Could These New Tests Be a Coronavirus ‘Game...
on March 31, 2020 at 1:48 am
A new brand of five-minute COVID-19 tests could help doctors keep sick patients from catching the virus, protect frontline health-care workers, and take some pressure off labs. Public health officials ...
Empire State Building honors COVID-19 first...
on March 31, 2020 at 1:45 am
New York's Empire State Building was illuminated to represent an emergency vehicle's light in tribute to first responders and medical professionals on the front line of the fight against coronavirus.
Coronavirus: Goats take over empty streets of...
on March 31, 2020 at 1:26 am
Usually, the wild herd of about 122 Kashmiri goats venture from the Great Orme into Llandudno during bad weather. But town councillor Carol Marubbi believes the lack of people around because of ...
Coronavirus: Men admit Nottingham hospital bike...
on March 31, 2020 at 1:25 am
Two men have admitted stealing bikes belonging to hospital staff who had been caring for patients with coronavirus. Several bikes were stolen from a compound at the Queen's Medical Centre in ...
Coronavirus in Ohio: Judge temporarily blocks...
on March 31, 2020 at 1:13 am
Ohio's abortion clinics can continue to provide abortions amid a state health department order to ban all elective surgeries during the novel coronavirus outbreak, a federal judge ruled Monday.
Rugby Australia predicts $120 million revenue...
on March 31, 2020 at 12:47 am
NZ Warriors veteran Blake Green says his side is prepared to do whatever it takes in order to get the 2020 NRL season back up and running Wide World of Sports Elliott forced to Darwin amid coronavirus ...
Former CDC head on coronavirus testing: What went...
on March 31, 2020 at 12:22 am
Who should seek a test? Should we test everyone? How much will that even help? Let's clear a few things up. Check out this story on azcentral.com: / ...
Some UK Police Might Have Gone Too Far on...
on March 30, 2020 at 11:58 pm
I am sure there are individual examples where perhaps you look at it and think that is perhaps a bit further than they should have gone but in general terms I think the case is t ...
Continuous Renal Replacement Therapies (CRRT) are dialysis treatments that are provided as a continuous 24 hour per day therapy.
GiViTI COVID19 MEETING 10 March 2020 – ICU PATIENTS
- The average age of patients is about 70 years old.
- The most frequent co-morbidity is OBESITY.
- A clear majority of patients are males.
- On admission PaO2/FiO2 < 100.
- CXR on presentation usually bilateral interstitial pneumonitis (can be asymmetric if co-infections).
- Beware of swab results as they may be negative initially. Clinical impression is more reliable. Confirmation often comes only later via BAL, as pulmonary involvement is lower.
- Pro-calcitonin (PCT) = 0 (in the absence of co-infections).
- High CRP.
- High LDH.
- Elevated liver enzymes (from virus +/- medications).
- High CK especially in younger patients (who usually have high fever, chills etc.).
- Extreme elevation of, and difficult to control blood glucose levels, often causes ketoacidosis.
- Low albumin (collected in the lungs??).
- Lymphopenia (low CD4).
- BNP normal.
- Lopinavir/ritonavir (KALETRA) 200/50 mg po BID.
- Chloroquine 500 mg po BID or hydroxychloroquine 200 mg po BID.
- Prophylactic antibiotics (variable according to local practice: piperacillin/tazobactam, ceftriaxone, TMP/SMX, antifungals (the use of azithromycin has been abandoned).
- Acetylcysteine 300 mg po TID (secretions not abundant, but dense when present).
- Steroids? Only in cases with fibrosis (do not use prematurely).
- Tocilizumab? IL-6 receptor inhibitor. Rationale is vast inflammation BUT use must be evaluated in setting of lymphopenia. At the moment NO indication for routine use and NO precocious use.
- Profound sedation.
- Fluid balance net NEGATIVE: the lungs act like sponges due to inflammation.
- Protective ventilation (require high PEEP, even > 15 cm H20, monitor carefully for possible complications such as subcutaneous emphysema, PNX – tolerate pH up to 7.3 – in contrast to classical ARDS, patients usually have good compliance and can be ventilated without high driving pressure).
- PRONE POSITION (18-24 hour duration – fundamental principle of management = extremely effective – require up to 7 rotations – do not trust initial improvement and continue this therapy at least until clear signs of progress with therapy).
- Tracheostomy often within 7 days allows for earlier and safer weaning attempts (high risk of relapse).
- CRRT? Reserve for patients with greatest chance of favorable outcome for the following reasons: increases labor burden on nursing staff, greater difficulties with prone position, creates problem of disposal of infected bags/waste.
- Nitric Oxide: have not seen significant beneficial effects, but can be useful in gaining time for the most critical patients (extreme therapy).
- ECMO: rarely necessary, because patients are very responsive to adequate ventilation. Indicated in cases of patients not responsive to therapy and extreme hypoxia.
- CXR to define clinical presentation. May be repeated but imaging does not correlate strictly with clinical condition.
- CT Chest NOT indicated because great difficulty of transport, great risk of spreading contagion
- U/S Chest highly indicated for daily assessment of pulmonary condition (PATTERN 1: diffuse B lines, PEEP responder – PATTERN 2: anterior zone clear, posterior zone consolidation, responsive to prone position) – useful in evaluating complications from high PEEP and recruiting maneuvers.
- Echocardiography: look out for dyskinesia (myocarditis?).
- Decrease in inflammatory parameters (CRP, LDH).
- PEEP < 12 cm H2
- PaO2/FiO2 > 150.
- FiO2 ≤ 50%.
- Do not trust initial improvement, because patients may experience early relapse.
by Trader in LA on December 1, 2018 at 4:00 pm
Stainless-steel molds for shaping the Filipino treats called polvoron. The post Polvoron Molders appeared first on Trader in LA.
by Trader in LA on October 25, 2018 at 4:06 am
Strongest exfoliant solution in MaxiPeel's 1-2-3 skin renewal system. Available in 30mL and 60mL. The post Maxi-Peel #3 appeared first on Trader in LA.
by Trader in LA on October 24, 2018 at 11:48 pm
The mildest exfoliant solution in MaxiPeel's 1-2-3 skin renewal system. Currently only the smaller 30mL size is available. The post Maxi-Peel #1 appeared first on Trader in LA.
by Trader in LA on October 24, 2018 at 4:05 pm
Medium-strength exfoliant solution in MaxiPeel's 1-2-3 skin renewal system. tretinoin hydroquinone 0.025 | 2% Solution Available in 30mL and 60mL. The post Maxi-Peel #2 appeared first on Trader in LA.