When a COVID-19 vaccine is available, will people...
on July 9, 2020 at 3:25 am
Rapper Kanye West made false claims about vaccinations and expressed hesitancy in receiving one amid the coronavirus pandemic.
Why men get sicker: Male hormones may help...
on July 9, 2020 at 2:43 am
More men than women get COVID-19, say studies at UCSF and elsewhere, and they have a worse experience and die more often ...
For the first time, the US has reported more than...
on July 9, 2020 at 2:41 am
America's seven-day rolling average of new daily coronavirus cases has skyrocketed since mid-June. Rising deaths may follow.
Coronavirus pandemic: Updates from around the...
on July 9, 2020 at 1:50 am
China recorded nine new coronavirus cases on Wednesday, the country's National Health Commission (NHC) said. This was the ninth consecutive day in which mainland China only record a single-digit ...
Dutch Housing Market Continues to Boom Despite...
on July 9, 2020 at 1:06 am
The fallout from the coronavirus shows no sign of derailing a boom in the Dutch housing market. The average price of a home rose 8.8% in the second quarter from a year earlier to 335,000 euros ...
Coronavirus cases top 20,000; Orange County’s...
on July 9, 2020 at 12:50 am
After the first infection was reported in late January, it took till June 12 for Orange County to reach 10,000 cumulative cases. Less than a month later, the county reached 20,225.
N.J. will now require people wear masks outside...
on July 8, 2020 at 8:33 pm
People in New Jersey will now be required to wear masks outside in public when social distancing isn’t possible to help prevent the coronavirus from spreading, under an executive order Gov. Phil ...
Covid-19 vaccine trials: Here's how to volunteer
on July 8, 2020 at 5:30 pm
The website will handle registration for the four large vaccine studies that are expected to start this summer and fall, and any others that follow. The US Department of Health an ...
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 April 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.
by Trader in LA on November 24, 2019 at 5:05 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.
by Trader in LA on October 24, 2019 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.
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.