IBCC COVID-19 Update #2

The Internet Book of Critical Care Podcast

Adam Thomas

Foam, Medicine, Health & Fitness, Science, Criticalcare, Medicaleducation

5 • 714 Ratings

🗓️ 30 March 2020

⏱️ 23 minutes

🔗️ Recording | iTunes | RSS

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Summary

In this episode, we right some wrongs. As we said in the beginning, given the fast pace we were bound to be wrong, and will be again.

1) New paradigm for COVID-19 patients

2) Procalcitonin: not as good as we thought

3) Malignant atelectasis and the crashing hypoxemia

4)SARS-COV-2 & DIC

5) Awake Proning / CPAP / Vent Splitting / Extubation

6) Ethical dilemmas

Transcript

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0:00.0	All right, so welcome back to the Internet Book of Critical Care Podcast.
0:08.4	I'm here with Adam Thomas and we're going to come at you with the third episode of our COVID
0:12.2	update.
0:13.2	And I'm supposed to, from a Canadian perspective, make fun of you, Josh, because it's COVID
0:17.2	up here, not COVID, but I'm with you.
0:19.5	I'm with you.
0:20.5	Yeah. I go back and forth. I can't quite
0:22.1	figure it out. We need to do a poll or something. Okay. Deal. Everyone listening, give us little
0:26.3	feedback. Am I right or is Josh right? So guys, today we've got a big update for you. And Josh has
0:33.5	feverishly been working on try to update this in the post. Stepping back, we just want to say, we hope you're well.
0:38.8	We understand there's a lot of people listening in some pretty hard hit areas,
0:42.2	and we're here with you in both spirit and in person.
0:45.5	Today, we'll cover current model of COVID, so the three dimensions of badness,
0:50.0	in particular with this disease.
0:51.4	We'll talk about the fall of procalcitonin. One of the best posts
0:54.3	I've seen Josh ever do is malignant adelectasis dive bombing. We'll talk about ventilation and
0:59.0	extubation and then some more specifics about complications. Josh, let's get straight into it.
1:04.3	Start me off with a bigger mental model of what's going on with these COVID patients.
1:08.8	When we first did our initial cast on COVID, we basically said, you just need to provide
1:13.4	these patients with supportive care, intubate them, protect their lungs, and they'll ride it
1:17.4	out. They'll get better. And unfortunately, like all things, COVID, I think that's probably
1:21.5	wrong, potentially at this point. What I have seen is there are some patients where intubate them,
	...

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