CoVid19 Part XII - 4,604 in ROI (137 deaths) 998 in NI (56 deaths)(04/04) **Read OP**

kilkenny31 wrote: »

I know. But the fact is the rate at which people are dying and the rate at which people are being admitted into ICU is low and not growing at a substantial rate. Obviously the hospitals are going to be busy but not overwhelmed giving the numbers that have been released to date. I'd imagine at the peak it may be 30-50 deaths per day which is awful but nowhere near as bad as it could have been.

Jeez, a week with that type of death rate would have us up where Belgium is at the moment. I was hoping that it wouldn't get to that

blackcard wrote: »

Jeez, a week with that type of death rate would have us up where Belgium is at the moment. I was hoping that it wouldn't get to that

I would hope so too. But we have to be realistic. It would be surprising if this thing didn't kill 500-1000 people like a bad flu season. We have already seen 10-15 people die in a day. Its not unreasonable to suspect that this could double over the next few weeks.

CitizenFloor wrote: »

Wish one of the journalists would ask about ventilators. Great, we created extra capacity with ICU beds. Does each ICU bed have a ventilator? The ventilators are the important piece of equipment. If we have 500 ICU beds but only 250 ICU beds have ventilators, I know which bed I'd choose.......my own bed at home, but you get the point.

I’m going to paste a previous post, it’s not the ventilators that are the issue here

Interesting read from a health sector worker in the UK.

I'll be honest, as I see it due to working in Intensive Care. The lack of ventilators, which the government is falling over itself to sort, is not the biggest issue at the moment, it'll be the lack of suitably trained people to operate the ventilators effectively, as part of overall care for a critically unwell patient.

You can give (and we are) non-Intensive Care nurses basic training on ventilators but, as experience is showing, many Covid-19 patients that are being ventilated on Intensive Care Units are effectively in multi organ failure, requiring wider treatment than 'just' ventilation.

Even those patients who aren't in multi organ failure require more complex treatment regimes due to the nature of the high pressures required for effective ventilation and to keep patients as sedated as we can in order that they are compliant with the ventilation settings.

(My apologies but some 'shop talk' will appear now, I'll link to articles explaining what I'm talking about where I can)

We are having to heavily sedate patients far deeper than the levels we usually aim for.

Usually we try to sedate patients to a RASS of 0 to -2, which means patients are very lightly sedated, often able to breath spontaneously under the sedation. This helps maintain strength in muscle groups required for breathing and means that hospital stays are shortened, less rehabilitation is required and patients outcomes are overall much better.

With Covid-19 though we are having to ventilate patients with much higher pressures than we normally would in order to counter the effects of the pneumonia that it causes. These higher pressures cause issues with patients not 'sycronising' with the events, in short because the body finds it uncomfortable and triesto resist (desyncronising). As a result we're generally having to sedate patients to a RASS of-4 to -5 (so-called "flattening them out") and are very often also having to use paralysing medications to ensure total compliance.

This level of sedation then introduces other issues, predominately sedation-related hypotension (low blood pressure), for which we then have to give other medications (inotropes) in order to vasoconstrict the vascular system and keep blood pressure high around the core organs to keep them perfused (well oxygenated via blood flow).

Using inotropes though has a knock-on issue of it's own, or rather two predominate ones; lower blood pressure in kidneys and poor blood flow at the extremities. The former causes a reduction in urine production, leading to poor excretion of harmful waste products within the blood stream, the latter can lead (in extreme case) to necrosis (cell death from oxygen starvation).

To add to this, we are unable to directly treat Covid-19 as there is currently no cure, so we're relying upon patients own immune system to deal with it. This causes other issues, among them; the immune response requiring large amounts of glucose to be released into the blood system to 'feed the body' and, as a consequence of so much glucose being used metabolically, an increase in the amount of Ketones within the blood.

The large amount of glucose needs to both be supplemented (through Nasogastric Feeding) and controlled (with Insulin) to try and restrict the levels of blood glucose. If left unchecked the body will just keep glucose (causing Hyperglycemia) and 'burning it' metabolically and in doing so releasing increasing amounts of Ketone (which is an acid, so causing Ketoacidosis). This rise in acidity, compounded by a drop in urine output, causes a drop in blood Ph, which is incredibly damaging to all parts of the body at a cellular level.

Whilst there is far more involved in looking afte a patient on Intensive Care I hope that this brief explanation shows that 'merely' putting someone on a ventilator has a knock-on to multiple organ groups, all that in turn have a knock-on to other ones.

Teaching someone to operate a ventilator is (comparatively) simple. Teaching someone how to titrate medications, adjust ventilator settings, when to give additional medications to address issues with observed patient 'vitals' etc is not. This is why, as I mentioned earlier in the thread, it can take 12-18 months of additional specialist training before a registered nurse can operate safely as an Intensive Care nurse.

We have to be able to keep the most dependant patients alive without the benefit of calling a doctor for advice all the time. Indeed, generally, the junior doctors will cede to the knowledge of nurses with regards to Intensive Care patients as we're often far more experienced in such s specialist ares than they are (due to the nature of their training/placement program).

- Ventilators are not the sole issue.

ITman88 wrote: »

Yeah the last point here is critical.

I hope I don’t sound callous but in nursing homes, when people of ailing health with a median age of 92 contract an infection, they are not going to go to hospital.
The main object of the staff is to make the patient as comfortable as possible.

When a patient has a covid - 19 positive test and dies, it is often not the cause of death.

Where did you get the median 92 for nursing homes, sounds way off.
You didn't - scanning inaccuracy on my part

Yes it is, it's the proximate cause of death, death is inevitable, one can have an underlying condition with potentially years of life to enjoy and die prematurely from COVID-19 aggravation.

COVID-19 IS the proximate cause of death.

igCorcaigh wrote: »

I've seen many wear scarves over their mouths when I went shopping a few days ago.

Is there any evidence for this measure? Or should we just do it anyway before the evidence comes in, one way or another?

https://twitter.com/BNODesk/status/1245822708337827840?s=19

Might be more likely to protect others from anything you are carrying rather than protecting you from something others are carrying but it's a nice common sense simple approach tot ake rather than wearing masks every where when there is shortages.

Logan Roy wrote: »

What? Belgium have 900 more deaths than us. It would take nearly 3 weeks of 50 deaths a day to get to where they are now.

Belgium has 87 deaths per million population, we have 20 deaths per million. If we had 50 deaths per day or 350 in a week, that would bring our rate to 92 deaths per million

MD1990 wrote: »

1,355 dead in france today.

very sad

884 of those is under reporting from previous weeks. Fatalities in nursing homes were not counted previously in the French total.

blackcard wrote: »

Far too early to be complacent. Also, I think that only 14 of those that died had been in ICU. Not sure why such a small number, I thought the most serious cases would have been in ICU. Maybe not moving elderly people from nursing homes? An element of triaigeing?

https://en.m.wikipedia.org/wiki/Frailty_index

How many Nursing Homes have ventilators?

Triaging/palliative care/ euth .. it’s a thin line

Solli wrote:

- Ventilators are not the sole issue.

Thanks for the explanation....

I guess my question if I was a journalist would be...."Are all our 500 ICU beds equiped with ventilators, and do we have appropriately trained staff to run them? If we do not, how many ventilators do we have, that staff are trained to use?"

macmahon wrote: »

Thankyou. But so far this isn't and it seems to be going on for a long time. I was up at the CUH today for an appointment and everything was quiet? Never seen the place so quiet!

It isn't (overrunning our health system currently) because of the measures we've put in place and the majority of people are adhering too.