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(The New York Times)   For this bonus round of the coronavirus pandemic, we've decided to provide all contestants with more than enough ventilators, but not enough people who know how to operate them   (nytimes.com) divider line
    More: Scary  
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856 clicks; posted to Main » on 23 Nov 2020 at 2:33 PM (7 weeks ago)   |   Favorite    |   share:  Share on Twitter share via Email Share on Facebook



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View Voting Results: Smartest and Funniest
 
2020-11-23 10:03:35 AM  
Woo-Hoo! Made it to the bonus round!
 
2020-11-23 2:36:03 PM  
DO we have more than enough, though? Or is that just what we're being told?
 
2020-11-23 2:36:26 PM  
Well, this is what you get when you treat an education as a luxury!  enjoy the death ladies and gentlemen!
 
2020-11-23 2:39:04 PM  
So what? All we need is a mommy blogger to write a post on ventilators and we'll create thousands of experts instantly.
 
2020-11-23 2:40:19 PM  

waxbeans: Well, this is what you get when you treat an education as a luxury!  enjoy the death ladies and gentlemen!


Conservatives have treated education as a liberal disease for years.  Predictable results follow.
 
2020-11-23 2:42:46 PM  
I'm guessing that when a ventilator is in play, the  patient is really on borrowed time.  Is that correct?
 
2020-11-23 2:43:31 PM  
Good thing they are a device of last resort now. It's pretty much a death sentence to go on one.
 
2020-11-23 2:44:56 PM  

Cache: waxbeans: Well, this is what you get when you treat an education as a luxury!  enjoy the death ladies and gentlemen!

Conservatives have treated education as a liberal disease for years.  Predictable results follow.


Yep .
 
2020-11-23 2:46:28 PM  

Stud Gerbil: I'm guessing that when a ventilator is in play, the  patient is really on borrowed time.  Is that correct?


No. And maybe.
I think it's 50/50.
People do get get off and go home, alive.
 
2020-11-23 2:49:50 PM  
wind them up and walk away...
 
2020-11-23 2:50:52 PM  

Alebak: DO we have more than enough, though? Or is that just what we're being told?


We might as it seems like we've been able to better gauge when a ventilator is needed and when it isn't. Sometimes some groups learn from experience.
 
2020-11-23 2:53:13 PM  
Up next: not enough ventilators and almost all the people who can operate the ones available are sick from Covid-19
 
2020-11-23 2:58:44 PM  

waxbeans: Well, this is what you get when you treat an education as a luxury!  enjoy the death ladies and gentlemen!


No, this is what you get when there is a sudden demand for more workers with a very specific skillset.  A few months ago we had the right amount of people to fill that requirement, and now we need more.  I mean do you expect people to train for something and then not be able to get a job in that field?
 
2020-11-23 2:59:33 PM  
You can wear a mask on your face now, or a ventilator later, choose wisely.
 
2020-11-23 3:00:21 PM  

waxbeans: Stud Gerbil: I'm guessing that when a ventilator is in play, the  patient is really on borrowed time.  Is that correct?

No. And maybe.
I think it's 50/50.
People do get get off and go home, alive.


I only know one person whom I can verify went on one.  He died soon after. 1/1.  That was in México so maybe it doesn't count.
 
2020-11-23 3:01:41 PM  

Alebak: DO we have more than enough, though? Or is that just what we're being told?


Probably.  It turns out that ventilators are basically for those who are already almost doomed.  With more experience and better triage, what was a first line treatment in March is now something used only as a last ditch effort to keep some people alive.

We'll probably run out of hospital space well before we run out of ventilators.  Hm, which might lead to only more severe cases getting in and mainly needing ventilators... supply curves are weird.  I hope that your area is flattening the curve!
 
2020-11-23 3:03:36 PM  

joker420: You can wear a mask on your face now, or a ventilator later, choose wisely.


We are still trying to convince some people that rubbers are a good idea when banging a $20 hooker.

Just let them go man and pray they don't take anyone else with them.
 
2020-11-23 3:03:39 PM  
Manufacturing ventilators is not the problem. It takes years to train doctors and nurses to use ventilator properly. The existing doctors and nurses are burning out or getting sick too.
The plague of stupidity will allow the covid virus to thrive.
Ventilators are not the cure for the covid pandemic.

Staying home and not spreading the virus is the answer.
Masks help prevent the spread if you have to go out.
Wash your bloody hands you heathen.
 
2020-11-23 3:03:46 PM  
Which ventilators?  The ones GM made?  Those are prone to vapor lock once you flood the carburetor.
 
2020-11-23 3:14:43 PM  
Trump should use this opportunity to grift and sell $50 000 per semester Trump university PHDs in ventilator operation.
 
2020-11-23 3:17:00 PM  

Jeebus Saves: waxbeans: Well, this is what you get when you treat an education as a luxury!  enjoy the death ladies and gentlemen!

No, this is what you get when there is a sudden demand for more workers with a very specific skillset.  A few months ago we had the right amount of people to fill that requirement, and now we need more.  I mean do you expect people to train for something and then not be able to get a job in that field?


Hahaha.
Utter malarkey beyond all comprehensible belief.
What you just mentioned is actually the result of refusing to have upscale capabilities because that would cut into maximized profits.
Meanwhile we pay people not to plant crops.
But you keep enjoying that smaller government doing less; see how that works out for you buddy.
/

FML.
That amount of faulty information used by the GOP is massive.
//
Will you rugged individuals enjoy dying on this hill of less.
///
All theses people dying isn't an error. This is exactly what GOP policies and shareholders mattering most leads to.

++++++
Enjoy profiting off deaths, you shareholders.
Let's see who is left to leech off of when 10% of the nation dies coughing. F%%k sticks.
 
2020-11-23 3:54:08 PM  

Alebak: DO we have more than enough, though? Or is that just what we're being told?


We really did build a farking shiat ton of them during the first go around.  But we can't make doctors overnight.
 
2020-11-23 4:20:13 PM  
We have underfunded and underpaid respiratory therapists, docs, nurses and med techs for years, squeezing them to make money for MBAs.

And now we reap the whirlwind.

And when this pandemic passes into memory in 10 years and the next pandemic comes along, we will do this dance all over again.
 
2020-11-23 4:20:38 PM  
Isn't a ventilator like a reverse vacuum cleaner?
 
2020-11-23 4:43:23 PM  

kbronsito: So what? All we need is a mommy blogger to write a post on ventilators and we'll create thousands of experts instantly.


No need to "create" them, there are millions of conservatives in this country who apparently are way smarter than "experts".  So just bring a few of them into the hospital and they'll show everyone what to do!
 
2020-11-23 4:44:31 PM  
At a minimum, if you are in a state that allows associate's, you get an RN, so a hard 2 years or an easier 3. Then it takes minimum a year of medsurg to grind down the basics, preferably two. Then you want a year critical care experience and certification.  So 4-6 years to produce a decent ICU RN. 

You cant just make them. You cant 3d print them. 

Add in the chronic shortage?

And the RNs that are really tired of the bullshiat are either retiring, quitting, or going temp cuz if you gonna be treated like a hoe, you might as well be a high class escort and get paid. Which leads to a bidding war where I am guessing North Dakota prolly cant hang with Miami or LA.

Its come up in my hospital and the management is all 'We are a TEAM, how could you leave?!" To which we reply "You decided a pizza party was sufficient instead of a raise or real hazard pay... they are offering the down payment on a house for a months work."

It isnt much better in RT land either from what I am told.
 
2020-11-23 4:44:42 PM  

PangolinPatientZero: We have underfunded and underpaid respiratory therapists, docs, nurses and med techs for years, squeezing them to make money for insurance company and hospital shareholders.


Corrected.
 
2020-11-23 4:47:25 PM  

elaw: PangolinPatientZero: We have underfunded and underpaid respiratory therapists, docs, nurses and med techs for years, squeezing them to make money for insurance company and hospital shareholders.

Corrected.


And who is it that runs those companies and and Hospital boards? It sure isnt Nurses.
 
2020-11-23 5:04:32 PM  

PangolinPatientZero: elaw: PangolinPatientZero: We have underfunded and underpaid respiratory therapists, docs, nurses and med techs for years, squeezing them to make money for insurance company and hospital shareholders.

Corrected.

And who is it that runs those companies and and Hospital boards? It sure isnt Nurses.


Yeah hospital boards, full of people who never worked a day in their lives in an ER, paid 5 times what nurses working 80h a week are making. Yeah we totally need them!
 
2020-11-23 6:00:56 PM  

Stud Gerbil: I'm guessing that when a ventilator is in play, the  patient is really on borrowed time.  Is that correct?


Sort of.  The media is playing fast and loose with the term (what else is new?)  Most of these stories imply that they are referring to intubation, which, yes, this has mostly turned into "don't bother, they are going to die anyway."  But the media refers to anything down to the bog standard nasal oxygen feed as a "ventilator."
 
2020-11-23 6:11:36 PM  

nobody11155: Stud Gerbil: I'm guessing that when a ventilator is in play, the  patient is really on borrowed time.  Is that correct?

Sort of.  The media is playing fast and loose with the term (what else is new?)  Most of these stories imply that they are referring to intubation, which, yes, this has mostly turned into "don't bother, they are going to die anyway."  But the media refers to anything down to the bog standard nasal oxygen feed as a "ventilator."


That claim there is going to need some citation please


Pretty please
 
2020-11-23 6:17:22 PM  

waxbeans: Stud Gerbil: I'm guessing that when a ventilator is in play, the  patient is really on borrowed time.  Is that correct?

No. And maybe.
I think it's 50/50.
People do get get off and go home, alive.


I've read 30%-50% COVID ventilator mortality rates cited now, down from 85-97% in March, 70ish% in April, and 60ish% in May. A Nature article last week mentioned a hospital with a 45% rate. There's a much lower COVID mortality rate regardless of ventilator use, and a lower portion of patients who need to go on ventilators, because of a wider array of treatment options available now.
 
2020-11-23 6:17:57 PM  
Idiocracy - Future Hospital Visit
Youtube hmUVo0xVAqE
 
2020-11-23 6:21:31 PM  

PangolinPatientZero: At a minimum, if you are in a state that allows associate's, you get an RN, so a hard 2 years or an easier 3. Then it takes minimum a year of medsurg to grind down the basics, preferably two. Then you want a year critical care experience and certification.  So 4-6 years to produce a decent ICU RN.

You cant just make them. You cant 3d print them.


True, that.  There are RN's who've spent their careers working Forensic Psych. ("patients" of the sort that, if given an opportunity, are as likely to decapitate said RN, and leave head on the med cart, than comply with the 'pill check'), who nearly collapse in a panic attack if any suggest that being assigned only 2-3 patients on an MICU might be an alternative.
 
2020-11-23 7:19:07 PM  

Crazy Lee: PangolinPatientZero: At a minimum, if you are in a state that allows associate's, you get an RN, so a hard 2 years or an easier 3. Then it takes minimum a year of medsurg to grind down the basics, preferably two. Then you want a year critical care experience and certification.  So 4-6 years to produce a decent ICU RN.

You cant just make them. You cant 3d print them.

True, that.  There are RN's who've spent their careers working Forensic Psych. ("patients" of the sort that, if given an opportunity, are as likely to decapitate said RN, and leave head on the med cart, than comply with the 'pill check'), who nearly collapse in a panic attack if any suggest that being assigned only 2-3 patients on an MICU might be an alternative.


And they know you dont want them. They dont know wtf they doing and hey know it. I mean most every nurse knows bls., but huge swathes dont transfer. I would lop off my leg before doing pediatric. Their numbers and ratios are completely different... Every specialty is so wildly different a nurse can be a danger if suddenly dumped in another. You know it, they know it, but management 'forgets' it.
 
2020-11-23 7:27:04 PM  

PangolinPatientZero: Crazy Lee: PangolinPatientZero: At a minimum, if you are in a state that allows associate's, you get an RN, so a hard 2 years or an easier 3. Then it takes minimum a year of medsurg to grind down the basics, preferably two. Then you want a year critical care experience and certification.  So 4-6 years to produce a decent ICU RN.

You cant just make them. You cant 3d print them.

True, that.  There are RN's who've spent their careers working Forensic Psych. ("patients" of the sort that, if given an opportunity, are as likely to decapitate said RN, and leave head on the med cart, than comply with the 'pill check'), who nearly collapse in a panic attack if any suggest that being assigned only 2-3 patients on an MICU might be an alternative.

And they know you dont want them. They dont know wtf they doing and hey know it. I mean most every nurse knows bls., but huge swathes dont transfer. I would lop off my leg before doing pediatric. Their numbers and ratios are completely different... Every specialty is so wildly different a nurse can be a danger if suddenly dumped in another. You know it, they know it, but management 'forgets' it.


So instead of a Space Force, maybe we need an emergency medical staff coups????
 
2020-11-23 7:29:06 PM  

waxbeans: PangolinPatientZero: Crazy Lee: PangolinPatientZero: At a minimum, if you are in a state that allows associate's, you get an RN, so a hard 2 years or an easier 3. Then it takes minimum a year of medsurg to grind down the basics, preferably two. Then you want a year critical care experience and certification.  So 4-6 years to produce a decent ICU RN.

You cant just make them. You cant 3d print them.

True, that.  There are RN's who've spent their careers working Forensic Psych. ("patients" of the sort that, if given an opportunity, are as likely to decapitate said RN, and leave head on the med cart, than comply with the 'pill check'), who nearly collapse in a panic attack if any suggest that being assigned only 2-3 patients on an MICU might be an alternative.

And they know you dont want them. They dont know wtf they doing and hey know it. I mean most every nurse knows bls., but huge swathes dont transfer. I would lop off my leg before doing pediatric. Their numbers and ratios are completely different... Every specialty is so wildly different a nurse can be a danger if suddenly dumped in another. You know it, they know it, but management 'forgets' it.

So instead of a Space Force, maybe we need an emergency medical staff coups????


*corps
 
2020-11-23 9:18:28 PM  

waxbeans: So instead of a Space Force, maybe we need an emergency medical staff coups????


The conservatives will never go for it.  They'll spend infinite money to kill foreigners that are a threat to Americans (or that they imagine are)(or just don't look like us), but if the threat is an illness, malnutrition, ignorance, poverty, environmental condition, other Americans, (...157 other things omitted here...), they won't spend one red cent.
 
2020-11-23 9:24:24 PM  

Jz4p: I hope that your area is flattening the curve!


I think most of North America is flattening the curve.  Hockey stick handles are flat, right?
 
2020-11-23 9:32:33 PM  

waxbeans: PangolinPatientZero: Crazy Lee: PangolinPatientZero: At a minimum, if you are in a state that allows associate's, you get an RN, so a hard 2 years or an easier 3. Then it takes minimum a year of medsurg to grind down the basics, preferably two. Then you want a year critical care experience and certification.  So 4-6 years to produce a decent ICU RN.

You cant just make them. You cant 3d print them.

True, that.  There are RN's who've spent their careers working Forensic Psych. ("patients" of the sort that, if given an opportunity, are as likely to decapitate said RN, and leave head on the med cart, than comply with the 'pill check'), who nearly collapse in a panic attack if any suggest that being assigned only 2-3 patients on an MICU might be an alternative.

And they know you dont want them. They dont know wtf they doing and hey know it. I mean most every nurse knows bls., but huge swathes dont transfer. I would lop off my leg before doing pediatric. Their numbers and ratios are completely different... Every specialty is so wildly different a nurse can be a danger if suddenly dumped in another. You know it, they know it, but management 'forgets' it.

So instead of a Space Force, maybe we need an emergency medical staff coups????


Maybe some kind of mobile army surgical hospital of some kind.  Also seems like that could make a good TV show.
 
2020-11-23 10:27:50 PM  

elaw: waxbeans: So instead of a Space Force, maybe we need an emergency medical staff coups????

The conservatives will never go for it.  They'll spend infinite money to kill foreigners that are a threat to Americans (or that they imagine are)(or just don't look like us), but if the threat is an illness, malnutrition, ignorance, poverty, environmental condition, other Americans, (...157 other things omitted here...), they won't spend one red cent.


😔
 
2020-11-23 10:29:07 PM  

Baloo Uriza: waxbeans: PangolinPatientZero: Crazy Lee: PangolinPatientZero: At a minimum, if you are in a state that allows associate's, you get an RN, so a hard 2 years or an easier 3. Then it takes minimum a year of medsurg to grind down the basics, preferably two. Then you want a year critical care experience and certification.  So 4-6 years to produce a decent ICU RN.

You cant just make them. You cant 3d print them.

True, that.  There are RN's who've spent their careers working Forensic Psych. ("patients" of the sort that, if given an opportunity, are as likely to decapitate said RN, and leave head on the med cart, than comply with the 'pill check'), who nearly collapse in a panic attack if any suggest that being assigned only 2-3 patients on an MICU might be an alternative.

And they know you dont want them. They dont know wtf they doing and hey know it. I mean most every nurse knows bls., but huge swathes dont transfer. I would lop off my leg before doing pediatric. Their numbers and ratios are completely different... Every specialty is so wildly different a nurse can be a danger if suddenly dumped in another. You know it, they know it, but management 'forgets' it.

So instead of a Space Force, maybe we need an emergency medical staff coups????

Maybe some kind of mobile army surgical hospital of some kind.  Also seems like that could make a good TV show.


Ooooooooo

Shea Moore as the general 😁
 
2020-11-24 8:14:16 AM  
Ventilator operation is actually pretty straightforward;  it wouldn't be that hard to come up with an algorithm for guidance that a person with only minimal familiarity with a given ventilator could use to take OK care of a patient.  As an example, ABG shows PaCO2 too high?  Increase respiratory rate.  PaO2 level too low?  Increase FIO2 or PEEP.  It takes WAY more expertise to figure out who should go on a ventilator and when it's appropriate to come off.  And shoving that tube in requires a bit of training too.  They teach intubation on ACLS but nobody expects those who pass to be experts at it;  I'd say it took me a solid 2 years of intubating almost daily to be really good at it.
 
2020-11-24 8:48:38 AM  
It's not that hard. Push button, turn knob, pull some widgets then set it and forget it.

I mean there is also blood gas interpretation, sedation and paralytic concerns, peak pressures because of acute respiratory distress changes, the potential for flolan which is it's own dirty beast trying to keep going while changing the syringe every few hours, and trying to flip someone prone with all the lines and tubes... But I mean, it's not that hard....
 
2020-11-24 1:03:35 PM  

hoyt clagwell: Ventilator operation is actually pretty straightforward;  it wouldn't be that hard to come up with an algorithm for guidance that a person with only minimal familiarity with a given ventilator could use to take OK care of a patient.  As an example, ABG shows PaCO2 too high?  Increase respiratory rate.  PaO2 level too low?  Increase FIO2 or PEEP.  It takes WAY more expertise to figure out who should go on a ventilator and when it's appropriate to come off.  And shoving that tube in requires a bit of training too.  They teach intubation on ACLS but nobody expects those who pass to be experts at it;  I'd say it took me a solid 2 years of intubating almost daily to be really good at it.


Also about the volume of air you're pushing.  Ruptured lung ain't good.
 
2020-11-24 1:28:28 PM  
The previous three comments show what i like to call 'expertise blindness' You think its easy if you get it and you forget most people cant get past suctioning the skrawk outta there. They would wince putting tube back after  a hard cough. I bet Shaq thought dunking was easy too. Its a little harder at 5'5".
 
2020-11-24 2:01:24 PM  

PangolinPatientZero: The previous three comments show what i like to call 'expertise blindness' You think its easy if you get it and you forget most people cant get past suctioning the skrawk outta there. They would wince putting tube back after  a hard cough. I bet Shaq thought dunking was easy too. Its a little harder at 5'5".


You said what I was going for better than I did.  It's been a busy morning, I forgot words while just posting casually during my break.
 
2020-11-24 4:24:34 PM  

PangolinPatientZero: The previous three comments show what i like to call 'expertise blindness' You think its easy if you get it and you forget most people cant get past suctioning the skrawk outta there. They would wince putting tube back after  a hard cough. I bet Shaq thought dunking was easy too. Its a little harder at 5'5".


Kind of what I was going for.

I find it really odd though. I was 21 years old when I was an Army medic and given 6 months of training and a little OTJ here's some extra crap and expected to manage acute care patients in an austere environment.

Now I have 16 years of formal and informal medical education and about to finish my doctorate and think: holy crap, I can't believe I did that knowing so little.
 
2020-11-24 9:04:38 PM  

plastic_cow: PangolinPatientZero: The previous three comments show what i like to call 'expertise blindness' You think its easy if you get it and you forget most people cant get past suctioning the skrawk outta there. They would wince putting tube back after  a hard cough. I bet Shaq thought dunking was easy too. Its a little harder at 5'5".

Kind of what I was going for.

I find it really odd though. I was 21 years old when I was an Army medic and given 6 months of training and a little OTJ here's some extra crap and expected to manage acute care patients in an austere environment.

Now I have 16 years of formal and informal medical education and about to finish my doctorate and think: holy crap, I can't believe I did that knowing so little.


Medics are the best of no options. And there is a commonality to combat trauma.... and a bluntness to their triage. With less training and tools, there is less to do. You save the ones you can while you can. In a hospital setting you start acting like Ash Ketchum and try to save em all, when in the extreme settings like NYC covid, you have to go back to medic thinking. Save who you can with what you got while you are there.
 
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