The Fall of Hospitals

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DrJenner

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As most of you know, I work in the ICU. We are hedging on overcrowding of epic proportions, so much so that states are implementing disaster standards of care (like Idaho).
What is the implication of this?
According to the standards, patients could be given a priority score based on a number of factors.

For example, if the demand for ventilators is exceeding supply, hospitals could put into place universal “Do Not Resuscitate” orders. That means if an adult patient goes into cardiac arrest, they could “receive NO attempts at resuscitation,” according to Health and Welfare’s strategies for scarce resource situations.

“The likelihood of survival after a cardiac arrest is extremely low for adult patients. As well, resuscitation poses significant risk to health care workers due to aerosolization of body fluids and uses large quantities of scarce resources such as staff time, personal protective equipment, and life-saving medications, with minimal opportunity for benefit.”

You can read the local article here:

This thread is not about vax vs no vax - this thread is about the very possible collapse of our healthcare system this winter (when we historically have higher numbers).
Healthcare providers are walking off the job at record numbers, and with the looming mandate in many states, we will be without many more healthcare workers - leading to even worse staffing issues and compromised care - further justifying implementing crisis standards of care.

What is happening in Idaho is now spilling into Washington state, with many of the residents of Idaho coming to Eastern WA to seek care, further increasing numbers hospitalized and in the ER. This will have a ripple effect across the nation.

What have you done to prepare for a collapse?
I'm attaching a list of supplies I have been collecting here at my place, and wanted to share with you all. Feel free to add something I've missed (which is entirely possible!)


Med Kit

AED/defibrillator
CPAP/BiPAP (if you can get now)
Portable O2 concentrator
Nasal cannula + face masks
Bag/valve mask
ENT kit
Dental kit
Box of nitrile gloves (different sizes)
IV catheter starts (can get on amazon)
IV tubing
IV bags - normal saline or lactated ringers
Potassium iodide
4 x 4 sponges
Abdominal pads (very absorbent)
Coban
Silk tape
Non adherent dressings
Sterile dressings
Bottles of sterile water/normal saline (for irrigation of wounds)
Silver nitrate sticks (can stop small bleeders)
Trauma dressing
Quick clot
Petroleum gauze (chest wound dressings)
14 ga IV cath - for needle decompression
Sutures and suture kit (needle drivers)
Suture removal kit
Hemostats
Scalpels (many different sizes)
Butterfly bandages
Newskin/glue for wounds
NG tubes
Eye wash solution
Antibiotic ointment
Soap
Hand sanitizer
Alcohol wipes or rubbing alcohol
Band aids (all diff sizes)
Q-tips
Cotton balls
Activated charcoal
Petroleum jelly (for lubrication)
Lidocaine (1%)
Needles 20 ga-27 ga 1/2 in to 1 1/2 in. The larger the gauge the smaller the diameter - so the 27 ga is smaller, and you would want 1/2 inch - can use that to start infiltration of lidocaine at a superficial level. The longer length ones and bigger gauge (20ga) would be for injection of medication
Syringes (all sizes from 1cc-40 cc) both leur lock and slip tip (For use with the NGT)
Diabetes syringes
Oral rehydration powder/electrolyte solution
Glucose monitor
Blood pressure monitor
Pulse oximeter
Thermometer


Meds:

(Make sure to have a stockpile of any prescription meds you take)
Steroids (dexamethasone or prednisone pills)
Antibiotics - good ones to have: azithromycin, ceftriaxone, ampicillin, clindamycin, erythromycin
Acetaminophen
Ibuprofen
Anti-diarrheal
Monistat 7 (or any type - to treat a female yeast infection)
Pantoprazole (protonix)
famotidine
Diphenhydramine
Allergy meds: allegra, claritin (etc)
Epi pen
Anti-venom
Ondansetron (zofran) (oral dissolving tablet)
Glucose tabs
Laxative
Aspirin (chewable 81 mg best)
Anti-histamines/cold medicine
Benadryl cream
Hydrocortisone cream
Topical lidocaine cream
Sunburn cream, sunscreen
 

MOS0231

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Doctor,
I applaud your intent.
But what is the first rule of medicine: Do no harm.
That is a great list, but without proper training (no, not a YouTube video) some of those things listed a person could cause even greater harm than good.
One of my instructors gave a patient the wrong dosage of insulin. She caught her mistake, admitted it, and then even after her shift ended, stayed to monitor the patients BSL and administer the correct meds to keep his BSL within normal parameters.
 

DrJenner

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Most of the medications listed have the doses on the bottle, and how often to take. I would hope that diabetics would know how to self administer their own insulin.
I agree with you, without proper training, you shouldn't self administer - but if you have the supplies and a doc or nurse happens to come along, they can help out with it.
You can pick up the book procedures for primary care physicians which goes over cleaning, debriding wounds and suturing.
You also can't do much damage with one bag of IV fluids for dehydration. Its also pretty obvious if you accidently cannulate an artery (spurting blood) instead of a vein.
Only ones here, would really be steroids and antibiotics, but there are protocols you can look up on medical websites (like SCCM, ABIM, AAFP)
famotidine 1 tab and diphenydramine 1 tab for an allergic reaction.

Had a patient I brought down to ICU this week who had COVID, former ICU nurse. She stayed home and treated herself with 100 mg of prednisone instead that she got from a friend.
You just can't solve all of it, but if you are prepared and resourceful and careful, I think it will be ok :)
 

DrJenner

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I have that one on my list. I am at such a disadvantage as I've only done in-hospital.
My hubby who is family med, used to be an EMT in Montana. He's much better at that stuff than I am.
Was also looking at these online courses, especially as they aren't expensive for CME classes.
 

jontte

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good comprehensive list, so you face the same as we face here, short staffing, no relife to be found, people quitting this job, 'cause of bad pay, shitty management and so on..
every time we get a new patient in, the first question I ask ; does the patient have those 3 letters??
this I do 'cause we have so many new staff, that I don't trust them yet, if something crappy happens.

personally I don't take doubles, but this fri will do,
 

DrJenner

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Yep, overcrowding, nurses leaving in droves to take travel assignments - making good money - but having to take 3 and 4 ICU patients (risking their licenses).
It's crisis standards, and things get missed.
Yesterday I had 5 family meetings with patients not doing well. (2 were COVID, the other 3 were not). We have restricted visitors, people are all angry and up in arms at us. Pretty soon, we can just make medical decisions to take people off life support when it's futile (takes 2-3 docs to agree, plus ethics - its not just one decision).
I will hate to see how people look at us then, we have been forced into this spot.

Meanwhile hospital administrators are buying luxury yachts and taking trips around everywhere.

There are demonstrations around the hospital, as people are upset about the vax mandate/passport like we can change anything about this hell on earth. Go demonstrate at the state capitol and leave us alone to try and do our jobs.
I just applied for my conceal carry.
 

ban1985

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Good stock list thanks for the info, I really appreciate it. I don't think I'll get all that here, one or the other I can probably forget.

What I can add, every evening a little glass of Wisky as a hardening and if it hits me with Corona and it gets bad and I know that I very certainly have to go to the hospital on the IPS then I still have a 9mm bullet that I can give me.

Dr. Jenner you do a good job of it I am convinced, my respect, but if I know when my days go to the end then I do the fast and hard way, because otherwise my hospital still gets 600 dollars Coronaprämie if I strive there to Corona and I do not begrudge them. ;-)
 

DrJenner

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Hot toddys solve everything, especially sore throat - whiskey, hot water, lemon and a bit of honey. :)

Also, thanks for the vote of confidence - totally don't blame you, I would rather go out that way then be hospitalized and endure what the end of lifers are. Just applied for my concealed carry. Fingerprints scheduled 10/5. I'm taking the advice of others and figuring out how to mount a small handgun under my seat in the car.
 

Amish Heart

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Husband and I did as well as we did having covid in December because of our equipment at home. Bi pap, oxygen, diabetic supplies, antibiotic husband takes normally, 02 finger thingy, nebulizer, albuterol...
He got tested, was positive, had the bam infusion the next day, and then we took care of ourselves at home. That was right before Christmas. So the last few weeks when I had pneumonia, had the equipment here to do neb treatments, and check my 02 regularly.
You made a good list.
 

DrJenner

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This will piss people off even more:
At least two states have instructed medical providers to prioritize monoclonal antibody treatments for those “most at risk” from Covid-19 after having their supplies cut by the federal government, with Tennessee making the controversial decision to recommend that nearly all vaccinated Covid patients in the state be denied access to the life-saving drugs.

 

Weedygarden

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This list has many things that I have no idea about. No idea what they are. No idea what they are for. No idea how to use them. No idea where to get them and what they cost. I have no doubt that this would be great stuff to have, but I am wondering if everyone else is up to speed about them? I am going to go down the list and ask about what I don't know about, item by item.

I'll take the first item on the list: AED/defibrillator. From CPR training, I do know what it is. It is used to help restart hearts. We did a fund raiser at school so we would have one on hand. It has been more than 10 years since my last CPR training.

I wonder if there is a recommendation on which one is a better investment and where to get it. And, do I really need one?
 

Weedygarden

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AED/defibrillator

Most that I am seeing online are $1275 and $1325. I think it will go to the bottom of my list for now. Maybe other things will join it, but for now, it is not the top of my list.
 
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Weedygarden

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CPAP/BiPAP

I know there are people who use these at night when they are sleeping. I have not been prescribed one. Amish, your husband probably has one.

They are upward of $500 for the machine. I know there are hoses and pieces that have to be maintained. It is going to the bottom of my list for now.

If someone were interested in having one, I wonder which ones are the best to have?
 
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Weedygarden

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Portable O2 concentrator

I see people walking around with these. With no experience of one, I am wondering what to look for and if there are better models to consider?

Nasal cannula
Next on the list and obviously goes with the Portable O2 concentrator. Very inexpensive. I see some for $3.25. I would only get them if I had a O2 concentrator.
 

Weedygarden

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Bag/valve mask



A bag valve mask (BVM), sometimes known by the proprietary name Ambu bag or generically as a manual resuscitator or "self-inflating bag", is a hand-held device commonly used to provide positive pressure ventilation to patients who are not breathing or not breathing adequately. The device is a required part of resuscitation kits for trained professionals in out-of-hospital settings (such as ambulance crews) and is also frequently used in hospitals as part of standard equipment found on a crash cart, in emergency rooms or other critical care settings. Underscoring the frequency and prominence of BVM use in the United States, the American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care recommend that "all healthcare providers should be familiar with the use of the bag-mask device."[1] Manual resuscitators are also used within the hospital for temporary ventilation of patients dependent on mechanical ventilators when the mechanical ventilator needs to be examined for possible malfunction or when ventilator-dependent patients are transported within the hospital. Two principal types of manual resuscitators exist; one version is self-filling with air, although additional oxygen (O2) can be added but is not necessary for the device to function. The other principal type of manual resuscitator (flow-inflation) is heavily used in non-emergency applications in the operating room to ventilate patients during anesthesia induction and recovery.

Use of manual resuscitators to ventilate a patient is frequently called "bagging" the patient[2] and is regularly necessary in medical emergencies when the patient's breathing is insufficient (respiratory failure) or has ceased completely (respiratory arrest). Use of the manual resuscitator force-feeds air or oxygen into the lungs in order to inflate them under pressure, thus constituting a means to manually provide positive-pressure ventilation. It is used by professional rescuers in preference to mouth-to-mouth ventilation, either directly or through an adjunct such as a pocket mask.

Bagger.jpg
 

Weedygarden

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ENT kit

This is really an unknown for me.

The ENT (Ear, Nose, and Throat) kit provides lighted access to the ears, nose and mouth, using a small otoscope, powered by the small flashlight. The equipment is packaged together in a zippered pouch. ... Lighted metal curette - Fits over the clear lens for removal of ear wax or small foreign bodies from wounds.

This is one that seems to be available, $113.95.

CFM Technologies, Inc. E.N.T. Basic Corpsman Kit
 

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