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  • Dueling Doctors

    Posted by TM Lutas on March 29th, 2020 (All posts by )

    In the blue corner, we have the joint statement on multiple patients on ventilators by the Society of Critical Care Medicine (SCCM), American Association for Respiratory Care (AARC), American Society of Anesthesiologists (ASA), Anesthesia Patient Safety Foundation (APSF), American Association of Critical‐Care Nurses (AACN), and American College of Chest Physicians (CHEST) which recommends letting people die when spare ventilator reserves run out. And in the red corner, we have the VESper by Prisma Health fresh off of its recent victory to get regulatory approval under emergency use rules to allow ventilators to be used by up to four patients.

    It is triage with its ugly logic of letting patients die vs hope and technical advancement to save everyone, live in the United States at Covid-19 virus hot spots across the nation. This may affect you personally so it is important that you know whether or not the hospital you might depend on to save your life has picked one side or the other in a thoughtful way.

    Everybody could ask the question but it would be better if our press did ask and broadcast the answers. At the time of writing, they’ve had two days to do so. Are you informed on the issue? Are your neighbors? Is your hospital?

    This lack of discussion is the death of journalism. This time ignorance can have deadly consequences for us all.

     

    9 Responses to “Dueling Doctors”

    1. Mike K Says:

      I tend to agree about multiple patients with ARDS on one ventilator but I don’t understand why we are not getting enough hydroxychloroquine and remdesivir available to prevent the development of ARDS. Some of it is testing failure as California is woefully behind. Some of it is slow response by front line GPs and family docs.

      Peter Navarro said on Hugh Hewitt’s radio show ten days ago that 90,000 does of remdesivir has=d been ordered. I understand that it may take a while to produce but I would like to hear some results. Hydroxychloroquine has been around since WWII. I read of millions of tablets being offered. We have idiot governors in NV and MI refusing but they are backing down.

      Maybe the sluggishness is normal but it seems there could be more progress. I am also hearing about empty hospitals. No elective surgery and employees laid off.

    2. PenGun Says:

      The Russians who are closely following the Chinese experience, are using Mefloquine, another antimalaerial drug, but with the added benefit of some immune suppression which can mitigate the cytokine storm.

    3. Mike K Says:

      Here is a audio update.

      I can find no evidence for the alleged Zinc role in HC and AZ action.

    4. PenGun Says:

      Here ya go: https://www.youtube.com/watch?v=U7F1cnWup9M

    5. Mike K Says:

      Lots of technical jargon. Some negatives on HC and AZ. Another anti-viral drug suggested. Prone position on vent.

      Discussion of cytokine storm which is the killer for the young. IL 6 is an indicator.

      MLR is maximal lymphocyte Ratio.

      10% positive PCR on minimal symptom cases. No random samples yet.

      This is NY City. Group activities.

      No NSAIDS like Ibuprofen as the virus is nephrotoxic. Kidney damage.

      High fevers in kids. Treated with cooling blankets. Tylenol can cause liver problem.

      Vitamin C not helpful.

    6. Achilles Says:

      High fevers in kids. Treated with cooling blankets. Tylenol can cause liver problem.

      Is this COVID-19 specific wrt acetaminophen or acetaminophen in general?

    7. Mike K Says:

      I think it is COVID specific because the virus is hepatotoxic. Avoid aspirin under age 5.

    8. PenGun Says:

      “Lots of technical jargon.” I probably should have posted this one: https://www.youtube.com/watch?v=Eeh054-Hx1U

    9. Jay Guevara Says:

      I can find no evidence for the alleged Zinc role in HC and AZ action.

      Looking at the structures of these compounds as a chemist, I don’t see either of these compounds as having the properties of typical zinc chelators. So the obvious mechanism of promoting zinc transport looks improbable to me.