I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I

Doc should know it has nothing to do with ACE2. The drug has some effect on zinc being pushed into the cell which stunts viral replication. At least that is the brief summation of the theory I have read. Funny how every other doctor has literally reported 100% success. One doctor prescribes zinc with it.

Holy fuck, how many of us might seriously die because of untreated TDS?!? Hating Trump has become part of some people’s self-worth. If they do not hate with purity then they have failed as a person.

"Plaquenil which has weak ACE2 blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post."

The doctor's message was clarified by someone else, also on the TexasAG board. His clarifications are in parentheses. It helped me understand some of the unfamiliar terms. Here is what he said:

I am an ER MD in New Orleans. Class of 98. Every one of my colleagues have now seen several hundred Covid 19 patients and this is what I think I know.

Clinical course is predictable.
2-11 days after exposure (day 5 on average) flu like symptoms start. Common are fever, headache, dry cough, myalgias (general muscular pain; back pain indicated as common), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

Day 5 of symptoms- increased SOB (shortness of breath), and bilateral viral pneumonia (double pneumonia) from direct viral damage to lung parenchyma (the portion of the lung involved in gas transfer - the alveoli, alveolar ducts and respiratory bronchioles.)

Day 10- Cytokine storm (overproduction of immune cells and their activating compounds (cytokines), signaling an inflammatory response flaring out of control) leading to acute ARDS (Acute respiratory distress syndrome) and multiorgan failure. You can literally watch it happen in a matter of hours.

81% mild symptoms, 14% severe symptoms requiring hospitalization, 5% critical.

Patient presentation is varied. Patients are coming in hypoxic (poor oxygen saturation; below 90%) even 75% without dyspnea (labored breathing). I have seen Covid patients present with encephalopathy (brain injury, headache), renal (kidney) failure from dehydration, DKA (Diabetic ketoacidosis: occurs when the body starts breaking down fat at a rate that is much too fast. The liver processes the fat into a fuel called ketones, which causes the blood to become acidic). I have seen the bilateral interstitial pneumonia on the xray of the asymptomatic shoulder dislocation or on the CT's of the (respiratory) asymptomatic polytrauma patient. Essentially if they are in my ER, they have it. Seen three positive flu swabs in 2 weeks and all three had Covid 19 as well. Somehow this ***** has told all other disease processes to get out of town.

China reported 15% cardiac involvement. I have seen covid 19 patients present with myocarditis, pericarditis, new onset CHF (Congestive heart failure) and new onset atrial fibrillation. I still order a troponin, but no cardiologist will treat no matter what the number in a suspected Covid 19 patient. Even our non covid 19 STEMIs (ST-Elevation Myocardial Infarction; serious heart attack) at all of our facilities are getting TPA (Tissue plasminogen activator used to dissolve blood clots) in the ED (Emergency Department) and rescue PCI (Percutaneous Coronary Intervention; aka angioplasty with stint) at 60 minutes only if TPA fails.

Diagnostic
CXR (Chest X-Ray)- bilateral interstitial pneumonia (anecdotally starts most often in the RLL (lower lobe of the right lung) so bilateral on CXR is not required). The hypoxia does not correlate with the CXR findings. Their lungs do not sound bad. Keep your stethoscope in your pocket and evaluate with your eyes and pulse ox.


Labs- WBC (white blood cell count) low, Lymphocytes low, platelets lower than their normal, Procalcitonin (substance produced in response to bacterial infections but also in response to tissue injury) normal in 95%.
CRP (C-Reactive Protein Test: A plasma protein that rises in the blood with the inflammation from certain conditions) and Ferritin (blood protein that indicates iron level) elevated most often. CPK (creatine phosphokinase: elevated levels indicate muscle trauma, including heart), D-Dimer (a small protein fragment present in the blood after a blood clot is degraded by fibrinolysis), LDH (Lactate dehydrogenase: plays an important role in cellular respiration, the process by which glucose (sugar) from food is converted into usable energy for our cells.), Alk (Anaplastic lymphoma kinase: plays a pivotal role in cellular communication and in the normal development and function of the nervous system), Phos (Phosphorus level: key to kidney function)/AST (Aspartate aminotransferase: released into blood when the liver or heart is damaged)/ALT (alanine transaminase: high levels can indicate a liver problem) commonly elevated.
Notice D-Dimer- I would be very careful about CT PE (CT pulmonary angiography used to detect pulmonary embolisms) these patients for their hypoxia. The patients receiving IV contrast are going into renal (kidney) failure and on the vent sooner.

Basically, if you have a bilateral pneumonia with normal to low WBC, lymphopenia, normal procalcitonin, elevated CRP and ferritin- you have covid-19 and do not need a nasal swab to tell you that.

A ratio of absolute neutrophil (type of white blood cell) count to absolute lymphocyte (type of white blood cell) count greater than 3.5 may be the highest predictor of poor outcome. the UK is automatically intubating these patients for expected outcomes regardless of their clinical presentation.

An elevated Interleukin-6 (IL6: stimulates the inflammatory and auto-immune processes in many diseases) is an indicator of their cytokine storm. If this is elevated watch these patients closely with both eyes.

Other factors that appear to be predictive of poor outcomes are thrombocytopenia (low blood platelet count) and LFTs (liver function test) 5x upper limit of normal.

Disposition
I had never discharged multifocal pneumonia before. Now I personally do it 12-15 times a shift. 2 weeks ago we were admitting anyone who needed supplemental oxygen. Now we are discharging with oxygen if the patient is comfortable and oxygenating above 92% on nasal cannula. We have contracted with a company that sends a paramedic to their home twice daily to check on them and record a pulse ox. We know many of these patients will bounce back but if it saves a bed for a day we have accomplished something. Obviously we are fearful some won't make it back.

We are a small community hospital. Our 22 bed ICU and now a 4 bed Endoscopy suite are all Covid 19. All of these patients are intubated except one. 75% of our floor beds have been cohorted into covid 19 wards and are full. We are averaging 4 rescue intubations a day on the floor. We now have 9 vented patients in our ER transferred down from the floor after intubation.

Luckily we are part of a larger hospital group. Our main teaching hospital repurposed space to open 50 new Covid 19 ICU beds this past Sunday so these numbers are with significant decompression. Today those 50 beds are full. They are opening 30 more by Friday. But even with the "lockdown", our AI models are expecting a 200-400% increase in covid 19 patients by 4/4/2020.


Treatment
Supportive

worldwide 86% of covid 19 patients that go on a vent die. Seattle reporting 70%. Our hospital has had 5 deaths and one patient who was extubated. Extubation happens on day 10 per the Chinese and day 11 per Seattle.

Plaquenil which has weak ACE2 (angiotensin-converting enzyme) blockade doesn't appear to be a savior of any kind in our patient population. Theoretically, it may have some prophylactic properties but so far it is difficult to see the benefit to our hospitalized patients, but we are using it and the studies will tell. With Plaquenil's potential QT prolongation (refers to an interval seen in an electrocardiogram (EKG) test of heart function) and liver toxic effects (both particularly problematic in covid 19 patients), I am not longer selectively prescribing this medication as I stated on a previous post.

We are also using Azithromycin, but are intermittently running out of IV.

Do not give these patient's standard sepsis fluid resuscitation. Be very judicious with the fluids as it hastens their respiratory decompensation. Outside the DKA and renal failure dehydration, leave them dry.

Proning vented patients significantly helps oxygenation. Even self proning the ones on nasal cannula helps.

Vent settings- Usual ARDS stuff, low volume, permissive hypercapnia, etc. Except for Peep of 5 will not do. Start at 14 and you may go up to 25 if needed.

Do not use Bipap (Bilevel Positive Airway Pressure, and is very similar in function and design to a CPAP machine )- it does not work well and is a significant exposure risk with high levels of aerosolized virus to you and your staff. Even after a cough or sneeze this virus can aerosolize up to 3 hours.

The same goes for nebulizer treatments. Use MDI. you can give 8-10 puffs at one time of an albuterol MDI (Metered-dose inhaler). Use only if wheezing which isn't often with covid 19. If you have to give a nebulizer must be in a negative pressure room; and if you can, instruct the patient on how to start it after you leave the room.

Do not use steroids, it makes this worse. Push out to your urgent cares to stop their usual practice of steroid shots for their URI (upper respiratory infection)/bronchitis.

We are currently out of Versed, Fentanyl, and intermittently Propofol. Get the dosing of Precedex and Nimbex back in your heads.

One of my colleagues who is a 31 yo old female who graduated residency last may with no health problems and normal BMI is out with the symptoms and an SaO2 (saturated O2 level in the blood) of 92%. She will be the first of many.

I PPE best I have. I do wear a MaxAir PAPR the entire shift. I do not take it off to eat or drink during the shift. I undress in the garage and go straight to the shower. My wife and kids fled to her parents outside Hattiesburg. The stress and exposure at work coupled with the isolation at home is trying. But everyone is going through something right now. Everyone is scared; patients and employees. But we are the leaders of that emergency room. Be nice to your nurses and staff. Show by example how to tackle this crisis head on. Good luck to us all.

Basically have to put people in a coma to intubate them.

24/7 however long. I don't know if they use fentanyl for that, but it would be my best guess.

Coincides with other reports I have read - heard, etc.

No steroids.

No anti fever meds.

Prone.

I just heard the term "compassionate medicine" today -

Basically it can give Dr.'s some sort of freedom to treat cases with alternative meds.

I'm sure there is paperwork involved.

A Chinese herb worked for patients in lung trouble - it was a natural ephedrine.

Can anyone decipher the medications used in this as something akin to ephedrine?

I’m calling fear porn/propaganda for the medically literate.

This doctor and his medical has used a combo Plaquenil, z- pack, zinc combo in over 500 patients and has had zero hospitalizations and zero deaths.

[link to twitter.com (secure)]

Extubation, I'M very skeptical about that statement, I was recently in ICU visiting a family member who could not breath on her own and she did just fine on the tube.

And what medicle professional cites any statistics from China for f*CKS SAKES.

And the one drug that have real people on FB who are well
Known be 100% cured, he disparage's it.

And why not just talk about his case's, oh no he brings his
Family in to it to really ratchet up the drama. Lol

This seems legit and consistent with our hospital sources (neighbors, best friends)

Do not get this. Lock the fuck down.

Like that KY mayor said: " Hey dipshits (nothingburgertards)...screw you."

5 atars OP.

We will kick its ass if we work together.

You have nothing to lose in suspending your paranoia over this. Its easy: if nobody dies, we'll praise you forever. Just stay home, hoping to woke us all someday soon.

Yet the verbose, brainwashed, spoon-fed automaton still doesn't realise that the pretty photos of viruses he thinks are real are ALL FABRICATED.

Imagine living your life as an unwitting tool who swallowed the virus theory of disease lie.

thanks! Just spit my drink all over my monitor...kma/lol

^^^ this

fuck op's fair tales

a fukcing shill is who

Godspeed and Thank you... Damn...this bioweapon design...fuck the damn fucks who invented this...

ma Huang

in other words, standard decongestant. sudafed. Treated the same way as the common cold.

HOAX

I feel for our ER docs and the intense shifts they do

But the above comment can’t be dismissed from what I’ve seen

Doctors are brainwashed too ... by the Big Pharma companies that own the medical schools and the medical journals and other gatekeepers of medical info

The CHEAP effective anti-malarial should be tried -
but CURING won’t achieve CULLING

Rum the fuck over?

If you're gonna try to sound like a bad ass....

Well, do I even have to say it?

Please.

While this is good advice, it's no match for this virus.

HEAR! HEAR!

Well put!

Nine doctors die from coronavirus in Philippines
[link to www.aljazeera.com (secure)]

Good point! My main question is how did this pandemic hit the elderly so hard contagion wise I mean;its not like they are international travelers or social butterflies so your question may have helped solve that puzzle. What we have learned so far about the evils of vaccines! Remember Italian scientist just came out with a study that over 500 strands of Cancer, Parkinson, schizophrenia, etc DNA were found in vaccines. Is Italy paying for this now? I also read (all on GLP) that vaccines in children make them immune to Covid-19 but also make them speed up helping to spread it so being around a non sick child could be just as dangerous as an infected person. Then we have the study where Covid-19 was "designed" to attach and partner with bad bacteria such as petrovella to make it deadlier ( wasn't this project pogo rumored last year?) Anyway this synopsis of this New Orleans doctor is a real eye opener, thanks for providing!

Last Edited by KuvaszLove on 03/26/2020 06:31 AM

Fact - It's illegal in the U.S. because it is so strong.

Fact - Sudafed is not illegal.

Fact - This "thing" hits the lungs.

Fact - Ma Huang is a bronchial dialator and stimulant deemed VITAL to patients with this.

Fact - the strength of the medicines I am making for my family and those who need it, are not something just anyone should have access too. They can be dangerous to people who think that fish tank cleaner ingredients are natural medicine.

Fact - In situation like this, "compassionate care" is allowed, and being practiced.

Fact - prove it doesn't work or it does, science is about results not opinions.

who is the fuckwit who decided to call it "Plaquenil'? is that to make themselves seem full of mystical knowledge?

why, no, you pesant, that's known as 'Plaquenil'

I call it BS. According to cdc.gov the flu killed 12000 to 59000 so far. Why no one talks about it in the news?

I posted this exact same thing earlier today and got 3 red karma for violating copyright.

Glad it got more exposure anyway....

Note the comment by the ER MD about lowered white cell counts. They normally skyrocket with infections.....except for HIV. And this.

How low do they go? Lowest normal is 500, AIDS is 200 or lower. Are these patients 400? 300?

Is it all patients? A percent? Are the low white cell counts similar?

How much did the HIV inserts in the COVID genome cause the AIDS like drop in lymphocytes and white cells?

Is this to some degree airborne AIDS? Why did China frantically lock down 700 million people? What did they know?

What are we not being told about lowered white cell counts?

People need to stop using the word "cure" to justify all of their incorrect posts/beliefs. Anything that helps a sick person is beneficial, it doesn't actually have to completely cure the problem. Many doctors are currently giving IV vitamin C to help their patients fight the coronavirus. It doesn't cure them but it does make a difference.

Doctors are also usually smart, but they can become stuck in the structure of prescribing drugs to fix problems instead of using the body's own natural systems and nutrients to help the body heal itself. The average doctor (in the US at least) has only a couple hours of total training in the areas of natural medicine and nutrition. If you spend your whole educational career being trained to be a great hammer, every problem you come across automatically starts to look like a nail. Some people are smart enough to realize that some problems are better solved with a screwdriver or a chisel.