- California lifts COVID-19 stay-at-home orderon January 25, 2021 at 2:37 pm
California lifted its stay-at-home order in the Bay Area and across the state based on improved ICU projections.
- President Biden reinstates COVID-19 travel...on January 25, 2021 at 2:33 pm
President Joe Biden on Monday reinstated travel restrictions to combat coronavirus infections, via a presidential proclamation. The restrictions, which were in place for most of 2020, apply to non-U.S ...
- ‘Queen Sugar’ Tackles Covid-19 Pandemic in...on January 25, 2021 at 2:26 pm
OWN has released the trailer for Season 5 of Ava DuVernay’s drama series Queen Sugar, which sees the Bordelon family and the community of St. Josephine come face-to-face with the Covid-19 pandemic.
- Coronavirus: Major improvements in cases,...on January 25, 2021 at 2:18 pm
Hospitalizations from COVID-19 have fallen substantially in nearly every region of California to the point where, this past weekend, there were fewer COVID-positive patients being treated in ...
- Cactus League, Arizona mayors want MLB to...on January 25, 2021 at 2:17 pm
The Cactus League and the mayors of the respective Arizona municipalities where teams have spring training facilities have asked MLB commissioner Rob Manfred to delay the start of spring training due ...
- Why cats and dogs may need their own COVID-19...on January 25, 2021 at 2:00 pm
Cats and dogs may eventually need their own COVID-19 vaccines to prevent the coronavirus from evolving further and "spilling" back to humans, according to one group of researchers.SARS-CoV-2, the ...
- Biden predicts anyone who wants a coronavirus...on January 25, 2021 at 1:52 pm
President Biden also cautioned that the vaccine rollout will be "a logistical challenge that exceeds anything we've ever tried in this country." ...
- Moderna Finds COVID-19 Vaccine Still Protects...on January 25, 2021 at 12:56 pm
In a new round of tests, the drug company wants to see if booster doses of its vaccine will ramp up defenses against emerging strains of the coronavirus.
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.