BREAKING: Must Read from Medical Whistleblower About the Surge
>https://theyflyblog.com/2020/03/19/breaking-must-read-from-medical-whistleblower-about-the-surge/
The surge starts suddenly. We went from low low volumes for a week and then one day the waiting room was full of respiratory patients. Don’t be lulled by the lull.
Get a Plan to have admitted patients tested and cohorted. There won’t be room for all the ISO’s. Testing should be more available soon and allow for this
Find safe treatment area for non-covids. Cafeteria, lobby etc.
Get a tent. Yesterday. Some are using it to screen non respiratory, others respiratory that can go home. Just get one and use it how you need to. You will need it.
Get an intubation team plan. Many places have anesthesia do all intubations. Be clear who is in the room and wearing what gear. There are hepa filters for the bag and vent. Order these now. Some folks have a plastic like tent for the intubation space to contain particles.
Discuss changing your schedule to benefit the staff. When you are at work, give each other breaks to get non covid air. Cut staff down to a minimum to avoid constant exposure. Spread out your shifts if you can.
Leave all your crap at home. Get a plastic bag to hold any necessities like your phone and id. You will start to feel like you are trailing virus everywhere and this will help keep home clean. Ditch your fleece or white coat.
Assume every patient has it. Weird presentations have included: diverticulitis, alcohol withdrawal, diarrhea. GI only is not unusual. Afebrile is not unusual. Finding many on belly CTs that show lung bases with viral pattern. X-ray liberally. I’m starting to think toe fractures might need a chest X-ray. If you saw them yesterday and they were fine and they come back, get another X-ray-we’ve seen one day Normal, next day bilateral pneumonia.
If anyone tells you not to wear a mask, ask them to speak to me. I have a colorful speech at the ready. In all seriousness-wear a mask. Always. Tell other staff to do the same.
Get goggles.
Use phone and telemed to communicate and evaluate. Once the patient is in the room, do as quick an eval as you can. Get their cell phone number and call them with results and updates. Instruct them to call the desk with questions. Let registration talk to family or use phone or telemed also. No visitors.
Be mindful of the nurses. Order everything at once. They spend more time in the rooms than we do. 13. Have clear cleaning protocols. CT scan can go down for over an hour for a clean. Limit CT’s when possible on covid patients.
Hire more housekeepers and transporters. People need jobs. We need people. Maybe the hospitals can get some of the stimulus money. Room turnover is slow in order to clean properly. All rooms eventually will be iso and need terminal clean. without extra help your waiting room will fill unimaginably. 15. Get other services to take patients off your hands. OB usually takes patients over a certain number of weeks. See if they will take all strictly ob/Gyn cases. Elective surgeries have been cancelled. What to do with all those PAs…. if you have Ortho pas or residents set up a place outside the Er for strict Ortho cases. There is usually an inpatient X-ray department. Let them see patients and send them there and treat them outside the Er. Anesthesia can do sedation in ASU for them if needed. The key is to get as many well patients out of your department as possible.
Get inhalers and spacers. Don’t use nebs.
These patients crash fast-if they have a high oxygen requirement put them in the ICU. If you are considering BIPAP, just intubate.
Protect yourself, your staff and your family. Don’t be a martyr. Demand a safe work environment. No coughing patients in the halls, etc. This is NOT the flu.
Forgive your non-medical family now for bitching that they can’t go to the mall. And the people you live with for not wanting to hear your misery day after day. They are scared too and the doom and gloom is overwhelming. That’s all for now. I will tell you that we are unnerved. Please be safe and well my fellow BAFERDS.