Posted: Mon Apr 20, 2020 8:51 pm
https://www.insider.com/photos-video-de ... CLMSc35f3I
Denver health worker ain't taking the protester's shit.
Denver health worker ain't taking the protester's shit.
The thing about arbitrary nonsense state boundaries with no restrictions about border crossings is that if you have them for a few centuries all the people on the inside come to identify way more with national group identifiers than states.Maj wrote:I keep seeing the US split. I hope the chances of that are way smaller than what my imagination is creating. There are going to be states (South Dakota, Florida) that suck at this. And they're going to have cases long after the west coast slows way down. Which is why I asked my first question because I can see states that smashed it not wanting traffic from states that didn't. And if we get to that point, wouldn't all hell break loose just like the stupid people protesting?
https://www.nbcnews.com/tech/social-med ... s-n1188021phlapjackage wrote:With all the bullshit "Free XX" stuff from Trump and the "movements" to open states up, it seems there is/was a massive astroturfing campaign to build support for these movements. So powerful forces are sowing chaos and unrest in a country wracked by a pandemic. And Trump et al are aligned with them. Hmmmm.
https://www.reddit.com/r/maryland/comme ... e/fnstpyl/
The thing about the stupid protesters is that their position is deeply unpopular and getting more unpopular. Actual polling grossly favors harsh quarantine measures.Maj wrote:I keep seeing the US split. I hope the chances of that are way smaller than what my imagination is creating. There are going to be states (South Dakota, Florida) that suck at this. And they're going to have cases long after the west coast slows way down. Which is why I asked my first question because I can see states that smashed it not wanting traffic from states that didn't. And if we get to that point, wouldn't all hell break loose just like the stupid people protesting?
So it's really unlikely that a popular movement based on human sacrifice to try to make the Dow Jones lines go up would be able to get any real territory. Even in Iowa, a majority of people think the governor is insane and the economy is tanking anyway."Cancel all meetings or gatherings of more than 10 people, like sports events, concerts, conferences, etc."
March: 85% support
April: 87% support
""The way things stand, things in the Deep South almost have to get better. Otherwise, the people who live there will devolve into preverbal, overall-wearing sub-morons within a century," said Professor Dennis Lassiter of Princeton University. "Either Southerners will start improving themselves, or they'll be sold to middle-class Asians as pets."deaddmwalking wrote:This Onion Article is from 20 years ago, but I thought it might be relevant.
While that might be her intention, still dumb action on her part.FrankTrollman wrote:The woman on the left of the picture is Melissa Ackison, co-owner of Ackinson Surveying and current candidate to be the Republican nominee for Ohio's 26th state senate district. She isn't out there demanding that she be allowed to die for capitalism, she is out there demand that her employees be allowed to die for capitalism. And she's not the grassroots of anything, she's literally a Republican politician.
-Username17
Link, please?Kaelik wrote:Senate Democrats officially going to support another bailout, no money for states or cities, nothing for election protection or the post office, no oversight, no limits on fossil fuel bailouts, no food stamps, just give the banks another big pile of money.
It's not about lives. It's not about the economy. It's not even about Trump's election. It's about their ability to push other people around. They want to be served and they honestly do not care what happens to the GDP or how many people die.Korwin wrote:While that might be her intention, still dumb action on her part.FrankTrollman wrote:The woman on the left of the picture is Melissa Ackison, co-owner of Ackinson Surveying and current candidate to be the Republican nominee for Ohio's 26th state senate district. She isn't out there demanding that she be allowed to die for capitalism, she is out there demand that her employees be allowed to die for capitalism. And she's not the grassroots of anything, she's literally a Republican politician.
-Username17
(depending on how many in that crowd had covid-19)
I really don't understand those people the more half hearted the social distancing the higher the cost for the economy (to use their argument, the economy)...
Their sample was a pool of countries with 50,610 confirmed COVID-19 deaths and 78,200 estimated excess deaths, suggesting that about 35% of deaths are going uncounted. For the current global confirmed COVID-19 death toll of 177,641, that would indicate an actual death toll of 273,292. So just shy of a 100,000.FrankTrollman wrote:In other news, if you compare total deaths from the last month to previous yearly averages it looks like the COVID deaths are being underreported by tens of thousands. So that's a thing. Also that's a sample of ten countries and a city, so by "tens of thousands" we probably mean "hundreds of thousands."
But a lot of countries aren't really admitting to any COVID deaths, and also aren't reporting their dead. The COVID deaths in North Korea, Cambodia, and Yemen are supposedly zero, and I'm willing to bet real money that the real number is infinity times higher than that. Less dramatically, most people seem to think the official undercount in the PRC is rather more than 35%.DSMatticus wrote:Their sample was a pool of countries with 50,610 confirmed COVID-19 deaths and 78,200 estimated excess deaths, suggesting that about 35% of deaths are going uncounted. For the current global confirmed COVID-19 death toll of 177,641, that would indicate an actual death toll of 273,292. So just shy of a 100,000.FrankTrollman wrote:In other news, if you compare total deaths from the last month to previous yearly averages it looks like the COVID deaths are being underreported by tens of thousands. So that's a thing. Also that's a sample of ten countries and a city, so by "tens of thousands" we probably mean "hundreds of thousands."
This kind of analysis is going to be real goddamn sensitive to the areas you're looking at, with hot spots and areas with poor health infrastructure missing way more deaths, so, grain of salt and all that.
I have been practicing emergency medicine for 30 years. In 1994 I invented an imaging system for teaching intubation, the procedure of inserting breathing tubes. This led me to perform research into this procedure, and subsequently teach airway procedure courses to physicians worldwide for the last two decades.
So at the end of March, as a crush of Covid-19 patients began overwhelming hospitals in New York City, I volunteered to spend 10 days at Bellevue, helping at the hospital where I trained. Over those days, I realized that we are not detecting the deadly pneumonia the virus causes early enough and that we could be doing more to keep patients off ventilators — and alive.
On the long drive to New York from my home in New Hampshire, I called my friend Nick Caputo, an emergency physician in the Bronx, who was already in the thick of it. I wanted to know what I was facing, how to stay safe and about his insights into airway management with this disease. “Rich,” he said, “it’s like nothing I’ve ever seen before.”
He was right. Pneumonia caused by the coronavirus has had a stunning impact on the city’s hospital system. Normally an E.R. has a mix of patients with conditions ranging from the serious, such as heart attacks, strokes and traumatic injuries, to the nonlife-threatening, such as minor lacerations, intoxication, orthopedic injuries and migraine headaches.
During my recent time at Bellevue, though, almost all the E.R. patients had Covid pneumonia. Within the first hour of my first shift I inserted breathing tubes into two patients.
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Even patients without respiratory complaints had Covid pneumonia. The patient stabbed in the shoulder, whom we X-rayed because we worried he had a collapsed lung, actually had Covid pneumonia. In patients on whom we did CT scans because they were injured in falls, we coincidentally found Covid pneumonia. Elderly patients who had passed out for unknown reasons and a number of diabetic patients were found to have it.
And here is what really surprised us: These patients did not report any sensation of breathing problems, even though their chest X-rays showed diffuse pneumonia and their oxygen was below normal. How could this be?
We are just beginning to recognize that Covid pneumonia initially causes a form of oxygen deprivation we call “silent hypoxia” — “silent” because of its insidious, hard-to-detect nature.
Pneumonia is an infection of the lungs in which the air sacs fill with fluid or pus. Normally, patients develop chest discomfort, pain with breathing and other breathing problems. But when Covid pneumonia first strikes, patients don’t feel short of breath, even as their oxygen levels fall. And by the time they do, they have alarmingly low oxygen levels and moderate-to-severe pneumonia (as seen on chest X-rays). Normal oxygen saturation for most persons at sea level is 94 percent to 100 percent; Covid pneumonia patients I saw had oxygen saturations as low as 50 percent.
To my amazement, most patients I saw said they had been sick for a week or so with fever, cough, upset stomach and fatigue, but they only became short of breath the day they came to the hospital. Their pneumonia had clearly been going on for days, but by the time they felt they had to go to the hospital, they were often already in critical condition.
In emergency departments we insert breathing tubes in critically ill patients for a variety of reasons. In my 30 years of practice, however, most patients requiring emergency intubation are in shock, have altered mental status or are grunting to breathe. Patients requiring intubation because of acute hypoxia are often unconscious or using every muscle they can to take a breath. They are in extreme duress. Covid pneumonia cases are very different.
A vast majority of Covid pneumonia patients I met had remarkably low oxygen saturations at triage — seemingly incompatible with life — but they were using their cellphones as we put them on monitors. Although breathing fast, they had relatively minimal apparent distress, despite dangerously low oxygen levels and terrible pneumonia on chest X-rays.
We are only just beginning to understand why this is so. The coronavirus attacks lung cells that make surfactant. This substance helps the air sacs in the lungs stay open between breaths and is critical to normal lung function. As the inflammation from Covid pneumonia starts, it causes the air sacs to collapse, and oxygen levels fall. Yet the lungs initially remain “compliant,” not yet stiff or heavy with fluid. This means patients can still expel carbon dioxide — and without a buildup of carbon dioxide, patients do not feel short of breath.
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Patients compensate for the low oxygen in their blood by breathing faster and deeper — and this happens without their realizing it. This silent hypoxia, and the patient’s physiological response to it, causes even more inflammation and more air sacs to collapse, and the pneumonia worsens until oxygen levels plummet. In effect, patients are injuring their own lungs by breathing harder and harder. Twenty percent of Covid pneumonia patients then go on to a second and deadlier phase of lung injury. Fluid builds up and the lungs become stiff, carbon dioxide rises, and patients develop acute respiratory failure.
By the time patients have noticeable trouble breathing and present to the hospital with dangerously low oxygen levels, many will ultimately require a ventilator.
Silent hypoxia progressing rapidly to respiratory failure explains cases of Covid-19 patients dying suddenly after not feeling short of breath. (It appears that most Covid-19 patients experience relatively mild symptoms and get over the illness in a week or two without treatment.)
A major reason this pandemic is straining our health system is the alarming severity of lung injury patients have when they arrive in emergency rooms. Covid-19 overwhelmingly kills through the lungs. And because so many patients are not going to the hospital until their pneumonia is already well advanced, many wind up on ventilators, causing shortages of the machines. And once on ventilators, many die.
Avoiding the use of a ventilator is a huge win for both patient and the health care system. The resources needed for patients on ventilators are staggering. Vented patients require multiple sedatives so that they don’t buck the vent or accidentally remove their breathing tubes; they need intravenous and arterial lines, IV medicines and IV pumps. In addition to a tube in the trachea, they have tubes in their stomach and bladder. Teams of people are required to move each patient, turning them on their stomach and then their back, twice a day to improve lung function.
There is a way we could identify more patients who have Covid pneumonia sooner and treat them more effectively — and it would not require waiting for a coronavirus test at a hospital or doctor’s office. It requires detecting silent hypoxia early through a common medical device that can be purchased without a prescription at most pharmacies: a pulse oximeter.
Pulse oximetry is no more complicated than using a thermometer. These small devices turn on with one button and are placed on a fingertip. In a few seconds, two numbers are displayed: oxygen saturation and pulse rate. Pulse oximeters are extremely reliable in detecting oxygenation problems and elevated heart rates.
Pulse oximeters helped save the lives of two emergency physicians I know, alerting them early on to the need for treatment. When they noticed their oxygen levels declining, both went to the hospital and recovered (though one waited longer and required more treatment). Detection of hypoxia, early treatment and close monitoring apparently also worked for Boris Johnson, the British prime minister.
Widespread pulse oximetry screening for Covid pneumonia — whether people check themselves on home devices or go to clinics or doctors’ offices — could provide an early warning system for the kinds of breathing problems associated with Covid pneumonia.
People using the devices at home would want to consult with their doctors to reduce the number of people who come to the E.R. unnecessarily because they misinterpret their device. There also may be some patients who have unrecognized chronic lung problems and have borderline or slightly low oxygen saturations unrelated to Covid-19.
All patients who have tested positive for the coronavirus should have pulse oximetry monitoring for two weeks, the period during which Covid pneumonia typically develops. All persons with cough, fatigue and fevers should also have pulse oximeter monitoring even if they have not had virus testing, or even if their swab test was negative, because those tests are only about 70 percent accurate. A vast majority of Americans who have been exposed to the virus don’t know it.
There are other things we can do as well to avoid immediately resorting to intubation and a ventilator. Patient positioning maneuvers (having patients lie on their stomach and sides) open up the lower and posterior lungs most affected in Covid pneumonia. Oxygenation and positioning helped patients breathe easier and seemed to prevent progression of the disease in many cases. In a preliminary study by Dr. Caputo, this strategy helped keep three out of four patients with advanced Covid pneumonia from needing a ventilator in the first 24 hours.
To date, Covid-19 has killed more than 40,600 people nationwide — more than 10,000 in New York State alone. Oximeters are not 100 percent accurate, and they are not a panacea. There will be deaths and bad outcomes that are not preventable. We don’t fully understand why certain patients get so sick, or why some go on to develop multi-organ failure. Many elderly people, already weak with chronic illness, and those with underlying lung disease do very poorly with Covid pneumonia, despite aggressive treatment.
But we can do better. Right now, many emergency rooms are either being crushed by this one disease or waiting for it to hit. We must direct resources to identifying and treating the initial phase of Covid pneumonia earlier by screening for silent hypoxia.
It’s time to get ahead of this virus instead of chasing it.
Richard Levitan, an emergency physician in Littleton, N.H., is president of Airway Cam Technologies, a company that teaches courses in intubation and airway management.
This is how things like Carbon Monoxide work. It binds so well to your red blood cells that oxygen doesn't get any room, and then even though you feel fine, at some point you fall asleep and die. It's just like breathing oxygen except you die. That and the easy availability are what make it a popular choice for suicide. It's what I was preparing for more than ten years ago when my meds kicked in.deaddmwalking wrote:If you're able to expel the CO2, but you're not getting enough oxygen, the symptoms are easy to overlook.
You get people dying from accidental Carbon Monoxide poisoning every so often. Often when they are asleep. There's a zillion survivalist type videos of homemade stoves on youtube but they never seem to address this point.Koumei wrote:This is how things like Carbon Monoxide work. It binds so well to your red blood cells that oxygen doesn't get any room, and then even though you feel fine, at some point you fall asleep and die. It's just like breathing oxygen except you die. That and the easy availability are what make it a popular choice for suicide. It's what I was preparing for more than ten years ago when my meds kicked in.deaddmwalking wrote:If you're able to expel the CO2, but you're not getting enough oxygen, the symptoms are easy to overlook.
I find it gallows humorous that WV is among the last to be picked for a team.FrankTrollman wrote:All in all, this is the most dystopian thing I've seen in my entire life.
On the map, its central location seems an ideal - even necessary stepping stone for imperial expansion. The map is different from the territory however. As many have learned, the harsh mountainous terrain, the fiercely independent warrior people, and the virtually incomprehensible clan politics make it virtually impossible for outsiders to maintain control for long. Historians call it the "graveyard of empires."Josh_Kablack wrote:I find it gallows humorous that WV is among the last to be picked for a team.FrankTrollman wrote:All in all, this is the most dystopian thing I've seen in my entire life.