Tuesday, March 31, 2020


Everyone is so fucking worried about not having enough ventilators - which is a concern, of course - but no one in the medial or at those circus-like "presidential" briefings has asked the more basic questions than "how are we going to get more of ventilators"?

That question - or questions - these folk should be:

1. Who the fuck is going to intubate all these patients? 

Outside of a medical student's (or possibly a resident) rotation in Pulmonary Medicine or Anesthesiology (about a month each), most doctors never have to intubate a patient again in their career.

How many available pulmonologists and anesthesiologists do you think are going to be free for all of these planned patients? And if they're not, how do you think patient satisfaction medical complications will go with the dermatologist on call having to put a tube into your lungs? Or a gynecologist or psychiatrist?  Because, honestly, that is what we are looking at.

2. Who the FUCK do you think are going to look after all these patients once they're intubated? 

Critical Care nurses do this now. Most floor nurses have never seen a ventilator, let alone cared for a patient on one. Sure, they'll rely on Respiratory Therapy to help calibrate the machine, but the overseeing of these patients?

Most critical care nurses have 1-2 patients when they're on vents. 3 at most, depending on the acuity.

Sooooooo.......let's say we, as a nation need 100,000 vents. Let's say half are in use. That's 17,000-50,000 nurses (just for vent patients) per shift. More, with those other patients too. Oh - and these nurses are not trained to treat patients on these machines. Oh - and there has been a national nursing shortage for well over a decade.

I'm sure you, as a patient or concerned family member, wouldn't even consider holding the hospital after a patients death that was due to inadequate staffing, training or equipment.  (btw, my typing fingers are dripping with sarcasm.)

Yes, COVID-19 has disaster written all over it, in many ways. Just not the ways most American's are thinking. I would gather to say that extends to BLOTUS, Ms. Pence and even to a degree, Andrew Fauci. Ditto for each an every governor.

I can tell you - it's a concern at the hospital level. Right now it's not an issue, as there aren't enough ventilators to worry about the staffing and adequate training of said staff.

Those two above questions and my $0.02 answers might be enough for you to stay home, and wash your hands.

Oh - and hospitals still don't have enough PPE.  My health system is recruiting volunteers to sew 100,000 masks in a two week period.  Yes - THAT is where we are as a nation in terms of 'need'.

Good Luck All.  We're gonna need it.

Song by: Maria McKee


Ur-spo said...

Good luck indeed.
It is going to be a lot worse before it gets better

DeeDee said...

I'm crying here because I am a respiratory therapist. At my hospital we have a float pool and all hospital staff are on deck when we aren't taking care of patients. I went to the float pool 4 times already this week. One time I sat at one of the entrances checking temperature on every employee that walked in. One time I filled and labeled small bottles for an hour with hand sanitizer donated by a local distillery that has converted to help. One time I cut filters for an hour out of vacuum cleaner bags to insert into home made cloth masks while other staff ran the sewing machine. I've seen the emergency room doctor intubate patients along with the anesthesiologists and the pulmonologists in the ICU. I am there observing and helping. Things have not peaked in my area. We are being trained on loaned vents from a neighboring nursing home that no longer has that type of patient. We are supposed to run out of isolation gowns by this Friday at the rate they are being used. We use the same N95 mask in COVID rooms as long as we can and keep them in our personal paper lunch bag until they are used up. I know other hospitals have respiratory therapists that do intubate, and also paramedics in the field that do intubate. I am in Illinois and we are in lockdown when we aren't at work. I am scared. Everyone is scared. I don't want to get sick either or take it home to my family. I jump in the shower and throw my clothes in the hot washer as soon as I get home. I try to get plenty of sleep but it seems restless every night. Worry worry worry.