Medical Discussion of Coronavirus

[pulmdoc]

I love hearing your experience from upstairs--keep it coming.

in terms of capacity, I also haven't been able to figure out the denominator. do they count unstaffed beds and/or unsuitable beds (NICU, L&D, PACU)?

when there are vented and other admitted patients living in the ER, one would think that by definition, the hospital is at 100% capacity...but I have yet to see that reported for my shop. perhaps things are only full when we suggest using the CEO's office to board patients.

What I have been told by my hospitals CMO recently is that numerator is patients admitted to ICU service (closed ICU model) and denominator is licensed ICU beds. That denominator is constantly in flux because the governor signed an emergency proclamation last year that hospitals could apply for extra licensed beds to deal with the pandemic without going through the usual bureaucratic red tape basically allowing hospitals to just say "we have 6 extra ICU beds now" and admit patients there immediately. We are currently planning to convert part of PACU, half the ED, and a room that has been used as IR holding for excess ICU beds just like last winter, just waiting on travel staff contracts. When that happens, our ICU capacity will go from 116% capacity to 70% capacity overnight. New infection rates have plateaued but it'll take 6 weeks for those patients infected today to make out of the hospital.

The other part that is frustrating is that the hospitals have to report their capacity at a given time each day. If 3 patients are transferred 20 minutes before cutoff, it'll look like there's capacity even if those beds get spoken for 30 minutes later. So functionally there is never an open bed but the reporting may show capacity. We do have a statewide bed coordinator now so that the rural hospitals can call them first and be told "it looks like hospitals A-P are full, try hospital Q, R or S" to avoid them needing to make 30, 40, 50 transfer calls. Of course, because of the "shadow ICU" situation I described in the previous post (ICU caliber patients needing to remain on the floor), we are trying to give open beds to the sickest floor patients first before the beds show up as available to outside transfers. This is the reality of rationing we're dealing with when there are 60-70 patients who could legitimately benefit from ICU care but we only have space for 30.

[CordMcNally]

We are currently planning to convert part of PACU, half the ED, and a room that has been used as IR holding for excess ICU beds just like last winter, just waiting on travel staff contracts.

This is terrible foresight on your hospital's leadership behalf.

[burritos]

obesity is contagious

https://www.nejm.org/doi/full/10.1056/nejmsa066082

https://journalofethics.ama-assn.org...bese%20%5B4%5D.

Physicians, like much of the American population, are not immune to the challenges of girth control [3]. A recent study of male physicians revealed that 44 percent of them were overweight and 6 percent were obese [4].

If the most highly educated and motivated group of people can't not be fat, what chance does the public at large have? Zero. To eliminate obesity in the USA and the western feeding world at large, you'd have to have implement authoritarian draconian measures that no one would tolerate. I have heard people say, "I would rather die than give up bread."

[burritos]

The average American man and woman were sitting in the drive-through at In-N-Out and could not be reached for survey.

Tried a chocolate shake the first time in a decade last month. The sensation was probably akin to like getting a dose of Heroin. Never tried, not certain if it should be on my bucket list.

[StarTrekDoc]

pulmdoc exactly our situation. ICU is really high end ICU. Vent or ecmo. Stepdown is bipap.

60 pts inhouse 12 being vaccinated and all of those with high risk underlying and none in the ICU.

ICU is all unvaccinated and run the spectrum of age and weight .

[Hatton]

pulmdoc exactly our situation. ICU is really high end ICU. Vent or ecmo. Stepdown is bipap.

60 pts inhouse 12 being vaccinated and all of those with high risk underlying and none in the ICU.

ICU is all unvaccinated and run the spectrum of age and weight .

I just cannot comprehend The thinking. Examples abound. Vaccine is available. Evidence is published. What does it take to get the populace vaccinated.

[CordMcNally]

Tried a chocolate shake the first time in a decade last month. The sensation was probably akin to like getting a dose of Heroin. Never tried, not certain if it should be on my bucket list.

What's the narcan equivalent to a chocolate shake? Celery? Does someone have to give you PR celery to reverse the effects of the chocolate shake?

[G]

PR pineapple!

[StarTrekDoc]

I just cannot comprehend The thinking. Examples abound. Vaccine is available. Evidence is published. What does it take to get the populace vaccinated.

Exactly- I would want all vaccine hesitant folk to walk through their local hospital ICU and randomly ask family there and staff any questions on vaccines.

I will bet you most will have a story of regret and wish to have been more thoughtful in their individual choice.

Very few are true believers of unvaccinated and the ramifications of that choice to themselves and family that they affect.

[Tim]

https://journalofethics.ama-assn.org...bese%20%5B4%5D.



If the most highly educated and motivated group of people can't not be fat, what chance does the public at large have? Zero. To eliminate obesity in the USA and the western feeding world at large, you'd have to have implement authoritarian draconian measures that no one would tolerate. I have heard people say, "I would rather die than give up bread."

This is where mandates come in isn’t it? Get employers and businesses to mandate limits and weekly weigh ins. Of course medical exemptions would be allowed. At least the religious exemptions would appear to not factor in.

Mandate what not to put in your body. Not sure if it should be above 2 yo.
Not so sure it would be feasible politically or legally. Can you imagine losing employment or access to a restaurant or concert because of a weight test? It is a significant public health issue

[pulmdoc]

This is terrible foresight on your hospital's leadership behalf.

Also opening up ED overflow beds at the same time, if ED capacity dropping was what you were referring to.

[G]

Exactly- I would want all vaccine hesitant folk to walk through their local hospital ICU and randomly ask family there and staff any questions on vaccines.

I will bet you most will have a story of regret and wish to have been more thoughtful in their individual choice.

Very few are true believers of unvaccinated and the ramifications of that choice to themselves and family that they affect.

We offer J&J in the ER. Not one family member of a sick Rona patient has taken up my offer. I gave up--not worth wasting my time--I'll see them in 7-10 days and collect some easy money.

[StarTrekDoc]

ED - they Still in Denial and angry stage.
floor - bargaining
ICU - acceptance

[burritos]

What's the narcan equivalent to a chocolate shake? Celery? Does someone have to give you PR celery to reverse the effects of the chocolate shake?

ipecac?

[Hatton]

ipecac?

Burritos has an eating disorder.