I started my shift with 2 patients, both vented and sedated and I ended my shift with 3 patients!! Which means for the first time since I started, all my patients survived the night! That being said I am not very optimistic that both patients will still be there when I return tonight to work. Both patients remained stable through the shift not needing high titrations of pressors or sedation until about 0600. One of my patients b/p crashed and her MAP was 40 (the goal number is >65) I was able to give her a low dose of Norepi which increased her MAP to around 68 and when I left her BP was holding with the Norepi drip at 6mcg
The third patient I got was my first NON-COVID patient since I have been here. It makes it tricky because it has mainly been just a Covid floor, so when I go in to his room I need to make sure to put on a plastic gown over my surgical gown and that I am not cross contaminating anything. He came with an altered Level of consciousness, hyperglycemia (hyperosmolar-non-ketotic hyperglycemia) and acute kidney failure. He was pretty sick. I had him on plasma-lyte, D5 drip for hypernatremia, and an insulin drip. His lab values were all over the place. If we can just treat these issues and he doesn't pick up Covid, he should make it out just fine. If he gets infected however I couldn't imagine him with a good outcome.
Some Covid treatment take aways... The first thing I will say is that any treatment that is going to work will have to happen early. When most of these patients make it to the ICU the disease has already done its damage to the heart and lungs and there is very little we can do to save them. Like my doc told me the other day, when they get to this point they either live or die and we have no idea why or how. I have given the antibody plasma twice and both patients died. I am sure this will be a great treatment option, but again it needs to happen sooner than later. They stopped giving hydroxychloroquine for the most part on any floor at my hospital. This drug causes prolonged QT and so does azithromycin which were being used together. This means the likelihood of an fatal arrhythmia is drastically increased. And there is a very strong cardiac component with Covid already. Proning (laying face down) is a pretty effective treatment on patients with ARDS. They do this with patients that are intubated and that are not. Another crazy component to Covid is a coagulation problem. There have been 3 young adults die on my floor since I have been here with strokes and pulmonary embolisms. I have even seen TPA given systemically. Almost every patient is on either a heparin drip or a lovenox shot.
I want to thank everybody for the support and kind words about my Blog. It has been really therapeutic to write down my thoughts and experiences and it gives me motivation to write when people are actually reading it.