COVID-19: WHAT I SEE AND WHAT I AM BEING TOLD BY ADMINISTRATION.

[Mike_RN]

Most of you know me at least a little and I am not a "story teller" or "self-aggrandizer". I am going to attempt to blog here as long as I can. I will need to keep HIPPA in mins and can't talk about specifics of patients but I will tell you what I see each day at work and what I am being told thru Infectious Disease Dr's and CDC updates as they roll in. Our policies and procedures are changing DAILY and the shit is very close to the fan in South Jersey. North Jersey is a Warzone now, my brother in law is an ENT Surgeon in Princeton and the line is moving south from NYC at a steady clip.

I work for a University Hospital System (research and teaching) with 8 full size Campuses. I'm an Emergency (ED) RN by trade but out of the loop 2yrs in Post Anesthesia Recovery Unit (PACU). The governor banned all Non Emergent surgeries in NJ so PACU RNs have been "volunteered" to the ICUs or EDs. Because I have 12yrs ED exp, I'm back in the trenches 2wks now with no end in sight. I have an 8yr old daughter and a wife with MS on Immuno-suppressive meds. She is also an RN in the Operating Room (OR) who fortunately got retained on the skeleton crew for the Emergency Surgeries.

This thread will be locked for comment, only to keep it from degenerating into chaos. I will have a separate thread to ask, add, refute or comment anything. I know I have medical colleagues here as well and I hope they can comment on their world there as well.

 

[Mike_RN]

PSA from the frontline...

It does you no good no know whether you are positive or not unless you are hospitalized and getting treatment. If you get tested today and are negative, what will that do for you?

We are only testing symptomatic people with severe respiratory symptoms so that we can isolate them from general hospital census and our nurses and doctors. If a civilian tests negative today and goes out like he/shes somehow "safe" their status as positive could change in a minute after the results are read. You could walk into your doctor's office, ER, testing center Negative and walk out Positive if the guy next to you had it.

Just stay the fuck home and get help if you get sick, not runny nose cough bullshit. I mean fever, shortness of breath and body aches sick. Otherwise DO NOT GO ANYWHERE NEAR ANY MEDICAL CENTERS!!!!! IT IS AN INVITATION TO CONTRACTING THE VIRUS.

In 12hrs yesterday, I treated 6 morons who came into the ER for twisted ankles, vaginal bleeding and other various NON EMERGENT bullshit. We also had 17pts on isolation awaiting test results and 3 Positives on ventilators. These Actual sick people came in the same doors and were less than 50' from the fools who are trying to get tested for peace of mind.

On a positive note the positives we had were all nursing home "gomers" with the exception of 1 x 35yr old who was asthmatic and MORBIDLY OBESE (BMI 56)

 

[Mike_RN]

This is the protocol for hydroxychloroquine

Potential hydroxychloroquine side effects: dizziness, headache, loss of appetite, nausea, vomiting, QTc-prolongation, retinopathy with prolonged use, liver function test abnormalities .

Dosing Hydroxychloroquine 400 mg PO BID (by mouth twice a day) x 2 doses followed by 200 mg PO BID x 8 doses (4 more days).

**I AM NOT A DR. This is not medical advice this is INFORMATION***

 

[Mike_RN]

On the subject of postmortem The refrigerator trucks are because the bodies cannot be released to the funeral homes until the (posthumous Covid 19) results come back.

We only have about 8 lockers in our morgue and funeral directors normally pick up within the first 48hrs. Now they can’t embalm safely or do cremations on time.

If you burn a Covid positive body the virus can be aerosolized (main danger of coughing as well).

For this reason OR staff are all wearing Surgical masks over N95 masks because we use cauterizing devices which burn and aerosolize blood and tissue.

 

[Mike_RN]

Just getting off back to back 12hr shifts. Will update today after workout.

 

[Mike_RN]

Too drunk to say anything meaningful but the Obese 35yr old i mentioned above actually came off the ventilator and is recovering on a regular medical floor now. He’s doing really well after the Hydroxychloroquine regimen.

 

[Mike_RN]

So the big wave has yet to hit, although we have been expecting it since Friday. There seems to be an invisible line at Central Jersey (Trenton Area). We had two days where we only intubated a total of 6 people. Two of the ED nurses who were quarantined after testing positive have returned to work. My friend Allie was exposed during intubation and the other guy was exposed by a false negative walk-in patient who returned via ambulance 2 days later.

**It will be interesting to see if re-infection is possible or if we really can build immunity thru exposure. Also of note there is now data that our "false negative" rates are around 40%!!! It's basically a still a coin toss if we tell you that you don't have it. That's fucking unacceptable for American Industrial standards!!!

We are doing a pretty good job of containment on the unit but one glaring problem is our breakrooms & locker rooms. The ED is split in 3 parts with isolation between them being the fire doors and a prayer(lol).

1) We have staff on the "hot" side who are in direct contact with known and suspected COVID-19 patients.

2) We have staff on the warm side which is non-respiratory complaints from institutions where transmission rates have been high. Nursing homes, detention centers, group homes and of course any of us who get sick.

3) Then we have the "cold" side for all non-respiratory complaints coming from a private residence (Stroke. Chest Pain, Trauma).

The problem is when breaks are taken all three sets of staff are in the breakrooms together with the scrubs they are working in. You have to unmask to eat so its Russian Roulette to congregate with the very people you rely on to survive. I have been eating cold food on the curb outside to decrease the chance of infection by my coworkers. We sit 3-5ft apart and the line of us outside is getting longer everyday.

I can't say enough about the local Wawas, Pizza places and local McDonalds. McDs brings about 100 breakfast sandwiches every day at 8am. Random candy snacks and coffee arrive once or twice a day. If any of you have the means to help your local ERs it's amazing how much a box of Joe (From Dunkin or Tim Hortons) can keep Drs and RNs going at work. Show them some love

PPE is still being rationed and we are getting 1 Surgical mask per day, 1 N95 per week (3 x 12hrs for most staff) and 1 cleanable face shield which can't be replaced unless destroyed. The administration is still crying about staff wearing their own PPE but is no longer threatening discipline for those who do so. The same assholes who wouldn't let us use masks 3wks ago for fear "it would scare the patients"; have made masks a blanket policy for everyone in the building. They have erected changing tents in the Parking Garage for staff to get out of dirty scrubs before getting in their cars. I'm very lucky to be Surgical Services (on loan to Emergency) so I get my scrubs from a commercial laundry and don't have to wash them at home like all other hospital staff.

Sorry for the book but I have been busy or drunk for the last few days and so much has happened since St Patty's day it feels like a deployment.

 

[Mike_RN]

I have a request from all our builders, carpenters, painters and/or handymen. I have secured 8 x 3M 6000 series half-face respirators from a buddy who does Mold Abatement. He couldn't provide additional filters and they cannot be purchased right now due to Government control measures.

I need your help if you can spare anything. I give you my word as a man, a father and a nurse that I am not selling or profiting from them or the masks. I am keeping 1 for myself and giving them to my coworkers who are in direct contact with patients in the Emergency Dept. PM me if you have the means to help. I just need filters, I want you to keep your masks for your own use if it gets that bad. Even if you just a pair to spare it might help save a life

We need 3M: 2091s or 6001s rated at N95, P95, N100 or P100 "bayonete style" filters.

Even USED ones that have only been exposed to paint and dust (not COVID-19 or organic pollutants)

 

[Mike_RN]

Serious "Props" to @NavyChief for being a friend and patriot. I want everyone to know he donated Mask/Filters out of pocket and shipped on him. I can't thank you enough brother. The more we slow this shit down in the Urban centers of America, the better chance we have of a cure or vaccine before more lives are lost.

I want to write so much down but after 12hrs in PPE (eerily reminds me of being in MOPP4 in Iraq) all I can do is shower, drink whiskey and fall asleep. I am troubled by being back in the ED, my anxiety levels are climbing. I'm back on Blood Pressure meds which I've not needed since going to PACU.

I made the decision to send my daughter to her grand mom's Monday. This will be permanent until the virus has finished it's course in NJ. I told her it was to protect Nannie who is in her 70s and has Parkisons. We are seeing a big problem with Parkinson's and COVID-19 as the medicine timing for Parkinson's patients MUST be individualized for each patient. All COVID-19 patients are on "Cluster Care" meaning we only go into the rooms when ABSOLUTELY necessary and meds are not given multiple times per day. This is causing rapid decompensation and I can't have my mother-in-law in a hospital right now. I can't chance giving it to my daughter since my wife and I are both working and nannie is our only childcare.

So instead I moved my 8yr old daughter (our only child) out of my house. Fuck my life.

My old PACU has been converted into another ICU since the OR is only doing life threatening Emergencies. Today there was only 1. My wife is afraid that the OR staff will be reassigned in to the PACU/ICU as helpers. OR nursing is unlike any other RN role so OR-RNs are difficult to redeploy to other areas of the hospital. Some of them are standing at entry doors handing out Masks as staff arrive. Many are cleaning equipment and ventilators when patients expire. Some are even working in the kitchens. My wife is still in the OR as of this morning but she's gonna be shut down soon we fear. Her MS medications are directly suppressive to the immune system and I simply will not allow her to get any closer to the fire than she already is. Our employer has allowed staff with cancer to furlough but they will not let Nurses with MS or RA layoff yet. So much for caring for the sick huh? I think she will have to resign within a week or two if the governor won't allow Tier 2 (less emergent but crucial) surgeries to resume.

One last rant: I wish my colleagues in areas less impacted would stop posting those stupid "dancing" videos and PPE selfies. It just looks fucking unprofessional and helps create animosity between the Drs & RNs who are ACTUALLY fighting on the frontlines and the posers who are really safe in the rear and bored.

 

[Mike_RN]

Interesting development. We are seeing a correlation between severity of symptoms and ferritin levels (Iron in the bloodwork). The virus seems to cause respiratory issues and we focus on oxygenation. Instead evidence gained here shows it might be attacking our hemoglobin and our cells ability to carry oxygen. All this time we're intubating and ventilating patients may actually be causing lung damage while not increasing blood oxygen levels enough.

Italy's higher death rates might be due to their genetic predisposition to Thalassemia (abnormal hemoglobin). We are beginning to BiPap patients and/or use High Flow O2 instead of just "tubing" everyone when they crash. BiPap is non-invasive and similar to the C-pap us big neck boys are using already (lol). It simply prolongs the inhale and exhale cycles to move more CO2 out of a patient (which directly controls O2 levels).

Virus could be more about blood than lung tissue and might be treated better with Iron Infusions and Packed Red Blood Transfusions. Luckily the average Steroid user already has high hemoglobin. Maybe a good time to run some EQ again ?!?

 

[Mike_RN]

So NJ is in deep shit. I haven't been posting simply because I have nothing left in the tank after a shift. The symptoms are now everything from "stroke like" to diarrhea, to fainting spells and runaway blood sugars. Essentially everything that walks thru the doors besides obvious trauma is being treated as positive.

Much like NYC we are now rationing everything especially gowns. Their are state laws in place for VRE and MRSA patients that we MUST be gowned to care for them. Suddenly Monday we are being told the new policy is that we are NOT to use gowns for MRSA/VRE anymore. The masks we are given (donated by FEMA) are like tissue paper and the ear loops break the first time you talk in one. We are now officially "allowed" to wear PPE from home and nobody from administration is even setting foot in the Emergency Dept or ICUs anymore. Most of us in the ED have been in our own PPE for weeks now but at least we can't be disciplined for it anymore. Again I gotta thank @NavyChief for his donation. I was able to give 4 coworkers a half face respirator and filters thanks to him and my buddy here at home.

I had trouble believing @2ez when he first talked about how bad NY was, I feel bad for doubting because it's here on my doorstep. I salute you bro.

We are pronouncing death after 2 rounds of EPI and CPR. That is less than 10mins of attempt. Check a rhythm give EPI (1min or less),2mins of CPR, rhythm check (10secs),2mins CPR, rhythm check...time of death pronouncement. We are essentially NOT working codes. If you are from a nursing home and come in as an "arrest", you are dead (this is against everything medicine stands for). Everyone I work with is either overwhelmed or numb.

Yes there are still empty beds in our ICUs simply because we are not wasting resources on the dying anymore.

Yes our testing centers are not being utilized. That's because we are seeing FALSE Negatives in the 40% range.

The current RAPID diagnostic tools are basically useless. If you are negative with high suspicion we are sending the 24-48hr tests and they are coming back positive. The federal gov't is lying about availability. We get 20 RAPID swabs a day in our ED...a slow day is 60-80 patients.

If you've ever been at a kill shelter and felt/heard the the dogs who are not going to be adopted...that is what it feels like at work.
I'm a pretty stable person despite seeing many bad things, on the streets, at war and in the ER. I have a brilliant wife who centers me and we are together in all of this. Despite this, I am using THC and drinking nightly for the past 2wks. I can only facetime my kid but at least I am healthy and my wife is doing fine. The single people, especially the new nurses and residents are falling apart. I can't imagine the families with only one Healthcare provider in them. If your husband or wife was doing this everyday how could they even explain what they are seeing?

Outside the police and fireman are parading by our hospitals "saluting the heroes" The fucking Blue Angels did a flyby Monday (what a waste of taxpayer dollars). McDonalds still sends breakfast everyday and my neighbors complain about boredom. Inside we are hurting bad not because "we're all gonna die" but simply because everyone outside of NY/NJ is living a different reality. My fellow vets will intimately understand what I mean. Everything you experienced/are experiencing is nothing but a news story (or worse an exaggeration) to everyone outside of it.