The Gaspasser

[Loki]

I wonder when we will start talking about advance directives.

That’s a gruesome but necessary account

[jon-nyc]

Wow.

[George K]

I stay in touch with a lot of the people with whom I used to work. All of my former partners have new jobs in at least 4 local hospitals, and they're doing well - or at least they were.

I've also been in frequent contact with our former "anesthesia tech." I think I've mentioned her before.

Two weeks ago, she posted this about the University of Chicago, where she works now:

I have no idea how many ORs the U of C has, but if it's anything like where I used to work, I'd guess that it's north of 50. Add to that the number of "off-site" anesthetics being given (endoscopy, MRI, etc), and I'd guess that they have about 75 "anesthetizing locations."

Today, they have 7 cases.

Seven.

Anyhow, we stay in touch. Last week, on the 31st, I asked her how things are:

I'm doing good. We have 80 covid pts. Only a dozen on vents. Several dozen have already been discharged. It's going ok.

Then I asked: "Any word from Large Suburban Hospital how John and Bob are doing?

John is on the covid team.... Senior attendings with most intubations. He figured he and Bob have done more than these people.

I can't imagine.

[Loki]

Large study of vent survivors over age 65

https://medicalxpress.com/news/2010-12-older-survivors-mechanical-ventilation-significant.html

Things to think about with the advance directives if you are looking for something to do.

[George K]

@Loki said in The Gaspasser:

https://medicalxpress.com/news/2010-12-older-survivors-mechanical-ventilation-significant.html

Yes. Not surprising at all, and it sort of tracks with the mortality, over time, of something like a hip fracture. Older people don't do well.

I didn't get into the weeds of this, because I'd love to see what the reasons for ventilation were: pneumonia? Post-surgical support? Heart attack? Those are, presumably short-term issues that get resolved within days, perhaps a week. But with this disease we're seeing much longer need for ventilation and the primary problem is pulmonary and untreatable. That's a recipe for disaster.

[taiwan_girl]

wow. Interesting article and discussion. Thanks for sharing!!

[LuFins Dad]

The answer (if this is going to be the dance and not the hammer) is more focus on treatment earlier in the process. All those people being sent home after being diagnosed and being told to take otc cold medicines until it gets so bad that it’s basically too late. By the time you get to the Vent, the horse has already left the barn so to speak.

[Aqua Letifer]

@LuFins-Dad That's exactly right.

Also, okay, let's pretend we're on the other side of the curve. New case percentage is nominal. They're talking about relaxing the lockdown and having people go back to work.

Are we going to be in a position where we're going to be able to see the next outbreak coming far enough in advance that we can shut down soon enough to not cause hospital saturation? I very much doubt that.

[mark]

interesting and scary.

[Copper]

@Aqua-Letifer said in The Gaspasser:

Are we going to be in a position where we're going to be able to see the next outbreak coming far enough in advance that we can shut down soon enough to not cause hospital saturation? I very much doubt that.

We should be able to take a shot at calculating the answer to that question now.

Hopefully that is part of the plan used to turn the world back on.