From the New Orleans War Zone: Clinical Pearls on #Covid19 for ER Practitioners and Others #Coronavirus

Not in New Orleans

I read an anonymous post a few day ago at TexAgs.com, which I assume is a forum for graduates of Texas A&M University. You will find it interesting and useful if you are a physician, respiratory therapist, or nurse that will be treating COVID-19.

The writer says he (she?) works at a small community hospital in New Orleans that has 22 ICU beds. I’m guessing total bed total is 300-350. The entire article seems legitmate, but you never know. The only slightly fishy item was a mention of checking interleukin-6 (IL-6) levels, which I never see ordered in my hospital. I always figured it was just a research tool. He implies it’s a marker of imminent clinical deterioration.

I am an ER [emergency room] MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know [On March 25, 2020].

Clinical course is predictable.

2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.

Day 10- Cytokine storm leading to acute ARDS and multiorgan failure. You can literally watch it happen in a matter of hours. 81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.

The writer has not seen any great improvement with hydroxychloroquine.

He posits that worldwide 85% of COVID-19 patients that go on a ventilator die. I’ve never seen that figure before, and question it. I think we just don’t know yet. Wouldn’t surprise me if true.

The actual ventilator is out of the picture. This is the tubing. 

I’m sure the author would advise all practitioners to stay alert for new and optimal treatment modalities. We’re still learning the best way to treat this thing.

Source: Clinical Pearls Covid 19 for ER practitioners | TexAgs

Steve Parker, M.D.

Steve Parker MD, Advanced Mediterranean Diet

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