Medical Discussion of Coronavirus

[Brains428]

Ah, yes. The lung zone argument. The peds radiologists were okay with it. The adult chest radiologists hated it. For any radiologist trainee who lurks and reads this- like many things in life- know your audience.

We can save debates upon descriptors on various images for the radiology specific website that no one visits anymore.

[Panscan]

If it’s an AP how can you know unless obvious silhouette or etc ? I’d rather say lower lung zone than say lower lobe which may or may not be true. Not trashy at all, it’s literally correct. It’s disregarding basic anatomy and understanding X-ray to not use lung zone IMO unless you are sure. You don’t know where it is, so how can you say? It’s not our job to guess. I will even say in on PA and lateral if unsure like if patient body habitus very tough or just a subtle finding.

My standard description is patchy alveolar/ground glass opacities with a mid to lower lung zone predominance. I will add peripheral too if I think it fits. I personally think you can use ground glass on CXR (which I’m sure some academic will lose their mind over). If I think it’s going to be ground glass on a CT I will call it as such. Obviously depends on exam and technique if you can actually tell.

[Brains428]

Panscan I think its the term "zone" that chest radiologists have issues with. I don't personally use it, but it doesn't keep me up at night if I see it. Same with infiltrate.

[Panscan]

I see the infiltrate criticism but I just don’t see logically the zone thing like what do they want instead? I can’t tell you it’s in the lower lobe if I’m not sure.

As I’m sure everyone in this conversation understands, you don’t know where it is on 1 view unless it’s clearly abutting a fissure or silhouetting something

[MPMD]

Seeing so much covid has really sharpened my ability to see subtle infiltrates on chest xrays. Usually you are left guessing whether an infiltrate was real or not. When the ED is packed with covid patients getitng a f/u CTA chest you know if you were right or wrong.

CTA practice seems to have changed recently.

early pandemic it seemed pointless and a waste of PPE.

then we seemed to realize that covid seems hypercoagulable?

now we're mostly holding off on CTA unless there is some specific concern for PE (hypoxia, chest pain, tachy, sob obviously don't cut it)

[PedsCCM]

https://www.dallasnews.com/news/watchdog/2021/08/19/if-north-texas-runs-out-of-icu-hospital-beds-doctors-can-consider-a-patients-vaccination-status/

Came across my news feed. I feel incredibly lucky to take care of kids. It would be crazy to hold children responsible for decisions their parents made but I really feel for our adult colleagues. With our PICUs quite full, we constantly make decisions on who most needs the resources of the large academic PICU (happens every winter and now this summer). I cannot imagine how hard it would be to manage a full MICU and try to make those types of triage decisions without letting my frustration over vaccine politics unduly influence my choices.

[Ekanive23]

CTA practice seems to have changed recently.

early pandemic it seemed pointless and a waste of PPE.

then we seemed to realize that covid seems hypercoagulable?

now we're mostly holding off on CTA unless there is some specific concern for PE (hypoxia, chest pain, tachy, sob obviously don't cut it)

Shortness of breath, d dimer elevation, hypoxia, they are getting dye.

I have found a ton. Have had 2 icu downgrades with d dimer 4000 plus and got the PE diagnosis within a week of each other.

if during hospitalization d dimer rises and I hadn’t scanned yet, I consider.

it’s helpful for me to see if my diuretics I put most my covid patients on are targeting anything.

[Ekanive23]

Anyone doing plasma anymore?
im starting to think remdesivir needs to end.

currently I’m a gram of Tylenol scheduled q8, MDI, pearls tid schedule, robittusin AC, decadron 6 and escalate to 10 bid during crash, I diurese the heck out of them. If prediabetic I start lantus 5 bid even if never on insulin. I saw two bounce backs in DKA/HHS on PREDIABETICS with covid plus steroids. If I know they are discharging on steroids I start diabetes education and insulin usage. Enroll them in a monitoring system at dc called hospital at home where oxygen and symptoms are watched daily. I have IL 6 and CRP and dimer trended and do Toci if moving in wrong direction . Procalcitonin To rule out bacterial infection. Full dose or hybrid dosing AC isn’t done in Indiana university systems buy at the VA snd Loyola in chicago at my other gigs they do.

I’ll do anything I can to chill people out to prone.

my hospital we handle 5 mcg of levophed, cardiac drips, bipap, and optiflow up to 60 L 90 percent on the step down unit. When I transfer patients.... it’s always to our other affiliates ICUs.

I notice sinus bradycardia super common in these patients. Also transaminitis.

anyone doing anything different?

I don’t do any of the scam invermectin, plaquenil, D zinc etc

ive probably done over 5000 rvu of covid so far ...

[Bellescamp]

Anyone doing plasma anymore?
im starting to think remdesivir needs to end.

currently I’m a gram of Tylenol scheduled q8, MDI, pearls tid schedule, robittusin AC, decadron 6 and escalate to 10 bid during crash, I diurese the heck out of them. If prediabetic I start lantus 5 bid even if never on insulin. I saw two bounce backs in DKA/HHS on PREDIABETICS with covid plus steroids. If I know they are discharging on steroids I start diabetes education and insulin usage. Enroll them in a monitoring system at dc called hospital at home where oxygen and symptoms are watched daily. I have IL 6 and CRP and dimer trended and do Toci if moving in wrong direction . Procalcitonin To rule out bacterial infection. Full dose or hybrid dosing AC isn’t done in Indiana university systems buy at the VA snd Loyola in chicago at my other gigs they do.

I’ll do anything I can to chill people out to prone.

my hospital we handle 5 mcg of levophed, cardiac drips, bipap, and optiflow up to 60 L 90 percent on the step down unit. When I transfer patients.... it’s always to our other affiliates ICUs.

I notice sinus bradycardia super common in these patients. Also transaminitis.

anyone doing anything different?

I don’t do any of the scam invermectin, plaquenil, D zinc etc

ive probably done over 5000 rvu of covid so far ...

We have stopped using remdesivir and plasma
otherwise pretty similar

[FIREshrink]

Anyone doing plasma anymore?
im starting to think remdesivir needs to end.

currently I’m a gram of Tylenol scheduled q8, MDI, pearls tid schedule, robittusin AC, decadron 6 and escalate to 10 bid during crash, I diurese the heck out of them. If prediabetic I start lantus 5 bid even if never on insulin. I saw two bounce backs in DKA/HHS on PREDIABETICS with covid plus steroids. If I know they are discharging on steroids I start diabetes education and insulin usage. Enroll them in a monitoring system at dc called hospital at home where oxygen and symptoms are watched daily. I have IL 6 and CRP and dimer trended and do Toci if moving in wrong direction . Procalcitonin To rule out bacterial infection. Full dose or hybrid dosing AC isn’t done in Indiana university systems buy at the VA snd Loyola in chicago at my other gigs they do.

I’ll do anything I can to chill people out to prone.

my hospital we handle 5 mcg of levophed, cardiac drips, bipap, and optiflow up to 60 L 90 percent on the step down unit. When I transfer patients.... it’s always to our other affiliates ICUs.

I notice sinus bradycardia super common in these patients. Also transaminitis.

anyone doing anything different?

I don’t do any of the scam invermectin, plaquenil, D zinc etc

ive probably done over 5000 rvu of covid so far ...

Thank you for this!

Why not remdisivir any more?

Also, where do monocolonals fit in? In your above scenario, patients have passed that point?

With delta, how often are you seeing young, truly healthy patients (ie, under 50 or under 40, not obese, not diabetic, etc)?

[StateOfMyHead]

Thoughts on South Florida physicians protesting unvaccinated patients?

[artemis]

Thoughts on South Florida physicians protesting unvaccinated patients?

I'd like to hear more about that (so far I've not seen much about it in the media). I can certainly understand their motivations.

Pfizer got got full FDA approval. Moderna is expected to receive it by the end of September. So much for the "it's experimental!" excuse.

[MaxPower]

I'd like to hear more about that (so far I've not seen much about it in the media). I can certainly understand their motivations.

Pfizer got got full FDA approval. Moderna is expected to receive it by the end of September. So much for the "it's experimental!" excuse.

Except now the goalposts will move to “they rushed it through approval so it’s still NoT lEgItImAtE.”

[artemis]

Except now the goalposts will move to “they rushed it through approval so it’s still NoT lEgItImAtE.”

Of course. The excuses are endless. But this removes a big hurdle when it comes to employers mandating employees to get vaccinated.

[Jaqen Haghar MD]

Thoughts on South Florida physicians protesting unvaccinated patients?

I wonder what this was? I don’t think it was a real “walkout”, but I can’t find many details. I’d bet everyone stood in the parking lot at lunchtime for 2 minutes, as a publicity stunt. Anyone know anything?

Here, we’ve likely gone over the hump now. We have given close to 1,000 doses of monoclonals out of the ED here at this point. The Covid units opened back up, freeing up hospital beds. Volumes in the ED have gone from record breaking, to just busy. I still see a bunch of new Covid patients per day, but it’s not twenty a day, like it was a couple weeks ago. I’m hoping we are in the burnout phase of this wave, but school is starting, so we shall see if it’s just a lull.

Nurses are tired, but many are happy, as they are making up to $1,000 per shift around here if they play their cards right. The docs here are beat up, but nobody is cracking. I see 1-2 vaccinated infections per shift, but I did see 6 breakthroughs on one shift - most are doing well. Nurses can make $90k for three months if they are willing to travel a little bit.

Unvaccinated cases are the ones not doing well, middle aged and chubby seem to do poorly. Pretty consistently at most places 90/10 breakdown for admission at this point.