4 ms·

It is a ventilator in terms of displacing exhaled CO2 via the volume of air moving through the circuit, mask and lungs. It also provides positive pressure to a

It is a ventilator in terms of displacing exhaled CO2 via the volume of air moving through the circuit, mask and lungs. It also provides positive pressure to aid in more effective oxygenation. There is alot of selective focus and attention to "ventilators" currently. The danger is people believe that a fuller featured ventilator will save them when in reality (it will in some cases) public health focus should (arguably is) be on everything that can be done to keep COVID patients from being intubated and needing a full featured ventilators. There is a risk that we run out of ventilators because they are dedicated to long term life support of patients that become dependent on them when they could be providing the short term ventilatory support of patients who will recover enough not need one. This is another scenario given our medical capabilities, well trained healthcare workers, and cultural outlook we are not yet talking about.

iso1631 7y ago
> This is another scenario given our medical capabilities, well trained healthcare workers, and cultural outlook we are not yet talking about. In the UK the ethics boards are working on policies for triage
- jcrubino 7y ago
  I saw the Italians intubation protocol has this in mind. A very public discussion of these issues could create more panic than productive conversations in the media, but it really it will need to be addressed openly sooner or later before long-term ventilators start stacking.
  - iso1631 7y ago
    One person I speak to online is a reverend, who's been asked to be part of an ethics committee which will be making those decisions when resources run out What do you optimise for? Number of lives saved? Number of Years saved (so better to save someone with a life expectancy of 40 years than 2 people of LE of 5 years each)? Do you remove ventilators from those who it's just delaying the inevitable? How to do you factor in non-covid cases? Do you take into account how "good" the patient was? Were they self isolating or did they go to a pub lockin? Have they been hoarding toilet paper? Do you save the person who caught it performing CPR? What about the Key Worker who caught it while delivering food to the town? How about the dumbass politician who's encouraging people to ignore the restrictions?
    - jcrubino 7y ago
      Generally (Used to be) in the united states the social worker will present the general ethical frameworks to reason within and it is up to family to provide the answer. Ethics boards develop recommendations as needed, when courts have to step in. I will say working in a Trauma and ICU rooms, families are generally well aware of the decisions to be made when it is time.
      - iso1631 7y ago
        What do you mean "up to family"? 500 people outside need ICU beds, 6 patients have just died, so you have 6 new beds open. Which of the 500 do you treat?
        jcrubino 7y ago
        Family = Next of Kin They are assigned a triage score and that score will be updated routinely. As beds open, the people who fit the criteria get the bed. I believe that is fairly standard in a public hospital type setting. I have only ever worked in public and military icu, wards, er and trauma rooms so I do not know too many details on how that works in practice.

iso1631 7y ago

> This is another scenario given our medical capabilities, well trained healthcare workers, and cultural outlook we are not yet talking about. In the UK the ethics boards are working on policies for triage

jcrubino 7y ago
I saw the Italians intubation protocol has this in mind. A very public discussion of these issues could create more panic than productive conversations in the media, but it really it will need to be addressed openly sooner or later before long-term ventilators start stacking.
- iso1631 7y ago
  One person I speak to online is a reverend, who's been asked to be part of an ethics committee which will be making those decisions when resources run out What do you optimise for? Number of lives saved? Number of Years saved (so better to save someone with a life expectancy of 40 years than 2 people of LE of 5 years each)? Do you remove ventilators from those who it's just delaying the inevitable? How to do you factor in non-covid cases? Do you take into account how "good" the patient was? Were they self isolating or did they go to a pub lockin? Have they been hoarding toilet paper? Do you save the person who caught it performing CPR? What about the Key Worker who caught it while delivering food to the town? How about the dumbass politician who's encouraging people to ignore the restrictions?
  - jcrubino 7y ago
    Generally (Used to be) in the united states the social worker will present the general ethical frameworks to reason within and it is up to family to provide the answer. Ethics boards develop recommendations as needed, when courts have to step in. I will say working in a Trauma and ICU rooms, families are generally well aware of the decisions to be made when it is time.
    - iso1631 7y ago
      What do you mean "up to family"? 500 people outside need ICU beds, 6 patients have just died, so you have 6 new beds open. Which of the 500 do you treat?
      - jcrubino 7y ago
        Family = Next of Kin They are assigned a triage score and that score will be updated routinely. As beds open, the people who fit the criteria get the bed. I believe that is fairly standard in a public hospital type setting. I have only ever worked in public and military icu, wards, er and trauma rooms so I do not know too many details on how that works in practice.