COVID Nursing...Ask Me Anything

[ru4por]

I am a 56 y/o nurse, now working on a Medical/Surgical floor at a local Metro Detroit hospital. My hospital is 100% COVID positive, by design. We are importing COVID patients from the other 7 hospitals in my system as well as many area systems, as well.

I thought I could avail myself, if anyone had questions on how the hospitals work in this kind of crisis. Please don't trash me, if you are not interested, you don't have to read or participate. In the ever changing craziness, I thought people might be curious at to what is happening inside the protected walls of medical facilities.

Talking about it also is pretty good for me. With golf out of the question, I have fewer coping mechanisms. *Self serving disclaimer.

There may be stuff I am not able to answer, I will be upfront about what I do not know, and things that would be inappropriate for me to discuss.

Lastly, if you know or know of anyone working in hospitals...try to support them. I am here to tell you they need it. The nurses, doctors, respiratory therapists, unit clerks, nursing assistants, housekeepers, security, .....ARE putting their lives on the line.

 

[Halcón]

Is Covid all that it's cracked up to be? If you had to give us the top five most common symptoms, what are they? Have all of your patients also been tested for the flu?

Thank you for what you're doing, by the way. When I said that you had been drafted, several days ago, I had no idea that you were gong to an all Covid hospital. I have faith that PPE will start to become more plentiful, as production has greatly increased. You should find some relief in that very soon. In the meantime, take care of yourself as best as possible.

 

[ru4por]

Is Covid all that it's cracked up to be? If you had to give us the top five most common symptoms, what are they? Have all of your patients also been tested for the flu?

Thank you for what you're doing, by the way. When I said that you had been drafted, several days ago, I had no idea that you were gong to an all Covid hospital. I have faith that PPE will start to become more plentiful, as production has greatly increased. You should find some relief in that very soon. In the meantime, take care of yourself as best as possible.

Thank you for the well wishes.

The symptoms I see are the commonly broadcasted symptoms. Fever, cough, difficulty breathing, decrease oxygen exchange by the lungs, weakness. Several of the younger patients report a loss of smell/taste. This often results in a decrease in appetite. Another bad thing, given all sick patient's need for good nutrition to heal.

We initially tested for both flu and COVID, resulting the flu portion first. If the patient tested positive for influenza, they would not test for COVID and save the test. If flu positive, they were sent home. We are no longer testing patients for the flu, but we are coming out of the flu season now.

COVID is indeed as bad as advertised. Since going back to work on the floor, we have successfully discharged 5 patients and have had 4 patients expire. That is not a great ratio. Damn frustrating part is the lack of a clear and effective treatment plan.

 

[Broken Shoulder]

Thank you for the work you're doing.

Do the other professionals you're working with have any speculation/guesses on the commonality between patients who are severely affected that are otherwise healthy... no obvious underlying conditions, etc.?

 

[ru4por]

Thank you for the work you're doing.

Do the other professionals you're working with have any speculation/guesses on the commonality between patients who are severely affected that are otherwise healthy... no obvious underlying conditions, etc.?

It sounds like severity in younger patients is thought to be driven by the severity of the immune response to the virus. This severe response is really moving the mortality needle on health young folks, without significant co morbidity's. Some of these folks go downhill very quickly. They develop Acute Respiratory Distress Syndrome. (A lung condition where organs have inadequate oxygen supply due to fluid buildup in the lungs.) This forces our hand. We are doing everything we can to keep patients off vents. Both to save the vents for people that would not survive without them and because they seem to be a point of little return. We are more inclined to use a high flow O2, humidified and sometimes heated, to help the younger patients.

Where this severe immune response comes from and why some experience it and some don't, I don't know the answer.

 

[Broken Shoulder]

Are you taking any special precautions to not infect anyone at home now that you're constantly exposed? Segregating inside your own home?

 

[Cgkdisc]

Of those who have had severe cases and/or expired, can you comment on age range, nursing home location, race and/or gender? Reports today are indicating higher rates for the older black population likely due to pre-existing conditions like diabetes, high blood pressure, smoking, etc. Detroit area already has higher black population than many other major cities potentially skewing stats even more.

 

[DavidSauls]

Thanks, ru4por.

When someone is sick enough to be hospitalized, but not severe enough to be put on a ventilator, what's being done for them? There's no cure, we can take fluids and food and NSAIDs for fever at home. What is the treatment for those in this middle range, that makes hospitalization a good idea?

 

[esdubya]

Do you have enough PPE?

How many Canadian nurses do you work with?

Cheers mate. I'm praying for you. Hopefully we can throw a round together sometime this fall or next spring!

 

[armiller]

When someone is sick enough to be hospitalized, but not severe enough to be put on a ventilator, what's being done for them? There's no cure, we can take fluids and food and NSAIDs for fever at home. What is the treatment for those in this middle range, that makes hospitalization a good idea?

I was kind of wondering this too. Obviously when true ARDS sets in, then ICU physicians and respiratory therapists become particularly important. You mentioned that you're on a med-surg floor, so I'm guessing you don't have much ICU exposure currently, but are many of your patients in "stepdown" or a similar level of care? As far as monitoring those patients, is it mainly watching vital signs like respiration rate, heart rate, and oxygenation? Or are there other things to watch out for that other nurses or physicians might not think to look for?

Thanks, and best.

 

[ballgolfconvert]

Any thoughts on this Twitter thread. It says that they need to start treating like high altitude sickness. I have also seen elsewhere that it is the blood cells failing to pick up the oxygen, not necessarily the lungs inability to bring Oxygen in. This Doc thinks they could be ruining peoples lungs treating for the wrong thing.

https://twitter.com/hashtag/oxygennotpressure?src=hash

"Cameron Kyle-Sidell, MD
@cameronks
·
Apr 1
Everyone in the medical field...Please read! https://atsjournals.org/doi/pdf/10.1164/rccm.202003-0817LE
Patients need OXYGEN not PRESSURE. COVID-19 is not ARDS. March 30 letter by "THE" Italian and WORLD expert on ARDS. Protocols MUST change. The time is NOW! Save 100,000 lives! "

 

[ru4por]

Are you taking any special precautions to not infect anyone at home now that you're constantly exposed? Segregating inside your own home?

I am married with no kids. Yes, but sadly, no matter the precautions, I am placing my wife at risk. I strip in the garage and shower in a separate bathroom. I am sleeping in a spare room. I am fortunate to have a big enough house to segregate. That all sucks. But, we are all making sacrifices these days.

 

[DiscFifty]

12 days ago potential exposure to cv. 5 days later dealing with aches and pains, headache, limited coughing (more like bursts of shortness of breath). Lung capacity staying strong. No fever. Able to exercise, etc. Past 3 days feeling much better, foginess gone, no aches and pains. Only lingering thing is dry mouth and slight stuffy nose. Never was tested due to obvious not wanting to waste resources. In your opinion, could this have been cv or just standard allergies, cold, etc? Thank for all you are doing. Stay safe.

 

[ru4por]

Of those who have had severe cases and/or expired, can you comment on age range, nursing home location, race and/or gender? Reports today are indicating higher rates for the older black population likely due to pre-existing conditions like diabetes, high blood pressure, smoking, etc. Detroit area already has higher black population than many other major cities potentially skewing stats even more.

In general terms. Preface by the way my patient demographics are populated.

I am in a 100% COVID positive facility. The ED/OR are closed and operating as Intensive Care units. So we have to input process, outside of transfers for other hospitals. Most of our transfers, at the moment are coming from lower social economic areas. That has a big impact on race/gender/general health. We also have been taking in a fairly high number of nursing home patients. They are very sick folks when they arrive.

So, we are seeing a large population of aged black population. Probably for many of the reasons I have stated above and many that you have posed above, as well.

Nearly all of the deaths are on patients above 80, with significant co mobidities. About half are "do not resuscitate" patients. Those with expressed wishes to not have heroic measures attempted if death is imminent. I cannot speak to the ICU.

 

[ru4por]

Thanks, ru4por.

When someone is sick enough to be hospitalized, but not severe enough to be put on a ventilator, what's being done for them? There's no cure, we can take fluids and food and NSAIDs for fever at home. What is the treatment for those in this middle range, that makes hospitalization a good idea?

David, that is really whom I am working with. We have no vented patients in my area. Sadly, we are doing very little. There is no treatment for the virus itself, so we essentially are treating symptoms and providing comfort.

Breathing difficulty is the hospitalization threshold. As long as the lungs are effectively exchanging O2, you stay home. Once hospitalized, O2 therapy is used. We measure the amount of O2 being carried around the blood, usually via a finger probe, measuring O2 saturation levels. We strive to keep this number above 90%. If it drops below this, we turn up the oxygen. Once we hit 6-8 Liters of O2, we begin high flow O2 treatments. 8-15 L of O2, humidified and heated. This is pretty effective, but obviously the patient cannot continue to survive with this kind of intervention.

Other than that, we are giving high doses of Vitamin C, Vitamin D, Zinc. Antibiotics to treat secondary infections. We are using some corticosteroids, though their effectiveness is not documented, nor have I seen them as very effective. IV fluid use is restricted in many cases, for fear of fluid overload. This would have a serious impact on the lungs, but hydration is also important. We keep a pretty close eye on fluids. We have just begun "proning" patients. Encouraging them to lie on their stomachs. This seems to facilitate better lung protection, inflation and hygiene. It is now part of our ICU protocol, and the trend seems to be moving to earlier intervention, on my floor.

 

[ru4por]

Do you have enough PPE?

How many Canadian nurses do you work with?

Cheers mate. I'm praying for you. Hopefully we can throw a round together sometime this fall or next spring!

Thanks, man. We are struggling with N95 masks. They are so critical. Our protection is hinged on their availability. Other than that, equipment seems to be holding out pretty well. The community at large has really stepped up and donated equipment they don't need. Doctor's offices, universities.....tons of stuff.

I work with a couple Canucks. Though, throughout my career they have been a decent size of the workforce in Detroit area.

 

[ru4por]

I was kind of wondering this too. Obviously when true ARDS sets in, then ICU physicians and respiratory therapists become particularly important. You mentioned that you're on a med-surg floor, so I'm guessing you don't have much ICU exposure currently, but are many of your patients in "stepdown" or a similar level of care? As far as monitoring those patients, is it mainly watching vital signs like respiration rate, heart rate, and oxygenation? Or are there other things to watch out for that other nurses or physicians might not think to look for?

Thanks, and best.

At my facility, there are two levels of care. Medical and ICU. It is all a numbers game. O2 saturation levels and O2 intervention. Once a patient has decompensated below 90% O2 saturation on 15L high flow, a rapid intervention team is called and the patient is moved to ICU to be vented. We do frequent blood gases on the more critical patient to monitor several other significant lab values, but it is really a game of O2. We have no vented patients on my floor.

 

[ru4por]

Any thoughts on this Twitter thread. It says that they need to start treating like high altitude sickness. I have also seen elsewhere that it is the blood cells failing to pick up the oxygen, not necessarily the lungs inability to bring Oxygen in. This Doc thinks they could be ruining peoples lungs treating for the wrong thing.

https://twitter.com/hashtag/oxygennotpressure?src=hash

"Cameron Kyle-Sidell, MD
@cameronks
·
Apr 1
Everyone in the medical field...Please read! https://atsjournals.org/doi/pdf/10.1164/rccm.202003-0817LE
Patients need OXYGEN not PRESSURE. COVID-19 is not ARDS. March 30 letter by "THE" Italian and WORLD expert on ARDS. Protocols MUST change. The time is NOW! Save 100,000 lives! "

I saw you mentioned this in a different thread. I don't know much about it. Much of what I do know kind of concurs with the premise. Things do point to the exchange at an alveolar level as the problem point. Virus are a funny thing, forcing genetic replication to cause problems. I am far from a genetic expert and really am a caregiver. Honestly, I find I have to do some research to do my job, but for my sanity, I try to limit the time spent doing it.

 

[discerdoo]

What were you doing before getting drafted to be a superhero again? Any desire to stay with nursing when the dust settles?

 

[ru4por]

12 days ago potential exposure to cv. 5 days later dealing with aches and pains, headache, limited coughing (more like bursts of shortness of breath). Lung capacity staying strong. No fever. Able to exercise, etc. Past 3 days feeling much better, foginess gone, no aches and pains. Only lingering thing is dry mouth and slight stuffy nose. Never was tested due to obvious not wanting to waste resources. In your opinion, could this have been cv or just standard allergies, cold, etc? Thank for all you are doing. Stay safe.

I can't speculate. But, you should touch base with your primary care physician. At some point you will have access, to be tested to see if you did have it. There is an antibody test available, but that will hopefully be something we look at in a few months. Glad to hear you are feeling better, but there is some evidence that the virus can exacerbate any time throughout the two week period. Keep doing the things you can to help your body stay healthy and call your PCP.