Dr. Kusum Mathews is a pulmonary and critical care physician and researcher at Mt. Sinai in NYC. She staffed the first week of her hospital’s COVID ICU. The week started off with only a few COVID-19 positive patients and escalated to having patients spilling over into multiple ICU areas by the end of the week. Dr. Mathews discusses her experiences with vent management, the ethics of vent distribution, and coping mechanisms in the stressful and challenging working environment caring for critically ill patients with COVID-19.
Useful review, particularly since New York has almost half the positive coronavirus cases in the US today! However, many Geriatric Emergency Medicine COVID-19 relevant questions left unanswered in this Critical Care review with multiple EM-specific references to guide decision-making and problem-solving not cited. For example,
1) Inadequate number of ventilators – mechanical ventilation of >1 patient with one ventilator is possible as demonstrated in #FOAMed https://onlinelibrary.wiley.com/doi/abs/10.1197/j.aem.2006.05.009?sid=nlm%3Apubmed and video demonstration by Charlene Babcock https://www.youtube.com/watch?v=uClq978oohY&feature=youtu.be
2) What is the role of biomarkers to distinguish bacterial from viral lung infection (and/or severity of COVID-19)? See https://onlinelibrary.wiley.com/doi/abs/10.1111/acem.13889 + SGEM-HOP episode http://thesgem.com/2020/03/sgem287-difficult-to-breathe-it-could-be-pneumonia/?
3) What structure is available to ethically triage ventilators? See https://onlinelibrary.wiley.com/doi/abs/10.1197/j.aem.2005.07.037?sid=nlm%3Apubmed. Also, with so many specialties less busy than usual (Example: Anesthesiology with elective surgeries postponed) what is role of Anesthesiology to manage ventilators (or split ventilators) in overflowing EDs or traditionally non-ICU wards?
I will post a link to this podcast and the same questions/citations on Twitter and Facebook.
Thanks, Chris – These are great topics and each one could certainly be its own whole podcast. I’m open to covering them in more detail in the future. Our goal for this one was to give an overview of her experience as the first COVID ICU attending in her hospital, and also just introduce some of the major issues that we should be thinking about. Thank you for the references to dig deeper into each of these topics.
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