Conundrum with scarce resources. Rationing medications.

1,958 Views | 16 Replies | Last: 5 yr ago by VKint
Marcus Aurelius
User Profile
Private Message
Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
8:02p, 6/18/20
AG
I have posted on this before. But I'm on call and experiencing it again tonight first hand. I post because I'm frustrated. So I've have 2 new COVID patients today admitted to ICU. One - 47 male HTN o/w healthy. Sick. Requiring high level HFNC. Severe viral pneumonia. Another - 80 y/o NH female DNR, intubated max vent severe viral pneumonia/ARDS, renal failure. Family reversed DNR to "give her a shot."

Remdisivir requires infectious disease approval. We have one dose of remdisivir (x 5 d) left in pharmacy. ID doc approves for 80 y/o but not for the 47 y/o.

We discussed and he won't budge. Tough call but would treat the 47 y/o IMO.

Dealing with this day to day.
Reply Quote
9
1 edit
aggiemetal
User Profile
Private Message
Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
8:11p, 6/18/20
AG
Can't imagine. Hard call but clearly you think the call would be not gamble on the younger guy not getting the dose who has a fighting chance and likely a lot more current family wise at stake (no offense to the old guy but you know what I mean, assuming young daddy, husband etc). Or just imminent help but in helping his quality of life in the other issues following his hopeful recovery (potential long term renal, heart etc issues).

Hell of deal, prayers for you in doing a warriors work day in day out.
Reply Quote
1
3 edits
AgResearch
User Profile Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
8:24p, 6/18/20
AG
Is dexamethasone being used in the US or considered following the Oxford information? Would it be a fit for the 47 year old?
Reply Quote
Marcus Aurelius
User Profile
Private Message
Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
In reply to AgResearch • 8:25p, 6/18/20
AG
Yes. Both are on it. Plus full anticoagulation (we are anticoagulating all that require ICU admit. D Dimer high as well).
Reply Quote
1
1 edit
AgResearch
User Profile Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
8:35p, 6/18/20
Duncan Idaho
User Profile Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
8:54p, 6/18/20
Jesus. Thanks for fighting this. My prayers go out to you and your team.
Reply Quote
4
OldArmy71
User Profile
Private Message
Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
8:56p, 6/18/20
AG
So sorry you're going through this. I hope sharing it helps you deal with the stress.
Reply Quote
Post removed:
by user
8:58p, 6/18/20
Marcus Aurelius
User Profile
Private Message
Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
In reply to OldArmy71 • 9:15p, 6/18/20
AG
Good point. TexAgs is kinda my sounding board. Hope this is OK with this board. But maybe ya'll can learn/enrich from real experience? (I have gotten flack from my wife that says she is my only sounding board).
Reply Quote
11
1 edit
Pasquale Liucci
User Profile
Private Message
Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
In reply to Marcus Aurelius • 9:23p, 6/18/20
AG
More than ok with this board. Can't tell you how much comfort your posts have given me just to have some sound, objective info from the front lines.

God bless you and may he place his healing hands around your patients Marcus. I'm just one of many laymen on the boards but don't hesitate to reach out here if there is anything we can do to help. The whole is much greater than the sum of the parts.
Reply Quote
3
FlyRod
User Profile Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
9:24p, 6/18/20
Absolutely sucks that you are in this position...infuriating and inexcusable that you don't have enough doses needed.

Let your heart be the judge of what you do, nothing more or less can or should be asked of you.
Reply Quote
1
OldArmy71
User Profile
Private Message
Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
In reply to Marcus Aurelius • 9:27p, 6/18/20
AG
MANY people have said this to you: PLEASE continue to contribute to the board, even if it's tragic stories such as this one. We learn so much from you and perhaps it helps you, too.
Reply Quote
3
Diyala Nick
User Profile Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
9:28p, 6/18/20
AG
It should go to 47 year old.

Crazy town. 87 years is a full life.
Reply Quote
k00bz
User Profile Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
9:28p, 6/18/20
AG
I actually appreciate your posting style. It's like you're thinking out loud and I get to see how you as a front liner are feeling about the situations you encounter and your clinical decision making. I also glean in-depth knowledge of current treatment protocols. If I get this bad enough to be admitted, the physicians will be annoyed with me. "What's my d-dimer and ferritin levels", "did you start anti coagulants", "do you have remdisivir available", "shouldn't I be proned", lol. Please continue posting. Even if you feel like you are talking to a wall and no one is listening. Several of us are listening...and learning.
Reply Quote
6
Jackal99
User Profile
Private Message
Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
In reply to Marcus Aurelius • 9:32p, 6/18/20
AG
Vent. Share. It's eye-opening to get such a first-hand perspective. And be safe out there.
Reply Quote
2
Marcus Aurelius
User Profile
Private Message
Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
9:54p, 6/18/20
AG
Real time. Just re talked to ID doc. He is holding remdisivir for 47 y/o. Yes.
Reply Quote
11
OldArmy71
User Profile
Private Message
Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
In reply to Marcus Aurelius • 10:05p, 6/18/20
AG
That is great!

Very sorry that the other patient has to be denied. I wish there were enough for both. I know you do too.
Reply Quote
2
VKint
User Profile
Private Message
Ignore User Stop Ignoring
How long do you want to ignore this user?
24 hours One week Permanently Cancel
In reply to Marcus Aurelius • 11:24p, 6/18/20
AG
Sounds like good time for palliative care consult.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Reply Quote
Refresh
Page 1 of 1
 
×
subscribe Verify your student status
See Subscription Benefits
Trial only available to users who have never subscribed or participated in a previous trial.