More of our #COVID19 experience here in #NYC:

Most if not all ICUs are full & the ED is quickly becoming an ICU. There's been a push away from early intubation for those that may not need it

1/9 #COVIDfoam #FOAMed @cameronks @srrezaie @ThinkingCC @emcrit @19criticalcare
As a result, theres a very large number of “Happy Hypoxic” patients who have been tolerating HFNC for hours & sometimes for days. SpO2 continues to remain unreliable (as do certain "traditional" exam findings of respiratory distress). PaO2s continue to correlate

2/9 #COVIDfoam
The oxygen requirement these patients need is very high. Hospitals w/lower volumes of #COVID19 patients should start from now in securing the appropriate resources and have contingency plans to accommodate for this

3/9 #COVIDfoam
Although logistically challenging due to limited space/resources, we’re quickly learning that admitted #COVID patients should NOT go unmonitored or behind closed doors as they require frequent re-evaluation & can very rapidly deteriorate.

4/9 #COVIDfoam
Those requiring more respiratory assistance based on their overall clinical picture (ie mental status, WOB & rising pCO2), end up on mechanical ventilation, however the decision to intubate is extremely difficult & should not be made by a single healthcare provider alone.

More patients are coming in and These portable LTV ventilators have become more common. Many healthcare providers appear to not be as familiar with them and as a result mislabel them as inferior or inefficient.

6/9 #COVIDfoam #FOAMed
Below is the first of two, step-by-step guide for healthcare providers on setting up two commonly used modes on these LTV Ventilators, please provide feedback.

7/9 #COVIDfoam #FOAMed
Here is the second step-by-step guide for healthcare providers, describing how to set up CPAP on these LTV ventilators, again feedback is appreciated.

8/9 #COVIDfoam #FOAMed
As we continue to learn more about #COVID19 we must be prepared to utilize & ration the resources we have in regard to everything from PPE to ventilators. Also wanted to thank all the amazing nurses/support staff who have helped keep the hospital running!

9/9 #COVIDFoam #FOAMed
You can follow @MRamzyDO.
Tip: mention @twtextapp on a Twitter thread with the keyword “unroll” to get a link to it.

Latest Threads Unrolled: