"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 keep 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."
"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."
The whole article is interesting and worth reading. It turns out that I actually have a pulse oximeter, which I got from Amazon for about $20 a few years back. It probably needs the batteries replaced. It is about 2 inches by 1 inch, and clips onto one's finger.
I have one also, Katherine. Got it to monitor my mother's O2 level. I think it only costed $15. An oximeter and a thermometer are the only widely available COVID test.
ReplyDeleteI had not previously known that people's O2 levels could get so dangerously low before they were aware of it.
DeleteIf you have one, I would recommend every individual get a series of baseline readings and not wait until they feel ill. I'm not sure about the absolute accuracy of these devices. If one knows where one naturally measures, one can look for drops in the readings. The most accurate test involves taking blood from an artery. I understand that that hurts.
DeleteI have one. Check it every morning. But I have COPD, and my O2 level is always on the lower side.
DeleteWe had an oximeter for Dad, who had COPD. Maybe something useful to have around the home these days.
ReplyDeleteJean, check it out to make sure it's working and establish a baseline for you, Raber and the Boy.
DeleteGood advice! My O2 is usually low to mid 90s, but I am also a CO2 retainer because my blood doesn't work right, so they chart that every month or two. There are exercises I can do to help. But I have to be alert enough to know I'm "sinking" and not just sleepy. O2/CO2 can also mess with your moods. So, yah, completely believe that people can be sick with pneumonia and think it's something else.
DeleteTemperature seems like it also needs a baseline. I have never read above 97.5°F if I am not sick. But also know that doctors don't call 99° a clinical fever.
ReplyDeleteKatherine, I think time of day affects it, too. Maybe readings morning, afternoon and evening. I don't know if O2 varies depending on the time of day.
DeleteHere's a source form them for under $10, excluding shipping:
ReplyDeletehttps://www.wish.com/product/5b7a86d9e4a91374c4cdf05f?hide_login_modal=true&from_ad=goog_shopping&_display_country_code=US&_force_currency_code=USD&pid=googleadwords_int&c=%7BcampaignId%7D&ad_cid=5b7a86d9e4a91374c4cdf05f&ad_cc=US&ad_curr=USD&ad_price=7.00&fallback_cids=5ba9d30285a01e170fa085815b7d052b6a4a994f63260ce35c820455b1ad6a7c9e61ec915b8f4d2f40112e39502431f65b83e95189e0f116869234c4&campaign_id=7203534630&gclid=Cj0KCQjws_r0BRCwARIsAMxfDRhr7R5kBTg0XVf71R-HWqeSA9eOughm7TPcq1JcDpBTxw32Ig3essMaAlEIEALw_wcB&share=web
Good price, I see that Wish has a lot of health care stuff.
DeleteKatherine, many thanks for the article. Sobering! - especially for those who might be inclined to write off COVID-19 as a bad bout of the flu.
ReplyDeleteMost people don't get the severe form of the illness, but for those who get to the point of needing a ventilator, the outlook isn't good. The pulse-oximeter can give an early warning of silent hypoxia when lesser interventions are still possible.
DeleteThis was in the WaPo today. If you are at elevated risk for clots, make sure your caregivers know:
ReplyDeletehttps://www.washingtonpost.com/health/2020/04/22/coronavirus-blood-clots/
News from the front: The cases in NJ hospitals are leveling off. Social distancing is working.
ReplyDeleteYesterday, my friend's daughter who is in a COVID unit was training an older nurse who came out of retirement to care for the ventilated. By the time the day was over, the "newbie" was hyperventilating. She did not return today. The young nurse lost 11 pounds since this started and I think she only weighed 110 to start. I saw her. She's a wisp now.
The people on the front lines must be exhausted. They're going to need some serious rest and relaxation. Unlike the rest of us who are getting plenty of that.
Delete