Two guys posted the following on the only other MB I post on, a private OU board. The first one has a fraternity brother who is a doctor in IIRC the Kansas City area, so he's pretty much up on at least the gist of what's going on where the rubber meets the road. The second one is an ICU nurse.
First Guy: _____ - would you comment on what I’m going to post. It’s from a gal in Joplin that I went to school with and it is from her sister who is a nurse at one of the hospitals there:
In the COVID ICU we use medications like vecuronium to completely paralyze your muscles so we can control every aspect of your breathing. So now you are paralyzed but we don't want you paralyzed while alert and awake, that would be inhumane. So we add at least 2 sedation medications. One is usually propofol (the one linked to Michael Jackson's death) and the other is fentanyl (the one linked to so many opioid overdose deaths). Of note, all these medications usually go on an IV, but not on your arm like they would do in the emergency room, we put IVs right into your jugular. But hey, all this sedation also lowers your blood pressure and you need an adequate pressure for blood to reach your vital organs, like your kidneys, you don't want kidney failure. So now you are on another medication called levophed to keep your blood pressure up. But being on all these medications while completely unable to move and with a tube down your throat... where do you get your nutrition from? So we put another tube down into your stomach, we put another tube in your urethra to make sure you are urinating, the tube feedings and antibiotics cause diarrhea so we put a tube in your rectum to further protect skin and prevent infections. Meanwhile your muscles are wasting away from being paralyzed, you are at an insanely high risk of infection because of all these tubes and IVs in places where they don't belong, your skin can breakdown due to prolonged contact pressure from being paralyzed, and you can develop heart rhythm irregularities as side effects of these medications, which now puts you at an increased risk of cardiac arrest and dying.
So when you are bitching about having to wear a mask, think of these patients I take care of. Already battling #covid19 with a pair of sick lungs, completely paralyzed, alone, sedated and fighting for their lives. #wearamask
2nd Guy: Pretty much spot on. I worked a three-week crisis travel contract in a COVID-ICU at Houston Methodist back in late March/early April. It was an eye-opener to be sure. I’ve never seen so much death in one place. With no known effective treatments for the virus, these critically ill patients just don’t get any better. They’re intubated for weeks at a time. Yes, we used paralytics, especially in the worst pulmonary cases where they were repeatedly proned on their stomachs in an attempt to build recruitment of the pulmonary alveoli. Our drug of choice was Nimbex, but Rocuronium would work, too. You can’t paralyze patients without sedating them - it’s inhumane - so we’d place the patiencs on IV Propofol drips, Fentanyl drips, Precedex drips, even Ketamine drips in those patients that were the most difficult to achieve adequate sedation. ICU psychosis is a real thing, especially in sedated patients, and the long-term psychological effects of long-term intubation/sedation in COVID patients are just now being realized. These patients are fucked up. No family members are allowed in the rooms. Normal mechanisms for orienting these patients just aren’t available in a COVID ICU. Not to mention all the healthcare workers are esssntially dressed like stormtroopers with all their PPE. I can only imagine how scary that must be for the patientr. Yes, while the patients are intubated they can’t eat or drink, so a nasogastric or orogastric tube is inserted down into the patients’ stomachs and tube feeding and medications are given through these tubes. Weeks of inactivity causes severe muscle atrophy, so even if these patients survive (which isn’t often - mortality rates in intubated COVID patients range from 50 to as high as 90% at the worst of the NYC crisis back in April), these patients are weak and immunocompromised and at risk of succumbing to myriads of associated health conditions. COVID attacks the heart and cam cause extreme heart failure, to the extent that these patients are sometimes placed on ECMO, which is basically like a giant bypass machine that pumps blood through the body when the heart is unable to do its job. The catheters through which blood exits and enters the body required for ECMO are the size of large drinking straws. These are the most extreme cases and they’re almost certain to die if ECMO is necessary. Long-term pulmonary failure eventually impairs the kidneys, so these patients go into renal failure and can require continuous renal replacement therapy (CRRT), which is essentially continuous dialysis. These COVID units are a hell on earth, where all nurses, physicians, physicians assistants, nurse practitioners, respiratory therapists, nurse techs, etc. are scared to death or contracting the virus. The mental and emotional toll of seeing all that death and basically being unable to help anyone is immeasurable. I drove home from Houston to Oklahoma and, completely exhausted from 60-70 hour work weeks, I missed speed limit signs in a small town about 30 minutes from home and got pulled over by local police. I was so emotionally strung-out that this was the tipping point and I just started bawling as the officer made his way to my car. I managed to explain what was going on and the officer asked if I had emotional support at the destination to which I was traveling (I was going home to see my fiancée) and he let me go without so much as a warning. About all I was able to say to him was to just repeat “so much death” over and over. I’m sure I was a sight to see. So if anyone ever tries to tell you that COVID is some kind of hoax, just remember my words here. It’s real, it’s terrible, and it’s the worst thing I’ve ever seen in 11 years of ICU nursing.
