next_rounds_on_me

In your vagina

So the lungs primary job is to exchange oxygen and CO2 at the alveolar level. The alveoli are tiny balloon-like structures at the very end of your bronchial tree. You have millions of them. We call getting oxygen into he bloodstream "oxygenation". We call getting CO2 OUT of the blood stream "ventilation".

Illness or injury can cause these tiny, delicate alveoli not to function. Oxygen or CO2 can reach dangerous levels. Rapid onset of inflammation in the lungs can cause ARDS (acute respiratory distress syndrome). This can be very dangerous. And it is a snowball effect - the worse these numbers get, the less able the lungs are to correct them. Eventually they just cannot.

We intubate with an endotracheal tube and connect the patient to a ventilator. Most strategies from there involve setting a set pressure to fill the lungs (and see what volumes we get) or set a specific volume to deliver to the lungs (and see what pressures we get. Then there is the rate of breaths, the inspiratory time, the I:E ratio, the rise time of each breath, how much pressure we leave in the lungs at the end of each breath, and how much oxygen we deliver. We are basically trying to force air into the lungs in a very specific way so we can make those alveoli function better, without causing harm. We monitor the patient and make changes as necessary.

The ultimate goal of using a ventilator it to keep the patient alive long enough to overcome the disease process.

Good question! That is the problem and one reason it is so important to keep us safe and healthy!

On any given day I manage 4-7 ventilators in the ICU. That means I am actively monitoring the patient, collaborating with other disciplines, and optimizing the therapy. If I have to manage more than that, quality of care declines for sure. But in what could be a battlefield scenario we will do the best we can.

Yes! We are trying to get PPE from any local source we can! Had 200 N95s donated by a guy who cleans crime scenes...

We are ok now, low on masks and sanitizer but ok. If things get crazy in the next 2 weeks we are in trouble.

Well it won't be much training. It will be a protocol we are told to follow. It will designed to take the decision making away from us, which I appreciate. They haven't rolled it out and I hope they won't need to.