PaladinNites   Posted at 2020-03-20 17:40:58(244Wks ago) Report Permalink URL | ||
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| G'eve and welcome to the First Nighter's Theater Macabre. A departure from the norm here, as these are extraordinary times for all of us.  This is a tale of fiction-maybe.But it's happening day in, day out. All across our planet. And the best way I can introduce this story, comes from a line in Predator 2 "You can't see the eyes of the demon, until him come callin" Dramatis Personae; A patient A CCRN A rider astride a pale horse A tiny winged creature. Meet patient ItMightBeYou Present location - AnyHospitalICU The time - the last day The CCRN was exhausted. All Iso rooms & ICU beds full. Hospital staff down to 78%. Due to staff sick, or having to stay home and take care of kids - you see the day cares have been closed. Those Critical Care staff still able to work are doing 12 hours shifts...no days off. Iso wear, N95 respirators are being re-used. Why? Supplies are at near exhaustion levels, and emergent resupply orders have yet to be recieved. There were 2 mortuaries in town, but one is shut down, due to self quarantine. The ME's office staff has been decimated as well. So autopsy is far behind. The dead are being stacked in chillers.  The CCRN checks the history again on the patient. It began with a cough. An otherwise healthy 51 y.o. but kept on going out and about,because the patient stated "thought this was all BS and media hyped". The cough worsened, became productive with thick foul sputum. Fever began and by the time the family called EMS,it was a struggle to breathe. The patient didn't know of the high blood pressure as seldom when to a Doctor. The test for Corona was positive. Oxygen sats were down, Chest X-ray showed wide, diffuse pneumonia-both lung fields. That was Day 5 The Hospital is at Level 3 alert. Only visitor allowed are 2 for patients. And they must pass a screen of Thermal temp scan, breath sounds etc. But in Iso or ICU there is no access. Nurses meet with allowed family in the 'Quiet Room" as they can, when they can. Any viewing &/or speaking to the patient is done via Ipad.  Day 7; Further deterioration caused more invasive measures to be taken. Intubation & a ventilator.  IV's, catheter, frequent breathing treatments by aerosol medication to try and force open constricted and purulent mucous filled airways, low-flow suction to remove the fluid & mucous as it broke loose. Lab values showed continued deterioration, Liver and kidneys failing. The ECMO is hooked up, basically a last ditch attempt to get oxygenated blood to the patient. An EEG is initiated to see brain wave patterns.  Pretty much a last ditch attempt... Day 8; Patient has continued downward spiral. ECG shows frequent PVC's and a slowing of rhythm. Blood pressure continues to fall. The CCRN does an eval of her patient. The hands, arms, feet, and lower legs are cool to the touch. Some parts of the body are becoming darker or blue-colored. Breathing even with the vent shows little real chest movement and lung sounds are like hearing fine sand on a can. Suction is bringing up pus colored mucous, now blood tinged. Her Vocera pages that the attending is on his way up with the last lung scan. He arrives and pulls up the scan on the computer, motions her over. The scan shows involvement of all areas of the lungs.  Biopsy EM scan COVID19 has penetrated deep into the lung tissue  The attending points to the images "The immune system is now spiraling out of control and causing damage throughout the body. Septic shock has set in and we have multi organ systems failure.There is nothing we can do... I've ordered the ECMO d'c, We've only have 3 of these units, and I've got others who need it. Keep all telemetry recordings and package for sending to the research facilities.Maybe they will soon get a better handle on this." He shook his head. "Maybe someone needs to look into the use of Chloroquine, It had some efficacy in SARS." He signs the DNR order, "How are you holding up". She shrugs her shoulders "Best I can, you?" But he's already headed down the corridor. Later in the shift; T-3 minutes left The alarms blare on the monitor bank. Heart rate has dropped to less than 20 beats per minute. The CCRN is in the room. All signs are dropping. She activates her Vocera and has ICU desk call the family in. The patient - What is left of the vision is blurry, doesn't know a thin film of gel has been applied to keep the eyes hydrated. Tries to move, but can't. So tired, confused."I can hear the sound of my heart...it's like a slow drumming. Can't get my breath"... Outside in the corridor, through the wall comes a Rider on a pale horse. A Scythe in a scabbard. The apparition slow trots right through Med Techs, RN's and goes to the patients room, and takes up a position at the foot of the bed.  Through the ceiling comes a curious creature. Tiny, winged and near invisible. It hoovers over and looks at the Rider. Each nods to the other. They have their own tasks coming soon. Very soon.  The CCRN can only watch the monitors. There are no procedures left, no drugs that can be given. She glances at the clock wondering is the family on their way, how close. She activates the Ipad just in case they do make it. T-2 minutes; The patient tries to focus the eyes and startled looks at...a horseman?. The Rider leans forward and crosses it's arms on the saddle horn. Moving the eyes takes all the effort and energy the failing body has, but sees the CCRN, she is by the bedside...and floating above and just behind her is the damndest thing. It has, I think wings? It's so tiny. And Where is my fam.... The ECG records a burst of V-tach, lasts just a few seconds. A couple of more regular looking beats then...flatline. The CCRN listens for any kind of heart sound. There is none. There is no BP registering. The face has become flaccid, the eyes have glassy and the pupils have started to expand. They don't respond to her pen light at all. She calls the Code Black, and a couple of Techs enter. She glances at the clock and calls out the time... T-1 minute; The patient hears "Time of death 22;33 hours. ECG, BP flat. Pupils dilated and non-reactive to light. No heart or breath sounds" The patient screams, but doesn't realize the only part still functioning are the electrical synapses in the brain, as long as what oxygenated blood is still there. Tries without success to move eyes, but they are fixed now, just towards the foot of the bed. The patient sees the Horseman stand up in the stirrups, pull out and raise the scythe.... Her Vocera chimes, the family have been delayed. Only one on the way and they still have to clear thru pre-screen to be able to access the Quiet room. Her shoulders slump, she turns off the Ipad. And her and the techs start to remove all the electrodes and IV lines. There is an occasional shudder of the body, just a normal reaction. As she extubates her patient, she takes a final look at the EEG. Just a few Delta wave bursts now. Once the ET tube is removed, she jumps as a weak cry is heard. It happens, just makes you jump because your not really expecting it. The Patient; What is left of vision is dimming, like a gray veil being pulled down. "Please just a little more ti..." The Scythe slams down. A tear takes form and slowly begins to move toward the rim of the eye... The CCRN sees a huge burst of Delta wave and then it to went flat. Finished cleaning up the patient best she could. She rolled her head, dreading having to face the hollow, haunted eyes of the family member. A task she had done, so many times before. The curious creature hovering now alights on the nape of her neck. ...the tear is now slowly making it's way down the patient's cheek. The tiny creature gives a gentle quick tug on the CCRN's ear, she flicks her hand thinking her hair is caught in the surgical cap again, but then notices the tear. Takes a tissue and dabs it. Squeezes the patient's hand. "I'm so sorry we couldn't do more" The curious little creature looks towards the Horseman and again nods. The Horseman slowly moves out the door and pauses in the hallway. His head snaps to the left. Another is on the precipice. Rider and horse move down the corridor and stop before a door. "CODE BLUE 327, CODE BLUE 327" Doctors, Med Techs and Crash Team members rush right through the Rider. He waits til all are in the room, gives a slight kick and moves into the room. Taking up his Sentinel post at the foot of the bed. Her Vocera tells her the one family member has arrived, cleared through and is suiting up in basic isolation garb in order to be allowed to meet in the Quiet room with the CCRN. She again dips her chin to chest and rolls her head. Feels like the weight of the world on her. The tiny creature now spreads it's arms around the back of her neck and a warm sensation comes to the CCRN, it then folds it wings about her neck and gives a gentle squeeze...and whispers in sub audible tone words to the CCRN. Startled a bit at the warmth spreading thru her, she flexes and rolls her shoulders. "I've got this" and heads towards the Quiet room to await the family member. The tiny, winged creature floats away. This job done, you see all RN's have been called Angels. And there is good reason for it. It turns and floats down the corridor, enters a room. The Horseman and it lock eyes for a brief moment. Again nod toward each other. The cycle begins again. ------------------------------------------------------- What is known so far; From initial infection, it takes approximately five to 12 days for symptoms to appear. Symptoms become more severe once the infection starts making its way to the lower respiratory tract. To date 13.8% of severe cases and 6.1% critical cases are due to the virus trekking down the windpipe and entering the lower respiratory tract, where it seems to prefer growing. Age range; 50 and up. Elderly and people with underlying problems like high blood pressure, heart and lung problems or diabetes, Lupus are more likely to develop serious illness. Depressed systems from Auto Immune disorders,Cancer, COPD, High risk Asthma. Also the very young, as their immune systems are not fully developed. How does it attack? What we know to date; The lining of the respiratory tree becomes injured, causing inflammation. This in turn irritates the nerves in the lining of the airway. Just a speck of dust can stimulate a cough. But if this gets worse, it goes past just the lining of the airway and goes to the gas exchange units,which are at the end of the air passages. If they become infected they respond by pouring out inflammatory material into the air sacs that are at the bottom of our lungs. If the air sacs then become inflamed, this causes an “outpouring of inflammatory material [fluid and inflammatory cells] into the lungs and we end up with pneumonia. Lungs that become filled with inflammatory material are unable to get enough oxygen to the bloodstream, reducing the body’s ability to take on oxygen and get rid of carbon dioxide. Covid19 pneumonia tend to affect all of the lungs tissue, instead of just small parts. ----------------------------------------------------- WTH was that ECMO thingy in your story? ECMO - extra-corporeal membrane oxygenation. This is essentially an artificial lung that takes blood out of the body through thick tubes, oxygenates it and pumps it back in. -------------------------------------------------------- About not covering that cough or sneeze the proper way.... Slow motion cough sprew Best Paladin  | |
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Post liked by - firebelle     , SweetSkunk , zeke23, bigboy12 , Janor, GhostRider, KIngsmoke | ||
| JanorPosted at 2020-03-21 01:35:22(244Wks ago) Report Permalink URL | ||
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| Very enlightening and informative. Thank you PaladinNites. Everyone should read this especially the ones thinking it's all BS... grrrr. Very well written as well... as always... you're an angel. O:-D hugs, love always, Janor, :love:love:love Last edited by Janor on 2020-03-21 01:35:36 | |
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Post liked by - cRAYz , bigboy12 | ||
| bigboy12Posted at 2020-03-21 01:45:16(244Wks ago) Report Permalink URL | ||
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| Thanks PaladinNites though it is a scary writing it is very informative.If only millions more could read this, it would or could make a difference in how people look at covid19. Well done my friend . 👍 | |
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| Post liked by - cRAYz, zeke23, Janor | ||
| SweetSkunkPosted at 2020-03-26 03:22:49(243Wks ago) Report Permalink URL | ||
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| Weird thread 8o (in a good way), but interesting.. :) A visual explanation of why to wear 'mask & gloves' now i don't feel so weird wearing 'mask & gloves' last time I went shopping 8o8o Last edited by SweetSkunk on 2020-03-26 07:16:23 | |
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| Post liked by - cRAYz, Janor | ||
| SweetSkunkPosted at 2020-03-26 07:14:56(243Wks ago) Report Permalink URL | ||
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| After thinking about it, not sure we can even imagine the endless examples of "whet is happening out there" Not sure why I even said that .. so scratch that part out :|:facepalm | |
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| Post liked by - cRAYz, Janor | ||
| cRAYzPosted at 2020-04-15 02:52:12(240Wks ago) Report Permalink URL | ||
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| wow..great piece of work... | |
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| Post liked by - Janor | ||