Doctor on the Horrors of the Pandemic: Rescuing a Dying COVID-19 Patient with Your Own Hands

The COVID-19 disease that has moved to Lithuania has fundamentally changed the work of most doctors, especially those working in the resuscitation and intensive care departments (RITS).

True, the realization that the coronavirus should be handled differently did not come right away.

Richard P., an anesthesiologist and resuscitator in the hospital’s intensive care and resuscitation unit, recalled persuading hospital administration and infectologists in March to get tested for COVID-19, even if he was not visiting areas of risk identified by the Ministry of Health (SAM) at that time.

So, no one knew what to do if the coronavirus test performed on the patient was positive.

At the time, the importance of personal protective equipment was not yet fully understood, so a COVID-19 patient who suffered clinical death was resuscitated without them.

The beginning of the fight against the pandemic was described physically by Dr. Richard P. on his Facebook account of the social network. With your permission we present the story on the portal. Delphi for readers:

With the new Chernobyl on fire, I want to share memories of mid-March.

QUARANTINE VIENNA

March 16, 2020, RITS on hold

After the RITS consultation, we began to prepare for the treatment of COVID-positive patients. Infectious Diseases Hospital inspected, where a 4-bed intensive care unit with 2 wards is being built [taip niekada ir nepanaudotas]. Upon arrival for inspection, a bathroom is installed. penny pincher.

The resuscitation department demonstrated the dressing and undressing procedure and began preparing reports on personal protective equipment (PPE). [kurias po to išdalijome ne tik kitiems skyriams, bet netgi kitoms ligoninėms]. Based on recommendations from global health societies, colleagues prepare guidelines for the treatment of COVID-19 in our department.

The Dr. comes to the room. a nephrologist to advise on treatment tactics for a patient with ventricular arrhythmias. The patient has been hospitalized since Friday, March 13, has returned ill from abroad and has undergone emergency dialysis for established kidney failure. Another half laughs and half serious question about whether a patient has been screened for COVID turns out not to be, and it was only a short time in our ward on Friday, because a catheter had to be inserted into a large blood vessel before dialysis.

Within a few hours, colleague D is called in to resuscitate and transports the same patient from the dialysis room. He suffered clinical death from ventricular fibrillation during dialysis. A laryngeal mask was inserted during resuscitation and emergency resuscitation assistance without PPE was provided during the rescue operation.

Both in radiography 03-13 and in computed tomography 03-16, image of ARDS and viral pneumonia, bilateral pleurisy. Blood lymphocytopenia. More and more light bulbs light up in my head. At night, we are persuading management and infectologists to ALLOW the patient to be tested for COVID. The arguments for NOT investigating range from “no indication because the patient did not visit countries at risk according to the SAM list” [nors toje šalyje tuo metu jau nustatytas plitimas visuomenėje, o keliauta per Stambulą]as well as “don’t squeeze and don’t panic” to “what will it look like and what should be done if the test is positive?” Finally, permission is granted, advice and bill of lading is completed for express transportation of the test to Vilnius.

The patient remains conscious, drowsy, breathing oxygen through a mask with a reservoir. In the RITS individual room, which we suddenly turned into a makeshift insulating box, staff in very different PPE work for the patient. In the boxing hall, where there has long been a stock of medical supplies, there is a drug-safe blood gas analysis machine that walks without PPE.

At about 1 pm we received a call from a Vilnius teacher in the evening; We are in a rush to announce that the patient’s COVID test is positive. We call upstairs, in the middle of the night, the administration goes to the hospital: the head of the ward, a head nurse, introduces herself as the deputy director responsible for establishing contacts. After rethinking the tactics, when the scheduled work stops, the isolator is prepared on the premises of the operating unit of the surgery department on the first day. Much friction and empty talk. Workers begin installing barriers, replacing the DPV oxygen reducing nozzle, as different sections have different oxygen inlets.

Around 5.30 pm we return to the resuscitation department. As soon as they are placed on wheels to transport patients in the hallway, the supervisor urges the patient to be intubated and transported to the DPV to be transported to the isolator until the wee hours of the morning.

With two nurses, J and E, we are fully dressed in PPE for the first time. In his eyes I see fright, fear, anxiety, resentment, the question in the air is “why us?” And “what will happen next?” There’s no time to think that I probably don’t look better. We prepared all the necessary tools, medications for accelerated induction, a video and simple laryngoscope, a set of intubation tubes, a walker, we discussed the action plan and entered boxing. After the banal and worn “we will give you the medicine and you will be relieved immediately”, we begin to put the patient to sleep. The patient has an aspect of suffering, obviously suffocated, seems scared, tired. The oxygen mask has been dropped, so it will be of little use. When the patient falls asleep and stops breathing with the help of an intubated video scope, we protect the aerosol with which the virus spreads the most in accordance with all international recommendations; We don’t start DPV until the circuit is connected and the tubing cuff is inflated. Peer counseling has been very helpful here, what if we hadn’t?

Although we work slowly, after so many layers of PPE are already hot, the glasses fog up and impair visibility. Continuing with PVD, we take the patient to the prepared isolator on the ground floor. As soon as you walk through the box door, a rod for hanging infusion solutions falls to the ground. Turns out it’s been broken for a long time and clings to tobacco. We step aside and get into the elevator. They all leave as if they were lepers, there is no elevator operator, well, self-service. We ride between the floors until we finally stop at the first. It turns out that it was necessary to press 2, because 1 is a basement, as we did not understand here before …

The insulator is already covered. Depressing atmospheric despite the old cheery and toning operating colors of the first day surgery department [didesnis kontrastas bus tik teikiant reanimacinę pagalbą sunkiai sergantiems karantinuotiems pacientams, COVID korpuso patalpas įkūrus vaikų ligų skyriuose]. The negative pressure room ventilation required to prevent the spread of the pathogen to clean rooms is not and will not be [kitame izoliatoriuje jį pakeis per langą išvesta šlanga]. There can only be positive pressure room ventilation in the operating room, because it is clean; the design was designed to prevent pathogens from entering, therefore the room ventilation is turned off completely. After an hour, the window will not open and will not close during the entire operation of the isolator, despite the fact that we are working in the focus of a particularly dangerous infectious disease.

We arrived at 8pm in the morning, when theoretically someone should change us. It turns out the team is still considering, negotiating what will be done, training in the section on how to properly dress and undress the PPE. 9 pm an angry and abandoned nurse comes to the patient to get a shift. Thank God everyone is already beyond the isolator door, preparing the PPE with the eyes of a large drowning animal.

The insulator has already been named REACTOR