LETHAL SUPERVIRUS

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Iska Waran
Iska Waran

Is there any doubt that American scientists have worked on bioweapons – or that American military tacticians have contemplated their use?

Dan
Dan

I agree. It would be easy to find similar statements by Americans. Pretty much anything uttered by John McCain, Lindsey Graham, Tom Cotton, John Bolton, Mike Pompeo, Dick Cheney …..

As far as I know, this is the only country where biological weapons (in the form of anthrax) was sent by the country’s MIC to target its political leadership.

MrLiberty
MrLiberty

I have no doubt that the same thing has been said by dozens if not hundreds of the humanity-hating folks that work in US bioweapons labs around the world. 13,000 according to one insider, and 400 labs. “Let he who is without sin, cast the first stone.” -(you know who).

GAZ
GAZ

Suck on this Hardbabble…

Clinical Pearls Covid 19 for ER practitioners
216,484 Views | 228 Replies | Last: 2 hrs ago by Infection_Ag11
nawlinsag1:27a, 3/25/20
I just spent an hour typing a long post that erased when I went to change the title so I apologize to the grammar and spelling police. This one will not be proofread and much shorter.

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(back pain), nausea without vomiting, abdominal discomfort with some diarrhea, loss of smell, anorexia, fatigue.

Day 5 of symptoms- increased SOB, and bilateral viral pneumonia from direct viral damage to lung parenchyma.

Day 10- Cytokine storm leading to acute ARDS 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 (even 75%) without dyspnea. I have seen Covid patients present with encephalopathy, renal failure from dehydration, DKA. 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 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 at all of our facilities are getting TPA in the ED and rescue PCI at 60 minutes only if TPA fails.

Diagnostic
CXR- bilateral interstitial pneumonia (anecdotally starts most often in the RLL 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 low, Lymphocytes low, platelets lower then their normal, Procalcitonin normal in 95%
CRP and Ferritin elevated most often. CPK, D-Dimer, LDH, Alk Phos/AST/ALT commonly elevated.
Notice D-Dimer- I would be very careful about CT PE these patients for their hypoxia. The patients receiving IV contrast are going into renal 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 count to absolute lymphocyte 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) 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 and LFTs 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 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.

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- 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. 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/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 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

gman
gman

thank you, for the post and your work.

MrLiberty
MrLiberty

So no measures of the patients actual HEALTH status at any point? No zinc levels, no vit. D, C, A levels. Just the typical “run after the symptoms and ignore the root cause or the patient.” No wonder the battle is being lost on so many.

RiNS

Notice they didn’t try the malaria drug.. interesting

gman
gman

“LETHAL SUPERVIRUS”

question: you’re a small tribal entity that feels entitled by god to rule the world, but the cattle just won’t cooperate and outnumber you by 100 to 1. what kind of weapon do you need to win?

answer: ….

Jason Calley
Jason Calley

The Chinese military scientist in the video is only saying what every person with knowledge of the subject would say. The Communist Party is guilty of withholding information on the severity of the outbreak, but that does not mean THEY made it or let it loose. Remember that this China virus is not the first disease outbreak in China in the last year. First all the hogs were wiped out. Then all the ducks and chickens were wiped out. Then the corn crop was wiped out. THEN the Wuhan virus hit, and at exactly the time when it would spread the most. It is possible that China might have four successive accidental pandemics, but unlikely. I think that China has been under bioattack, perhaps to weaken them while the US undergoes the inevitable breakdown of its failing fiat financial system. Actually, the whole world is under attack. Additionally, the timing of the virus is exactly what is needed to cover for the largest transfer of wealth and power in human history while the Global Deep State and the 0.01% sweep up everything.
Last summer Chinese farmers reported unmarked drones flying over their farms, apparently infecting the animals before the hog pandemic broke out. Last December, large areas of the US Midwest reported fleets of unmarked drones flying patterns over fields and farms — and the FAA and US Military said they had no idea who was controlling them. If they were spraying an animal disease, it would have broken out by now, but if it were a dormant spore or organism awaiting the spring plantings, who would know? If this year’s US harvest shows major losses from disease in the corn and/or wheat crops, I will assume it has been planned. I think it is the Deep State (and Bankers) doing it, but no doubt somehow the Chinese will get blamed for it.

gman
gman

“I think that China has been under bioattack”

my conclusion as well, a systematic comprehensive attempt at ethnic cleansing.

“Samson went and caught three hundred foxes, and took torches, and turned the foxes tail to tail and put one torch in the middle between two tails. 5 When he had set fire to the torches, he released [c]the foxes into the standing grain of the Philistines, thus burning up both the shocks and the standing grain, along with the vineyards and groves.” judges 15:4-5

and the chinese responded with

“Then the Philistines said, ‘Who did this?’” judges 15:6

Anonymous
Anonymous

When will emp attack occur?

SeeBee
SeeBee

Please Lord, take the poor suffering bastards dying with CV quickly, so we can free up beds for those with real diseases.

hardscrabble farmer
hardscrabble farmer

Now all we need is a true believer deep within the US Government, preferably at the CDC or related department who will act at the proper time based upon his/her loyalty to another faction.

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hardscrabble farmer
hardscrabble farmer

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SeeBee
SeeBee

You hit it on the head with his physiognomy. Fauci aka Fauxi. Please somebody sneeze on him. They are all Incestuous blood suckers.

hardscrabble farmer
hardscrabble farmer

Can you imagine a 72 year old man writing these fawning messages? Hillary’s speech on World in Transition: Charting a New Path In Global Health was so profound he was moved to tears?

Pathetic.

And this is the guy in charge, huh?

Mygirl...maybe

He’s gay.

Anonymous
Anonymous

Then who gets the strap-on? Tony or Barry?

SeeBee
SeeBee

Hillary.

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