/node/57517

https://www.era-leader.com/node/57518

https://www.freitag.de/autoren/bossmkmonir/chargers-vs-broncos-week-16-live

https://www.freitag.de/autoren/mkmonirkhancse/streaming-clippers-vs-mavericks-live-stream

https://www.freitag.de/autoren/mkmonirkhancse/world-juniors-championships-2021-live-stream

https://www.freitag.de/autoren/bossmkmonir/rams-vs-seahawks-live-stream-reddit-online

https://www.freitag.de/autoren/bossmkmonir/seahawks-vs-rams-live-stream-1

https://www.freitag.de/autoren/bossmkmonir/mavericks-vs-clippers-live-stream

First of all, almost all of these patients present with such frighteningly low oxygen levels. I am also a lung specialist, and I am accustomed to seeing patients with low oxygen levels. Normal oxygen levels are anything above 90%, and I have seen patients come with levels as low as the 70s. Rarely, however, do I see patients presenting to our hospital with oxygen levels in the 50s and even lower. What’s more perplexing, sometimes these patients have oxygen levels that low and have absolutely no symptoms. I have never seen that before in my career as either a lung or critical care specialist.

Frighteningly Quick Deterioration

Secondly, when these patients with COVID-19 crash, they crash very quickly and crash very hard. Each patient is a ticking time-bomb, and they could be doing fine for several hours, and then — suddenly — they are gasping for air with plummeting oxygen levels and a plummeting blood pressure. One patient — a sweet woman in her 60s — was holding her own for several days. She was still very sick, but she was holding her own. All of the sudden, she became severely short of breath and was gasping for air. Despite getting multiple interventions, including going on a ventilator, she suffered cardiac arrest and died. We were all devastated.

As a critical care specialist, I am used to seeing the sickest of the sick. Never, however, have I seen patients as sick as those with COVID-19

What I’ve Learned Taking Care Of These Patients

This disease is unlike anything we have ever seen. COVID-19 has confounded critical care specialists the world over. It has upended decades of critical care gospel, and it has left very smart clinicians, scientists, researchers and regular bedside doctors — like me — scratching their heads. Each patient acts differently to the virus, and we need to treat each patient differently. What works for one, may not work for another, and this is different than what we have been used to. This is ultimately a good thing, and it will make all of us better clinicians in the end.

Not every patient needs a ventilator right away. Early on, clinicians taking care patients with COVID-19 were recommending “early intubation,” which means placing patients on a ventilator if conventional oxygen treatment did not work. They were not wrong. At the same time, we have learned that some patients can avoid going on a ventilator if we can treat them with high amounts of oxygen with high flow rates. We have had great success using this treatment modality in keeping multiple patients from requiring a ventilator. In addition, we have found that, if patients can lie on their stomach themselves, this has helped many of them avoid having to go on a ventilator. A lot of research is being conducted on this treatment, but we have found good success with it in our patients. While a ventilator can be life-saving, and I would not hesitate to use it on any patient who can’t breathe, it can also damage the lungs, and it is important to try everything in our arsenal first before we place someone on a ventilator. Indeed, multiple guidelines have now come out saying the same thing.

We need to aggressively correct any dehydration. It has long been a teaching that the patients with the severe lung disease called ARDS, or Acute Respiratory Distress Syndrome, need to get as little fluids as possible. This is appropriate, because too much fluid in the body can cause the lungs to fill up with fluids and make the respiratory failure worse. At the same time, patients with COVID-19 typically come into the hospital and ICU very dehydrated. They have had fevers for several days, which causes dehydration itself, and they are not really eating and drinking (because they are sick). So, if we do not give them fluids, we are setting them up for kidney failure. As a result, we have been more liberal with fluids — all while not giving too much — and we have been very successful in preventing kidney failure.

We REALLY need to discuss goals of care with all patients admitted with COVID-19. This disease can kill. It can leave you needing a ventilator for a very long time, if not forever. Do you want this? Yes, of course, we try to “do everything” for all of our patients. The thing is, “doing everything” may not be consistent with someone’s wishes and values. Do you want to live the rest of your days on a ventilator? Do you want to die on a ventilator? Do you want to die with the team pounding on your chest? Whatever the answers are to those important questions need to be communicated to the doctors taking care of patients with COVID, BEFORE they go into respiratory failure. Having me, as a critical care medicine specialist, ask these questions is too late. It needs to be done sooner.

Like I said, I have never seen anything like this before in my career. This pandemic will have long-standing consequences on the medical profession, hospitals, the healthcare system, and society at large. I pray they are not all negative, and that — when this is all over…some day — we will all be better and stronger than we were before.

The opinions expressed in this blog are my own, and they do not reflect those of my employer or the institutions with which I am affiliated.

First of all, almost all of these patients present with such frighteningly low oxygen levels. I am also a lung specialist, and I am accustomed to seeing patients with low oxygen levels. Normal oxygen levels are anything above 90%, and I have seen patients come with levels as low as the 70s. Rarely, however, do I see patients presenting to our hospital with oxygen levels in the 50s and even lower. What’s more perplexing, sometimes these patients have oxygen levels that low and have absolutely no symptoms. I have never seen that before in my career as either a lung or critical care specialist.

Frighteningly Quick Deterioration

Secondly, when these patients with COVID-19 crash, they crash very quickly and crash very hard. Each patient is a ticking time-bomb, and they could be doing fine for several hours, and then — suddenly — they are gasping for air with plummeting oxygen levels and a plummeting blood pressure. One patient — a sweet woman in her 60s — was holding her own for several days. She was still very sick, but she was holding her own. All of the sudden, she became severely short of breath and was gasping for air. Despite getting multiple interventions, including going on a ventilator, she suffered cardiac arrest and died. We were all devastated.

As a critical care specialist, I am used to seeing the sickest of the sick. Never, however, have I seen patients as sick as those with COVID-19

What I’ve Learned Taking Care Of These Patients

This disease is unlike anything we have ever seen. COVID-19 has confounded critical care specialists the world over. It has upended decades of critical care gospel, and it has left very smart clinicians, scientists, researchers and regular bedside doctors — like me — scratching their heads. Each patient acts differently to the virus, and we need to treat each patient differently. What works for one, may not work for another, and this is different than what we have been used to. This is ultimately a good thing, and it will make all of us better clinicians in the end.

Not every patient needs a ventilator right away. Early on, clinicians taking care patients with COVID-19 were recommending “early intubation,” which means placing patients on a ventilator if conventional oxygen treatment did not work. They were not wrong. At the same time, we have learned that some patients can avoid going on a ventilator if we can treat them with high amounts of oxygen with high flow rates. We have had great success using this treatment modality in keeping multiple patients from requiring a ventilator. In addition, we have found that, if patients can lie on their stomach themselves, this has helped many of them avoid having to go on a ventilator. A lot of research is being conducted on this treatment, but we have found good success with it in our patients. While a ventilator can be life-saving, and I would not hesitate to use it on any patient who can’t breathe, it can also damage the lungs, and it is important to try everything in our arsenal first before we place someone on a ventilator. Indeed, multiple guidelines have now come out saying the same thing.

We need to aggressively correct any dehydration. It has long been a teaching that the patients with the severe lung disease called ARDS, or Acute Respiratory Distress Syndrome, need to get as little fluids as possible. This is appropriate, because too much fluid in the body can cause the lungs to fill up with fluids and make the respiratory failure worse. At the same time, patients with COVID-19 typically come into the hospital and ICU very dehydrated. They have had fevers for several days, which causes dehydration itself, and they are not really eating and drinking (because they are sick). So, if we do not give them fluids, we are setting them up for kidney failure. As a result, we have been more liberal with fluids — all while not giving too much — and we have been very successful in preventing kidney failure.

We REALLY need to discuss goals of care with all patients admitted with COVID-19. This disease can kill. It can leave you needing a ventilator for a very long time, if not forever. Do you want this? Yes, of course, we try to “do everything” for all of our patients. The thing is, “doing everything” may not be consistent with someone’s wishes and values. Do you want to live the rest of your days on a ventilator? Do you want to die on a ventilator? Do you want to die with the team pounding on your chest? Whatever the answers are to those important questions need to be communicated to the doctors taking care of patients with COVID, BEFORE they go into respiratory failure. Having me, as a critical care medicine specialist, ask these questions is too late. It needs to be done sooner.

Like I said, I have never seen anything like this before in my career. This pandemic will have long-standing consequences on the medical profession, hospitals, the healthcare system, and society at large. I pray they are not all negative, and that — when this is all over…some day — we will all be better and stronger than we were before.

The opinions expressed in this blog are my own, and they do not reflect those of my employer or the institutions with which I am affiliated.