What makes people need ITU?

What makes people need ITU?

The patients we are seeing all have similar stories. So much so that we have suggested we could have a rubber stamp to use instead of writing out their history. Cold or flu symptoms, then, after about a week of a dry cough that makes them feel worse than they have ever felt, they become short of breath. That difficulty in breathing is what brings them into hospital and, if severe, to our attention.

So why the difficulty in breathing? To oversimplify it, it’s fluid in the wrong place. 

I’ve taken the examples below via google. To be clear I’m not going to use the X-rays from my patients but these are representative of what we are seeing.

Have a look at the X-ray on the left. See the large areas of black within the rib cage? That’s air sitting in the lungs like it’s supposed to.

See the one on the right? See the bits that look like cotton wool? Those are areas where the immunological response to disease (in an extreme situation it can have bad as well as good effects) has led to patchy infiltrates in the lung. To grossly over simplify again - that’s the water in the wrong place. Where the air used to be there is solid matter and fluid.

Ventilation - forcing oxygen and air into the lungs using bellows. Very clever bellows, mind!

Ventilation tries to open the areas of the lungs that have become blocked off. We turn patients on their face (prone) and a few hours later on to their backs (supine). This ventilates and opens up different parts of the lung, shifts the fluid around a bit and, hopefully, ever so slowly over 10 days or more, we win. That’s it. No special medicine, no new ideas. Just solid, basic ITU care. Spotting problems each hour and correcting them. Adjusting the oxygen as necessary. Using the ventilator to open closed areas of the lung (recruitment).

And tons and tons and tons of nursing care, physiotherapy, washing patients to keep them clean to avoid further problems, taking care of pressure areas, feeding them via a tube etc etc etc. The daily skills of our ITU staff.

ITU is a team sport. Over 70 staff will interact with a single patient during their stay.

Why are we running out of beds in every country? That 10 day bed stay. If people got better in two days we would cope a lot better but they don’t.

The only way to cope is if fewer people each day got sick. That will slow down the numbers coming in and allow us to manage better for longer.

That’s why we need the population to keep away from each other. People will get the virus. People will die. People will get sick. Those that are sick need to get sick at a manageable rate.

Too many people are basically selfish idiots - see the pictures from the weekend. Worry about the ones that aren’t in a healthcare role but are typing away saying they know better. This gets worse in a crisis and is not specific to any socioeconomic or ethnic group. This is not a surprise to anyone in a customer facing role (healthcare or not). Civil disorder is already starting - again this appears to be in groups so Darwin will likely play a part.

This is why lockdown is inevitable. It’s to protect the innocent majority from the stupid significant minority.

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