Most people don’t understand that a ventilator is not a ticket back to health. You have to be on death’s door to get intubated and it comes with a lot of inherent risks (trauma to the lungs, ventilator-associated-pneumonia, ventilator dependency, aspiration, pressure injuries, malnutrition, etc.) The media has sold this impression that vents are life-saving 100% of the time, which is a lie.
COVID is also a disease we know next to NOTHING about. Our strategies to deal with it are constantly changing as we learn more and have more evidence available to guide our practice. For example, when it started we were tubing people quickly and putting them on certain ventilator settings. Then, in a week or so, we learned that early intubation and those ventilator settings weren’t helping - so we had to tweak our approach to find a way to help these people live. I don’t know if the average person understands how hard it is to be a healthcare worker who operates at a high level of knowledge and expertise (as most critical care docs/nurses/RT’s do) and not know how to treat something. It’s very sad and frustrating to know that you’re up against something that doesn’t have an easy answer and you second-guess all your treatment choices. It’s pretty insulting to us to have people accusing us of murder when in my experience we’re all just trying our damn hardest to help people heal - but having to do it with one arm tied behind our back.
People also don’t get what it’s like to be in an overwhelmed hospital. Just because there’s supposedly enough nurses on the floor to staff these ICU’s doesn’t mean they’re all ICU-trained, and doesn’t mean that they all have appropriate patient assignments. In my experience, an appropriate nurse:patient ratio for these COVID patients is 1:1. The critically ill ones are really that sick, they require constant focus and attention from a highly trained nurse. I recently traveled to a hospital in “surge” and was given a 3 patient COVID ICU assignment almost every night. It was wild and very difficult to provide care that met my idea of the ICU standard. If I hadn’t been ICU trained, I’m sure my patients would have died. The stuff this nurse talks about in the video is all stuff that happens when nurses have too much on their plates - either too many patients to practice safely, or not enough training to practice safely (but they got thrown into it by management). I agree with the nurse in this video - stuff like insulin errors, running tube feed without checking placement, letting your vasopressor drip run out, not thoroughly assessing your patient, etc. should NEVER happen. EVER. But a situation has been created where it’s much easier for this stuff to happen and it really sucks.
I can say that yes, these people do come off the vent - I’ve cared for several of them. Almost all of them were under 50 with a good baseline level of health, though.
The thing most non-healthcare workers don’t realize is that any elderly person who ends up on the vent - whether because of COVID or because of any other reason - will probably die. However, most people don’t have good conversations about end of life care with their families and doctors, so when we are legally obligated to intubate 90 year old grandma in respiratory failure, it’s not because we know she’ll get better on the vent.... it’s because she’s a full code and we have to act in accordance with her expressed wishes, even if we know her expressed wishes aren’t going to do her a lick of good. It’s frustrating and soul-crushing. The worst is when selfish family members refuse to consider withdrawal of care in these futile situations and force their mother/grandmother/whoever to linger on the vent, suffering.
Okay, dude or dudette, you come stand at the bedside doing nothing while your patient dies in front of you because they can’t breathe!
I have seen people go from having horrible blood gases pre-intubation (pH of 7, CO2 in the 80’s, pO2 in the 60’s or lower)/ on their way to a certain death, and then live after being intubated. Because you can use the vent to give them higher levels of oxygen, help them blow off their carbon dioxide, and utilize certain lung recruitment strategies to help oxygenate their blood.
I feel like you’re either being purposefully obtuse here or you truly don’t understand the point I’m making. Would you rather have someone die for sure without being intubated instead of give them the chance by giving them a breathing tube? Not every single patient who gets tubed dies. Like I said earlier, we try NOT to intubate people at my hospital but if it’s a certainty they will die without the breathing tube (they’re lying in the bed NOT BREATHING on their own) we don’t just sit there and watch them die. We give them the chance.
It’s a last-ditch effort. When someone’s oxygen saturation is 65% and they’re turning blue and unable to maintain their airway (aka breathe on their own), you don’t just leave the oxygen mask on them and hope for the best. You intervene (unless of course they have a MOLST signed saying they do not want to be intubated). Even if your intervention doesn’t have a high success rate, it’s better than just sitting there with your thumb up your ass watching a patient die.
ICU nurse here - this is somewhat true. However, in the two hospitals I’ve traveled to since this pandemic started I’ve seen the docs waiting until the last possible moment to intubate these COVID patients because we know once they go on the vent it is unlikely they will come off it. I HAVE seen it happen, but the extubated individuals were always young and relatively healthy at baseline. Old people should not be put on the vent, ever, imo. Even on a normal day, the elderly people who lie in the ICU on the vent are going to die. It’s just that here in America, we don’t have honest conversations with people about the limits of our life-sustaining interventions and we let people rot on the vent because their shitbag children refuse to let them die peacefully. The sad reality is that once an elderly and chronically ill person gets to a point where they need a ventilator to live, it’s highly likely they will die anyway. We are just prolonging their suffering at that point.
Have you ever cared for a person who can’t breathe? If you had, you would know that you would do anything to help them. We hold off as long as possible before tubing these COVID patients because we know once they go on the vent it’s a long haul and very difficult to get them off. We give them the highest levels of supplemental oxygen and prone them.... but when they’re unresponsive and their carbon dioxide levels are through the roof while their oxygen levels are in the toilet and their pH is becoming incompatible with life you either intubate them or you watch them die.
Big woop if you get COVID. Seriously. I work in a COVID ICU, reusing a respirator that doesn’t even fit, breathing in “high viral loads” of COVID multiple days a week as I care for the unfortunate people who end up needing critical care to fight off this virus. I’ve never even spiked a temperature. Neither have any of my coworkers. This shit is asymptomatic in huge numbers of people and is nothing to be afraid of, especially if you are healthy. My 68-year-old parents have lived their lives exactly the same as always through this and have had zero symptoms, not even a sniffle. I don’t know a single person who has gotten sick to the point of requiring hospitalization since this started. Even in the COVID ICU, patients come in for a day or two for extra oxygen support and monitoring and then most of them leave and ultimately go home. You have to be extremely unlucky to end up dead from this thing, and most people aren’t that unlucky.
Agreed with your opening point. I work in a COVID ICU in a hard-hit spot and every single person who is critically ill is either a.) elderly with significant underlying conditions, b.) young but with diabetes, or c.) young and FAT AS SHIT. Being overweight IS an underlying condition, so whenever I see these media reports of “young, healthy people” dying next to a picture of someone who is at the very least overweight, I roll my eyes. I’ve yet to see a young, fit person with no health conditions end up in our ICU due to COVID.
No. Night shift almost ruined my life. It’s very unnatural for your body to be awake at night. What you need to do is start committing to doing something early in the morning (e.g., hit the gym at 5 am). This will blow for a couple of weeks, but by week 3 you will be adjusted to it and by week 4 you will start to wake up earlier and with more energy without needing an alarm clock.
Wow. I remember TD back in 2016.... definitely thought then that it would be around for a long time. Sucks that all the fun got ruined. TD is the whole reason I switched from hating Trump to voting for him. I am still pretty “normie” or whatever but I love TD and am happy to be able to come here to enjoy the fun. 2016 was one of the most hilarious years ever as I enjoyed watching Trump absolutely wreck everyone in his path. Posting on TD and looking at all the spicy memes only made it better. RIP, THE_DONALD.
No problem! I’m happy to spread awareness that this isn’t necessarily a massive disaster, something that’s definitely needed right now.
We have tried the combo, but most times it comes too late. Last time I was at my home hospital (a few weeks ago) the director of the ICU’s was pushing to hit people with the promising medication regimen upon admission rather than waiting for them to become critically ill. After this push, we did become the first hospital in the area to have zero COVID patients on the ventilator despite having the highest concentration of COVID patients! Of course, correlation doesn’t equal causation but that fact gives me some hope!