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NEW: SO. NHS is NOT just short of protective gear and ventilators, per fascinating leaked memo by senior doctor; also #COVID19
#Coronavirus is NOT a "one organ" (lung only) disease - my latest via @FT 1/thread https://www.ft.com/content/e26524a5-c868-451c-a7d7-a91627a1722c">https://www.ft.com/content/e...
#Coronavirus is NOT a "one organ" (lung only) disease - my latest via @FT 1/thread https://www.ft.com/content/e26524a5-c868-451c-a7d7-a91627a1722c">https://www.ft.com/content/e...
First, the who/what etc
This is a 1,000-word memo from Prof Daniel Martin Intensive Care Lead for High Consequence Infectious Diseases at
Royal Free Hospital after a conference call with 80 other docs.
It is gripping for several reasons /2
This is a 1,000-word memo from Prof Daniel Martin Intensive Care Lead for High Consequence Infectious Diseases at
Royal Free Hospital after a conference call with 80 other docs.
It is gripping for several reasons /2
It essentially reveals two things:
1) the shortages and pressures on the NHS, on staff and kit
2) how care is evolving and still under discussion by docs. It is not as simple as just & #39;deal with pneumonia& #39;.
Take each in turn /3
1) the shortages and pressures on the NHS, on staff and kit
2) how care is evolving and still under discussion by docs. It is not as simple as just & #39;deal with pneumonia& #39;.
Take each in turn /3
First the shortages/staff
- nurse-patient rations (ordinarily one-to-one) are now 1-in-6 says Dr Martin
- and training is now & #39;on the job& #39; has has & #39;fallen by the wayside& #39; coz too much pressure /4
- nurse-patient rations (ordinarily one-to-one) are now 1-in-6 says Dr Martin
- and training is now & #39;on the job& #39; has has & #39;fallen by the wayside& #39; coz too much pressure /4
Also turns out that #Covid_19 is causing a lot of acute kidney disease (AKI), partly as a result of "over-zealous" use of diuretics (Frusemide) which, I understand from doc contacts, is part of a wider discussion on how much to hydrate Covid patients. Still an inexact science/5
This in turn is putting pressure on equipment, notably CVVHF machines, which I am told are a kind of dialysis/blood filtration machine used in intensive care. Also & #39;pumps& #39; for treatments. This is causing doctors to shift treatment. /6
Dr Martin games out what happens if they "run out of machines" - saying he& #39;ll revert to "PD" or "peritoneal dialysis" (described to me as & #39;stick a load of fluid in your abdomen and then drain it out& #39;) which he says is "not great" - OR "sharing machines". /7
It really is all hands on decks - everyone is getting dragged in from & #39;med students& #39; to dental hygienists; also clear that some "non-medical" workers are reluctant to go onto ICU. Dr Martin says is "unacceptable". His job to say that. I pass NO judgement. Not me on frontline. /8
On that note, more widely, none of this is about passing judgment. This is a wartime situation. Peacetime rules cannot apply. This is about docs fighting v hard to wrestle down a new enemy with less than perfect kit. Welcome to fight club. For real. /9
Which brings us to part 2 of this memo - the fact that #COVID19 is a moving target. It is NOT just a & #39;one organ& #39; disease (fixing lungs/pneumonia)...it still sounds like a moveable feast out there. And recall this is a memo of 80 top docs sharing & #39;combat& #39; experiences /10
So it turns out that ventilating patients too early, too aggressively as they head in ICU could be a mistake.
Also that taking patients off intubation too quickly may be a mistake.
We assume docs have all the answers; but they are learning as they go too. /11
Also that taking patients off intubation too quickly may be a mistake.
We assume docs have all the answers; but they are learning as they go too. /11
There is also an intense debate about how hydrated patients should be under the heading "fluid balance" - which I understand from a doc is a big topic of conversation. Dr Martin reports that everyone reckoned we are "getting this wrong" /12
All this is to note that - to quote Dr Martin in his sign-off - the docs know they need to "adapt *fast*" to learn about #Covid_19 #Coronavirus - and they are hard at it, trying to solve the puzzle.
And I love final words: "be kind to one another". All that. ENDS
And I love final words: "be kind to one another". All that. ENDS
