(COVID/ETC CONTENT HERE) China Locks Down 11 Million in Wuhan,

Originally Posted by ABNAK

In almost all cases when you go to alternative vent settings (like inverse I:E ratios and/or breath holds) you have to have the patient sedated and probably paralyzed too, as it's not a normal method of breathing. In fact it would be counterproductive and downright cruel to do it without having the person out like a light. As they (hopefully) begin to improve and you can switch back to more conventional vent modes you can start to wake them up.

Yes, absolutely. Patient management on the vent, that I know!

Originally Posted by mack7.62

The crazy is strong in New Orleans

https://www.breitbart.com/politics/2...n-of-firearms/

New Orleans Mayor Issues Coronavirus Order Allowing Ban on Sale, Transportation of Firearms and Booze

New Orleans Mayor LaToya Cantrell (D) signed a coronavirus emergency order last week allowing her to ban the sale and transportation of firearms.

She signed a follow-up proclamation on March 16, 2020, further emphasizing her emergency powers to “suspend or limit the sale, dispensing, or transportation, of alcoholic beverages.”

Didn't they learn their lesson the last time they tried some stupidity when it comes to firearms?

Originally Posted by mack7.62

And it starts.

https://www.sfchronicle.com/local-po...rce=whatfinger

San Francisco Bay Area orders ‘shelter in place,’ only essential businesses open in 6 counties

Six Bay Area counties announced “shelter in place” orders for all residents on Monday — the strictest measure of its kind yet in the continental United States — directing everyone to stay inside their homes and away from others as much as for the next three weeks in a desperate move to curb the rapid spread of coronavirus across the region.

The directive was set to begin at 12:01 a.m. Tuesday and involves San Francisco, Santa Clara, San Mateo, Marin, Contra Costa and Alameda counties — a combined population of more than 6.7 million. It is to stay in place until at least April 7. The three other Bay Area counties — Sonoma, Solano and Napa — did not issue similar mandates.

What exactly are they going to do for those that violate it? Put them in holding cells with with plenty of others? Isn't that kind of against what they are trying to do?

Originally Posted by ABNAK

In almost all cases when you go to alternative vent settings (like inverse I:E ratios and/or breath holds) you have to have the patient sedated and probably paralyzed too, as it's not a normal method of breathing. In fact it would be counterproductive and downright cruel to do it without having the person out like a light. As they (hopefully) begin to improve and you can switch back to more conventional vent modes you can start to wake them up.

Sedated and paralyzed is what was done to a guy in New Orleans. He appears to be improving according to reports. He is 45 years old.

https://www.nola.com/news/coronaviru...1eee858c8.html

Originally Posted by WillBrink

Attempting to connect some dots, if per the paper above "proteins could coordinately attack heme to dissociate the iron to form the porphyrin"

What, if any, relationship does that have to serum ferritin? Serum ferritin levels appear an indicator of cytokine storm and testing for it appears warranted as an indicated of cytokine storm (1), and serum ferritin are associated with sepsis. Would be interesting and useful to see what, if any effects, the drug has on Serum ferritin.


I'm currently attempting to put something together that connects all this for non sci/med types, and have been reading a bunch papers that may connect the dots.


(1) https://www.oregonlive.com/coronavir...al-report.html

Good question re: serum ferritin. It is an acute phase reactant (did my dissertation in part on s.f. and screening for cancer) and a marker of inflammation, but in regard to your question it could be a good marker of tx efficacy, but may not have a standard/benchmark for COVID-19. Additionally serum ferritin is not specific to COVID-19, so other disease and inflammatory factors would have an effect (for example, rheumatoid arthritis).

There are lots of other ways to detect for immune mediated and inflammations response as well (such as alpha1 acid glycoproteins, serum albumin, liver enzymes...). However, it may be easier to employ the cytokine release syndrome (CRS) grading scales from the American Society of Blood and Marrow Transplantation (ASBMT) that are used for CRS and CAR-T therapy: http://www.factwebsite.org/uploadedF...0IECs.2018.pdf

Does that make sense? I'm trying to multitask

Originally Posted by chuckman

The "common cold" is indeed a coronavirus, like a pug and a wolf are both canine species. They are not the same. Actually for the target population, it is 10x worse than the flu, not 1/10th as bad. A "common cold", even an "uncommon cold," does not lead to patients with a PaO2 of 40 requiring vent settings of FiO2 100%, PEEP 18, TV 300 x 28, peak pressure 30 cmH2O, PaO2/FiO2 ratio < 100, prone.

My SIL was quoting these on FB, she's a Nurse Atheist. What do these mean?

Originally Posted by mack7.62

‘Ethical Dimension’: Sweden Considers Who Will Live, Who Will Die in Rationing Coronavirus Healthcare

The Director-General of the Swedish National Board of Health has confirmed the country is looking into triage measures that could prioritise care for those most likely to survive serious coronavirus infection.

Director-General Olivia Wigzell spoke at a press conference saying that the authority was looking at triage measures that are often used in a crisis situation when resources are unable to cope with the volume of cases.

And just like that, Sweden wasn't mentioned any more by Bernie Sanders....

Originally Posted by mack7.62

The thing is we want to be South Korea not Italy, the question is how do we do this with a totally self centered population? I don't think there will be unquestioning acceptance, people are going to be pissed and skirt the guidelines and people will die because of this.

The problem is that the 'bad' behavior isn't linked with the dying.

Originally Posted by Vic79

Italy Italy Italy end of days, we got it. Italy’s death rate is so high because their population is so goddamn old. That’s what happens when you get old.

Seriously? Clearly uninformed... it's taking off in other Euro countries at the same rate, even without the aging population. Germany, Spain, etc.

Yes, clearly the old are more at risk. But if you think younger folks are risk free, then you are sadly misinformed. Let's just go ahead and clear the population of young folks with compromised immune systems, asthma, diabetics, those 40yo's taking preventative cardiac/hypertension meds, etc. Never mind the 50 and 60yo with risk factors. It's only 3-4% fatal for them.

Meanwhile the entire world is hell-bent on plunging into a depression over this bullshit.

So what's your answer? Do nothing? Poof! You are king for the day for the US. What do you enact or roll back (besides the ATF, what COVID related)?

I am asking myself: "what is the motive of countries to do things that for sure will have negative economic & political impact?". Clearly not in their best interest.

Especially the EU. Open borders between neighbor countries is the foundation of the EU. To close that is huge and will have huge impact.

What do they gain from this that would justify the financial & political impact? Is it a big practical joke? Regime change? What has the US done beside limit travel that hurts you? (Well, the market hurts, but you sound young and probably do not have significant investment in the market)

Make fun of France and even Spain. But the Swiss are per capita highly impacted. Norway is in lockdown apparently. Germany a new epicenter. These are not 3rd world countries. Are they all stupid/deluded? Blind followers of CNN?

I see what the US is doing, our military, our large corporations. What do they know that we do not to justify the response? It's really screwing up things. I see no upside. If you assume behavior is driven by self interest, greed, etc, what is the upside?

One positive note I do have the last three days I went to the gym. It’s been me and like one other person. It was awesome

Typhoid Vic in the making, great. Maybe go visit your parents or grandparents afterward? Make sure and hug them.

Originally Posted by chuckman

The "common cold" is indeed a coronavirus, like a pug and a wolf are both canine species. They are not the same. Actually for the target population, it is 10x worse than the flu, not 1/10th as bad. A "common cold", even an "uncommon cold," does not lead to patients with a PaO2 of 40 requiring vent settings of FiO2 100%, PEEP 18, TV 300 x 28, peak pressure 30 cmH2O, PaO2/FiO2 ratio < 100, prone.

Heh, I’ve proned patients with COPD and the only positive marker being coronavirus.

So what are the co-morbidities? Body habitus?


Sent from my iPhone using Tapatalk

I’m a physician working in an ICU in New Orleans right now.

There is no ban on alcohol or firearm sales.

Also, not sure why you’re all confused by ARDSnet protocol...

Originally Posted by Warg

Good question re: serum ferritin. It is an acute phase reactant (did my dissertation in part on s.f. and screening for cancer) and a marker of inflammation, but in regard to your question it could be a good marker of tx efficacy, but may not have a standard/benchmark for COVID-19. Additionally serum ferritin is not specific to COVID-19, so other disease and inflammatory factors would have an effect (for example, rheumatoid arthritis).

There are lots of other ways to detect for immune mediated and inflammations response as well (such as alpha1 acid glycoproteins, serum albumin, liver enzymes...). However, it may be easier to employ the cytokine release syndrome (CRS) grading scales from the American Society of Blood and Marrow Transplantation (ASBMT) that are used for CRS and CAR-T therapy: http://www.factwebsite.org/uploadedF...0IECs.2018.pdf

Does that make sense? I'm trying to multitask

Thanx for the paper. I was not thinking of it in terms of standard/benchmark for COVID-19 per se, but as a quick easy to administer test that indicates cytokine storm, and secondary to that, the need for controlling the excessive and highly damaging iron ions that appear a key aspect of the inflammatory response and cascade reactions from there, which causes the damage.