Week one in the COVID ICU


ImageDr. 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.

In this podcast, we discuss several resources for physicians to learn more about current recommendations for the management of COVID-19. These resources are listed below. You can listen to the podcast by clicking the player here or on iTunes from GEMCAST. 

 

Resources:

SCCM Surviving Sepsis Guidelines for COVID-19

SCCM Training for the Non-Intensivist

SCCM COVID Response Resources 

Clinical Trials

SCCM Capacity Report

BMJ Clinician Resources

 

Please note: the recommendations, guidelines, and the evidence base are changing daily. In addition, our discussion represents our own opinions and experiences, and should not be considered medical advice, and may not reflect the opinions of our respective institutions. 

 

 

This entry was posted in Cardiology and Pulmonology, Infections, Systems and Administration. Bookmark the permalink.

3 Responses to Week one in the COVID ICU

  1. 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.

    Like

    • 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.

      Like

  2. Pingback: COVID19 chat #physiotalk 23rd March 8pm – physiotalk

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