Consistent demographics still?

Thanks for the updates Doc

Speaking of shifting demographics, ran across this cool graph on Twitter for the shifting demographics in Florida. Lots of ways to analyze that information but interesting nonetheless

For those in the field - I would describe the covid agonal respiratory pattern as a Kussmaull like but with a much higher rate than a typical DKA patient. Frightening.


(Kussmaull respiratory pattern is seen in diabetic ketoacidosis as pts try to compensate for severe metabolic acidosis with a compensatory respiratory alkalosis. It is notable for extreme deep prolonged dramatic breaths but usually without severe tachypnea. They increase minute ventilation more so with tidal volume rather than rate.)

Most of the time - older more comorbid/obese. But some - no rhyme or reason.

I was thinking different disease progression or groups of symptoms leading to subtypes of severe cases. Maybe that isn't a thing.

Damn, thinking about you and your team having to witness that over and over. Just brutal.

How long after you identify the patients as terminal do they generally live? Days? Weeks? Dependent on medical directives/family wishes?

I would like to think, and I have no idea really, but I would like to think the reason you are seeing an increase in lower age groups, whether it is a percentage(which I think it is) or a total number compared to senior citizens is a direct result of protecting the older folks.

Marcus Aurelius said:

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An observation from the sickest pts who are agonal. The air hunger/respiratory distress is the most horrific I have ever witnessed in my career. Over any other "terminal" respiratory condition - i.e ARDS from other causes. Terrible to witness. Rounded on one today. Zero percent chance of survival. The family won't withdraw - and this poor lady is suffering. Even with propofol and fentanyl on the vent. Probably the most striking aspect of the illness and something I will never forget.

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Marcus, so sorry to hear about that situation. Air hunger is indeed absolutely horrible. How old is the woman, and is she otherwise healthy??

I would as well. Would make their sequestration worthwhile.

As to the question above about how long they live in that state, a buddy's dad was on a vent and the doctors told the family he wouldn't be coming home on a Monday. His lungs were shot and it was terminal. I thought he was gone then.

But, he actually died on Wednesday night or Thursday. I don't know if they didn't pull the mechanical support for some reason or what, but it's bothered me since then. Hate thinking of him fighting that battle everyone knew was lost for three days and nights.

Thanks for the update. Sorry people are having to go through this: patients, family and medical staff.

Marcus Aurelius said:

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More or less. As mentioned - more younger pts. Have a couple 30s, several 40s. But otherwise, disproportionate amount of black pts. Obesity, DM, HTN, cardiac renal disease very prevalent.

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My doctor has told my wife and I that to him, age isn't as much of a factor as obesity is. He is glad that we are fit and lean. He said that while age will be statistically a major factor, the ones not in their 80s and 90s that are younger and very overweight or obese are the ones that need to take their overall condition very seriously and lose weight and get in better shape.

Quote:

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We've had 30 deaths in last month. Not sure what is happening.

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I'm curious, and you don't have to answer if you don't want to,

Do you treat these patients with the specific combo of Hydroxychloroquine, Azithromycin and Zinc?

Marcus Aurelius said:

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No. They are arriving to hospital at day 7. No evidence it works then. The day 1 evidence is not convincing.

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Many doctors claim to have success with that specific treatment, even when administering when patients are to the point of being on a respirator. With that many of your patients dying, I was just curious if you had tried it.

Thanks.

ursusguy said:

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Pretty sure I remember him trying it months ago, and not working for them.

I could be completely wrong.

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This is why I asked. I'm very interested.

My wife's hospital now has a 16 year old on a vent. No idea if there's any pre-existing conditions. Crazy how in the last week, there's been this big influx of younger patients.

Marcus Aurelius said:

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No. They are arriving to hospital at day 7. No evidence it works then. The day 1 evidence is not convincing.

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So "kitchen sink" treatment does not include medicine that some studies show as beneficial?

https://www.henryford.com/news/2020/07/hydro-treatment-study

I don't understand. Enlighten me, I'm listening?

You seen the latest article on Remdesivir? Any plans on changing your treatments?

https://jamanetwork.com/journals/jama/fullarticle/2769871

We are sitting at about half of our peak now. Have been there for about a week and a half without a rise or decline in cases. People are lingering. We have one person who's been here since early June.

Several of these newer cases are readmits, people who were treated for Covid and released and now coming back for other things like chest pain. Many of these patients were already frequent fliers so not sure if these readmits are related to Covid at all. Negative PCR but positive IgG so still being put on the Covid floor and counted Covid census.

Marcus Aurelius said:

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Read my thread "Hydoxychloroquine." Most if not all studies and debate covered. I posted it in mid March.

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I'll look at it. Specifically, I've never seen a study on the specific combo of Hydroxychloroquine, Azithromycin and Zinc. Seen several studies that show one of these in studies, but not in combo.

I have seen many doctors say that specific combo has worked. Many. And several have administered that combo with success to patients on respirators.

Not really interested in studies just testing the effectiveness of HCQ by itself.

Marcus Aurelius said:

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Read my thread "Hydoxychloroquine." Most if not all studies and debate covered. I posted it in mid March.

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Ok, found the thread. https://texags.com/forums/84/topics/3101098/replies


I didn't see any studies in that 53 page thread that addresses studies specifically on Hydroxychloroquine, Azithromycin and Zinc.