- Covid-19: 'Too early to say' what Christmas rules...on October 28, 2020 at 3:54 am
Environment Secretary George Eustice warned "it's too early to say what restrictions will be in place". "I'm sure we will have a good Christmas," he told the BBC but added that while families will be ...
- UK coronavirus live: calls grow for UK-wide...on October 28, 2020 at 3:42 am
- After their mom died from COVID-19, her kids give...on October 28, 2020 at 3:25 am
Kathleen Berger died in May from coronavirus-related causes, leaving behind eight kids and a legacy encapsulated by a bright pink soda can. Berger, who was 73, was a voracious consumer of Tab, the ...
- Coronavirus live news: Germany sees record...on October 28, 2020 at 3:21 am
Germany reports 14,964 new infections; Russia has 346 daily deaths; Ukraine death toll also hits new high; ...
- White House science office lists 'ending the...on October 28, 2020 at 3:18 am
The U.S. reported 489,769 COVID-19 cases in just the last week, according to a USA TODAY analysis of Johns Hopkins University data.
- 'I witnessed first-hand the manipulation of...on October 28, 2020 at 3:04 am
Oliva Troye’s account is one of several in a new, three-part Washington Post documentary about the government’s pandemic response — both under President Trump and his predecessors.
- Meet the youngest participants in Covid-19...on October 28, 2020 at 3:03 am
I think that it could really benefit the world, and I think it could also help scientists know more about the coronavirus,” said a 12-year-old who recently received his first injection.
- Covid-19 Live Updates: Sharp Increase in Patients...on October 28, 2020 at 3:00 am
The number of people hospitalized with the virus has climbed significantly from a month ago, straining areas that were spared earlier in the pandemic.
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.
- Maxi-Peel #3by Trader in LA on August 25, 2020 at 4:06 am
Strongest exfoliant solution in MaxiPeel's 1-2-3 skin renewal system. Available in 30mL and 60mL. Price is subject to change. The post Maxi-Peel #3 appeared first on Trader in LA.
- Maxi-Peel #2by Trader in LA on July 24, 2020 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. Price is subject to change. The post Maxi-Peel #2 appeared first on Trader in LA.
- Maxi-Peel #1by Trader in LA on June 24, 2020 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. Price is subject to change. The post Maxi-Peel #1 appeared first on Trader in LA.
- Polvoron Moldersby Trader in LA on May 1, 2020 at 3:00 pm
Stainless-steel molds for shaping the Filipino treats called polvoron. The post Polvoron Molders appeared first on Trader in LA.