A DNR doesnt mean "dont treat" it means "treat but if things go bad, dont resuscitate "

So in our health system and with our current morals and the triage protocols they drive, if you are an old person that is sick enough DNR or not, you go to the ICU.

I dont believe we are at the point where we are triaging patients to be allowed to get in the ICU. Think "You must be this young/fit/otherwise healthy to get a vent/bed"...that day may come....I hope it doesnt.

Duncan Idaho said:

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A DNR doesnt mean "dont treat" it means "treat but if things go bad, dont resuscitate "

So in our health system and with our current morals and the triage protocols they drive, if you are an old person that is sick enough DNR or not, you go to the ICU.

I dont believe we are at the point where we are triaging patients to be allowed to get in the ICU. Think "You must be this young/fit/otherwise healthy to get a vent/bed"...that day may come....I hope it doesnt.

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No it certainly doesn't mean don't treat. But resources are becoming more scarce in a novel pandemic. Not a Italy type situation at all. Drs there were deciding who got vents, etc.

Hospice care does mean keep at home (or institution) and deliver comfort care, in no way should that lead to ICU/vent. The underlying cause of the hospice care is still there and will not be better.
DNR completely different of course. Yes, treat things that are treatable but do we want to have ICU beds taken by pts that will not get on a vent? Pressors yes or no? Inpt O2 and IV therapies absolutely. I don't care for them directly, are there therapies they are getting in ICU not available on the floor that would impact survival?
Difficult issue since this is the population that seems to be getting hit the hardest.
It really needs to be addressed if it all possible at the source - before getting to hospital.

New hospitalizations have fallen off a cliff here in Virginia. However it does appear that some of these patients are staying in the hospital for a very long period of time. Despite the drop in new hospitalizations, the total number in the hospital hasn't dropped that much. Seems like these hospitalized patients are being kept there for quite a while.

https://www.vdh.virginia.gov/coronavirus/

The University hospital cases have doubled to 60 over last week here.

VKint said:

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Hospice care does mean keep at home (or institution) and deliver comfort care, in no way should that lead to ICU/vent. The underlying cause of the hospice care is still there and will not be better.
DNR completely different of course. Yes, treat things that are treatable but do we want to have ICU beds taken by pts that will not get on a vent? Pressors yes or no? Inpt O2 and IV therapies absolutely. I don't care for them directly, are there therapies they are getting in ICU not available on the floor that would impact survival?
Difficult issue since this is the population that seems to be getting hit the hardest.
It really needs to be addressed if it all possible at the source - before getting to hospital.

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I agree! This needs to be addressed by the primary care physicians or hospice prior to sending them to the hospital. If they can't take care of them at home it should be clarified for hospice patients to only provide supportive therapy on the floor and no need for ICU. If patient has dementia and is DNR then a discussion with the family member with power of attorney about what type of treatments are appropriate should take place. Most likely they would be agreeable to staying out the ICU if they have a physician with a long relationship discuss this with them.

This should not have to handled by the critical care physicians and hospital attorneys. I actually usually do this at the time of recommending hospice, DNR or a living will.

gigemhilo are you in MP?

Yessir - you?

KlinkerAg11 said:

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Why are meat packing plants getting hit so hard?

Lack of PPE and work environment?

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the ideal environment for Covid-19 to spread. Younger workers often in meat processing plant but vulnerable due to a close working environment, working hand in hand closely in assembly line work with poor air exchange. Cold AC recirculating contaminated air over and over. So long exposure time despite the younger population.

One interesting variable is that often they are younger and foreign-born so they may have been vaccinated to BCG vaccine and MMR. This vaccination may lessen the severity of infection and mortality rate of mostly young meat packing clusters which bear out that lower mortality.

But that doesn't explain why they are entering Moxley's ICU. It makes sense that the virus would spread there, but why are they becoming sick enough to enter the ICU?

cc_ag92 said:

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But that doesn't explain why they are entering Moxley's ICU. It makes sense that the virus would spread there, but why are they becoming sick enough to enter the ICU?

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Increased viral load over time?

They are likely getting higher loads working so close to one another, often bused in, and live in multifamily housing. A large portion are from Somalia where there are a decent percentage of A blood type

P.U.T.U said:

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They are likely getting higher loads working so close to one another, often bused in, and live in multifamily housing. A large portion are from Somalia where there are a decent percentage of A blood type

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Norway's Somalian population has gotten infected at 10x the rate of other Norwegians.

https://www.reuters.com/article/us-health-coronavirus-norway-immigrants/covid-19-takes-unequal-toll-on-immigrants-in-nordic-region-idUSKCN2260XW

I really think there is something to vitamin D

In our town (#1 in EastTX), it's looking like all of it has been spread at a local chicken plant and housing/family system spread. Our town has a very high hispanic population that tends to be very social. This virus is seeming to thrive. We have been lucky with only 20 or so of the people out of the now 500 positives needing to be hospitalized. We have had 2 deaths and from what I'm told, one of them was very unhealthy before COVID.

There is a younger man who just went on a vent according to FB with no known prior issues other than being overweight (looks to be under 300lbs, so obese, but not huge.)

Bill Bigfoot said:

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There is a younger man who just went on a vent according to FB with no known prior issues other than being overweight (looks to be under 300lbs, so obese, but not huge.)

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If you are pushing 300 you are very likely to have things like high blood pressure, high cholesterol, etc. so he probably had a ton of inflammation to start with.

I don't know how there are so many big guys in east Texas, when I call on oilfield or manufacturing facilities most of the guys make me look like a shrimp and I am 6'1" 210 pounds. It is probably all of the fried catfish places out there

Y'all have been getting hammered out there. Your hospital has become or is close to being our second most frequent orderer of convalescent plasma. It seems like every day they have been calling for 2-3 units over the last week.

SoulSlaveAG2005 said:

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Y'all have been getting hammered out there. Your hospital has become or is close to being our second most frequent orderer of convalescent plasma. It seems like every day they have been calling for 2-3 units over the last week.

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Now that I've read both of your posts, I know someone who just had the plasma treatment in ET, wonder if it was at the same hospital.

Was it at TR in MP?

We supply every hosptial in ETX with all blood and blood products, so any hospital it would have come through our collection/distribution teams.

Hope it helped.