All I know is what I see in the news, so any input I have is purely speculative, and I'm speaking in generalities. But, I think this may simply be an issue if terminology.
People often mix up "cardiac arrest" (heart stops) with "heart attack" (damage being done to the heart by some mechanism). Every single person that dies, technically dies from "cardiopulmonary arrest" (heart and lungs stop, [because of something else], and they die).
There are 6 different "classes" of heart attacks. Usually when people talk about this, they refer to type 1, meaning there is a blockage in the blood vessels of your heart, and the heart muscle can't get oxygen, and it dies. This can, occasionally, lead to a bad cardiac rhythm (v. Fib) that stops blood flow, and then cardiac arrest ensues if not intervened upon.
All heart attacks involve a mismatch of oxygen supply (in the blood) and oxygen demand (heart muscle needs oxygen). If you increase the oxygen demand (ie heart working too hard--high blood pressure, high heart rate, etc) OR if you decrease oxygen supply (suffocation, pneumonia, ARDS/COVID, high altitude, etc) you can cause a mismatch of supply and demand which can cause heart muscle to die--a heart attack.
Intubation is a procedure often performed to secure a definitive airway and maximize oxygenation in the sickest patients. During that time, you TYPICALLY sedate the patient (inserting a tube through your vocal cords is highly noxious, your brain is programmed at the most basic level to protect your lungs from things going in there), and paralyze them so that the vocal cords stay open. There is a time between when you push the medication and you're waiting for the medication to take effect that the person gradually (over seconds to about a minute) stops breathing, before you insert the breathing tube. It's not always a straight shot, and some people have very challenging anatomy.
Healthy people who are fully oxygenated before intubation have about 8 minutes without breathing before their blood oxygen levels drop. With COVID, none of these people are well oxygenated and have no reserve, so as soon as they stop breathing, their oxygen level starts dropping. You try to get the tube in as fast as you can, but it's not guaranteed. There are many things you can and should do to optimize the person beforehand to increase your chances of success, and you always have at least one, sometimes two backup plans. But it's not a procedure to do without consideration to the risks involved, and that's why we often try not to intubate people because it's not a benign thing.
If the oxygen level drops too low before you get the tube in place, the person can quickly go into cardiac arrest (perhaps what happened in this case, and perhaps being mistakenly called a "heart attack"), and these patients are extremely hard to get back.
I don't know what procedure he was undergoing, but if I was a betting man, that's what I'd guess.
Bucking the vent means the patient's sedation is too light. Paralyzing them just takes away the ability to fight the vent, but it doesn't take away the discomfort. If you put an awake person on AC/VC and they'll buck the vent. You can paralyze that person and they won't buck, but they'll be awake and miserable. If you sedate that person, they'll be tolerant of the vent, and they won't be miserable.
As for paralysis decreasing oxygen consumption, here's a source: https://pubmed.ncbi.nlm.nih.gov/14707568/
All my patients with ARDS and a P/F ratio less than 85 get nimbex gtt.
The worst part is that intubation (the invasive part of ventilation) isn't necessary anymore.
Dude, what the hell?
You're mixing up respirators (wearable devices that filter air) and ventilators (machines that breathe for you).
The mask you linked is to make a diy respirator from a scuba mask. You still need an n95 filter to attach to it, to keep you from getting sick. You still need working lungs that can pull air in through the filters.
Once you have the virus, if it causes ARDS, and you cannot oxygenate even with high flow oxygen or bipap, then you are in "respiratory failure" and need to maximize oxygenation. That means intubation, and being placed on a ventilator, which will push breaths of 100% oxygen directly into your lungs, with no work of breathing required by you. (Respiratory muscles use oxygen too, just like the rest of your body, so paralytic agents are used in severe cases to take away any unnecessary oxygen use and save it for the heart and brain).
Ventilation means eliminating CO2. Breathing in oxygenates, breathing out ventilates. You ventilate by having open airways. That means either the diaphragm pushing air out of the lungs, or positive pressure (PEEP; positive end expiratory pressure) to stent the airways open. To create positive pressure, you need a seal. You accomplish that with either a mask (BVM, BiPAP or CPAP), or intubation. Masks only work in a competent person. Someone who is obtunded from lack of oxygen getting to their brain cannot comply with a mask and will aspirate without a secure airway.
Intubation is standard of care. But in the case of covid, it usually seems to prolong the inevitable. Only the ones with the worst disease get intubated, and once the disease is that bad, you're the least likely to survive. Intubation and mechanical ventilation isn't killing anyone. But most of the ones that are moribund get intubated.
I'm an ER doctor, I make these decisions all day. Please don't confuse a scuba mask with an air filter and a machine that breathes for you, and please don't spread around the idea that intubation is not necessary because of this 3D printed mask adapter.
Not commenting on whether that risk outweighs the risk of the Wu Flu. That's for each individual person to decide.
They said the majority of people are disfigured, which is fake news. Last I checked, 16% is not the majority. It's not good odds of permanent hemifacial palsy, but it's not the majority.
the majority will be left with a permanent disfigurement
Bell's is no joke, but let's not mislead people. Most people with Bell's Palsy DO recover, the majority are not permanently disfigured.
Source because we don't do fake news: https://pubmed.ncbi.nlm.nih.gov/7148998/
Seventy-one percent recovered normal mimical function of the face, 13 percent had insignificant sequelae, and the last 16 percent had permanently diminished function with contracture and associated movements.
The majority (71%) recover completely. 84% if you include "insignificant sequelae." But certainly the majority are not permanent disfigured.
Not commenting on whether that risk outweighs the risk of the Wu Flu. That's for each individual person to decide.
I'm an ER Doc in CA. Last week, business as usual. This week, our ER is getting crushed. We're short 7 or 8 nurses each shift, so while there may be enough physical beds, we don't have the staff to put patients in those beds. ICU is full, so when an ICU level patient comes in, they board in the ER for hours. When I come in the next day, there's often still patients I admitted last shift still in the ER waiting for an ICU bed.
Nurses can have a ratio of 1 nurse to 4 patients. But ICU patients have multiple drips needing to be adjusted frequently and close, frequent monitoring for changes in patient condition, so the ratio is 1:2. Since we're so short on staff already and the ICU is backing up into the ER, our staff is stretched so thin that it is unsafe for the patients.
Our nurses are performing admirably, no one is making tik tok videos, and no one is dicking around. I'm jealous of the hospitals that are empty, but know that many in CA are legitimately getting crushed. People coming in for medication refills have to wait sometimes an hour for me to see them (and I do feel very bad about that), because there's so many legitimately sick people in the ER.
A lot of the reason CA specifically is doing poorly, I think, has to do with the high number of illegals, who are poor, and who consequently live multiple families to a house, which spreads viruses quickly among family members. They also have poor health overall because many are uninsured and don't see a primary doctor. It's not the young ones that get sick--it's the old people with multiple chronic illnesses (and there are A LOT), like COPD, or uncontrolled diabetes that get tipped into DKA that get very sick.
I'll agree with you that these videos are stupid, and bad optics, and shouldn't be made. But maybe the ones saying they're getting crushed aren't the ones making videos?
I mean they are--they just have you sit outside under a tent, but that's too cold so they add propane heaters, and even then the wind makes it too cold, so they add walls to the tent...and then it's basically just inside.
do they automatically check voter rolls and either remove any and all voters also registered at that address
They probably got tired of couples/families or roommates living at the same address auto-cancelling each others' registrations. Makes sense if you assume every person is single and lives alone.
He had no clue Biden Taxes were going to take sooooo much more of his money
I just... Don't understand how people don't know this. This isn't just a Biden thing. It's a Republican vs Democrat thing. Everyone knows that the Dems are for higher taxes and bigger government.
Either way, good work, 'pede!
MD pede here. At my hospital, any time anyone comes to the ED, the triage folks have a list of like 20 questions they ask ALL patients coming to the ER specifically to screen for covid. (Any recent cough, fever, sore throat, loss of taste/smell, runny nose, recent travel, exposure to anyone known to have COVID, etc [probably including asking about joint pains {arthralgias}]) If they say yes to any of those questions, they ask me to decide if the person should go in isolation until we have a negative test (sometimes can be up to 7 days depending on the availability of tests), or if they can go into the main ED. If I have enough suspicion to test the person, and the test doesn't come back before I'm ready to discharge them, then I am putting "possible" "suspected" or "rule-out" COVID on the discharge diagnoses, along with anything else I'm suspicious of. I'm strongly suspicious that OP's friend said something unrelated ("yeah I do have a mild occasional cough, but I'm here for my knee") that made them test, and that's why it says that on the discharge paperwork. OP should ask their friend if they were treated in an isolation room/tent, and if the staff was wearing gowns and goggles and other PPE when speaking with the patient.
There is just no way they can explain away or run away from the fact that they decimated the economy, released criminals, allowed riots and oppressed small business owners and regular people for what amounts to a bad flu.
They can and will. They control the media. This will be swept under the rug. There will be no outrage.
Not to be a downer, but my MAGA-ladypede keeps telling me she can't wait for this to be over and for there to be repercussions for Newsom, Cuomo, etc. I tell her the same thing. They're going to drag this out until election day and then it'll just kind of peter off. Without a complicit media to fire people up, the public will lose interest, and no one will be prosecuted or face any sort of consequences for destroying the economy and terrorizing a country for a year.
C'mon pede.
California has been invaded by poor gibmedats who outnumber the productive members of society, and via their large numbers vote for more and more handouts, paid for by those who work for a living, thus drawing more moochers.
But why should they get this beautiful (geographically, not politically) state all to themselves, just because they come? Should we just hand it over to the liberals for free, just like we do with our ever increasing taxes?
I could have left the state for a higher paying job in a state that takes less of what I earn. But I'm staying and fighting for this state, because the liberals don't deserve it, and I'm not giving it to them without a fight.
It sucks to be subjected to liberal policies you didn't vote for and to lose every single election you vote in, but I hope for a little support from our likeminded friends in other states. With a little luck we can oust this little tyrant and start to take back our state.