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Generic situation unfolding across the US.
Mrs X is three days post COVID diagnosis. She hasn’t been eating. She’s growing more confused. Her oxygen levels are low. She lives in an assisted living facility. She walks and talks on her own, loves her grandchildren, has a good life
Mrs X is three days post COVID diagnosis. She hasn’t been eating. She’s growing more confused. Her oxygen levels are low. She lives in an assisted living facility. She walks and talks on her own, loves her grandchildren, has a good life
The staff check Mrs X oxygen levels. They’re now low enough to require oxygen. An ambulance is called and she’s transported to a local hospital. She’s now afraid and confused. The people now caring for her are unfamiliar and wearing gowns and masks and goggles. I want to go home
She tells you. You hold her hand. It’s ok Mrs X we are here to help. Please wear this oxygen for me ok? We’re going to draw some blood and snap a chest x ray! Please just keep your mask on for me ok? I’m scared, she says.
Me too, you think. But you squeeze her hand and tell her
Me too, you think. But you squeeze her hand and tell her
You’re not alone. I’m here ok.
The chest x ray is bad. The oxygen levels don’t go up with oxygen, in fact, they go down. As her hypoxia increases, so does Mrs X’s fear and anxiety. She begins to tear off her mask. Try to get out of bed.
The chest x ray is bad. The oxygen levels don’t go up with oxygen, in fact, they go down. As her hypoxia increases, so does Mrs X’s fear and anxiety. She begins to tear off her mask. Try to get out of bed.
Please Mrs X, please leave this mask on, ok?
I want to go home! Where is my husband?
You know he’s deceased. You know it’s time to move towards more aggressive measures. She won’t tolerate BIPAP. Airvo it is.
I want to go home! Where is my husband?
You know he’s deceased. You know it’s time to move towards more aggressive measures. She won’t tolerate BIPAP. Airvo it is.
Please Mrs X this will help.
Call the family. Message left.
Like hypothermic people remove their clothes, hypoxic elderly adults removed their oxygen and IVs. They assign you to stay with Mrs X, keep her in bed, her oxygen on. Fight to keep her off the vent, hard as you can.
Call the family. Message left.
Like hypothermic people remove their clothes, hypoxic elderly adults removed their oxygen and IVs. They assign you to stay with Mrs X, keep her in bed, her oxygen on. Fight to keep her off the vent, hard as you can.
It’s not working. She’s crying. Afraid. In a strange place, surrounded by strange people. You hold her hand. You beg. Cajole, distract, sing, ANYTHING to keep her oxygen on.
She is now afraid she’s hitting you. You know she’s just scared. You are crying behind your mask.
She is now afraid she’s hitting you. You know she’s just scared. You are crying behind your mask.
You ask about sedation. But it will knock down her drive to breathe. She’s fighting to breathe as much as she’s fighting you. Then it happens. The rapid decompensation. O2 drops. The eyes glass over. It’s time.
You call for help. Mrs X has gone limp. Her breathing is ineffective
You call for help. Mrs X has gone limp. Her breathing is ineffective
You place a new mask on her face and try to seal it while simultaneously squeezing a bag to deliver oxygen.
Outside the room your coworkers are frantically gowning up, and it seems to take forever.
GET THE RSI KIT.
Get a 7.5 ETT.
Who’s got suction?
Draw up the meds.
Outside the room your coworkers are frantically gowning up, and it seems to take forever.
GET THE RSI KIT.
Get a 7.5 ETT.
Who’s got suction?
Draw up the meds.
Bag faster. Her sats are 70.
I can’t, you say. Hard to bag. Even with a PEEP valve. Give the meds. Drop the ETT. Get a chest x ray. Get sedation on board! She’s fighting the tube.
Sats are still 70x heart rates dropping. 149, 120, 90.
Give paralytics.
BP is dropping.
Mix Levo.
I can’t, you say. Hard to bag. Even with a PEEP valve. Give the meds. Drop the ETT. Get a chest x ray. Get sedation on board! She’s fighting the tube.
Sats are still 70x heart rates dropping. 149, 120, 90.
Give paralytics.
BP is dropping.
Mix Levo.
Make sure you’re still talking to her. Tell her you’re still here. She’s not alone. You’re here. You’re here. You’re here.
Rhythm change. Monitors blaring.
Do we have a pulse? DO WE HAVE A PULSE WITH THIS?
Start CPR. Give Epi. Hyperventilate.
I am here, Mrs X, I am still here.
Rhythm change. Monitors blaring.
Do we have a pulse? DO WE HAVE A PULSE WITH THIS?
Start CPR. Give Epi. Hyperventilate.
I am here, Mrs X, I am still here.
Pulse check.
Try the family again.
Resume CPR.
Administer meds.
Keep bagging.
Repeat.
I’m still here, Mrs X.
Still here.
Pulse check. Do we have a pulse?
Try the family again.
Resume CPR.
Administer meds.
Keep bagging.
Repeat.
I’m still here, Mrs X.
Still here.
Pulse check. Do we have a pulse?
What’s our down time?
What’s our end tidal with CPR?
Have we gotten ahold of family?
Does anyone have any suggestions?
Resume CPR.
One more round of ACLS.
I’m still here, Mrs X.
What’s our end tidal with CPR?
Have we gotten ahold of family?
Does anyone have any suggestions?
Resume CPR.
One more round of ACLS.
I’m still here, Mrs X.
Time of death.
Make sure the eyes are closed. Fold the hands on top of the chest. Draw the sheet up.
Squeeze her hand.
I’m sorry, Mrs X.
Stay home for the holidays.
Make sure the eyes are closed. Fold the hands on top of the chest. Draw the sheet up.
Squeeze her hand.
I’m sorry, Mrs X.
Stay home for the holidays.
