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Guy1980
Registered: 09/11/12
Posts: 723
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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 [Re: morrowasted]
#26569643 - 03/31/20 05:44 PM (3 years, 9 months ago) |
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Quote:
morrowasted said:
Quote:
Guy1980 said: I don't think it is saying that. I believe the presence of troponin T indicates recent heart damage (within 7 days ish).
"On admission, none showed evidence of acute myocardial infarction"
They are just clarifying that the elevated troponin is due to the viral cardiomyopathy and not due a recent MI
So my heart damage (due to acute MI) doesn't make me a likely death candidate? CVD is minimal (LAD stented 2 years ago, no evidence of CVD other than stented area).
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morrowasted
Worldwide Stepper


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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 [Re: koods] 3
#26569667 - 03/31/20 05:56 PM (3 years, 9 months ago) |
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Quote:
koods said: You should read it again.
Quote:
The mortality during hospitalization was 7.62% (8 of 105) for patients without underlying CVD and normal TnT levels, 13.33% (4 of 30) for those with underlying CVD and normal TnT levels, 37.50% (6 of 16) for those without underlying CVD but elevated TnT levels, and 69.44% (25 of 36) for those with underlying CVD and elevated TnTs.
The paper is titled "cardiovascular implications of fatal outcomes..." The paper is not about the cardiovascular damage caused by the virus, though it does briefly discuss it. The paper is about the relationship between certain kinds of cardiac conditions and the development of complications and the efficacy of various treatments with covid19.
Quote:
Of 187 patients, 66 (35.3%) had underlying CVD including hypertension, coronary heart disease, and cardiomyopathy, and 52 (27.8%) exhibited myocardial injury as indicated by elevated TnT levels.
since it doesnt specificy WHEN 52 of the 187 exhibited elevated troponins, I assumed it meant ON ADMISSION because all of the other health history factors listed there like CAD and HTN are clearly "on admission". You may be correct that it means 27% developed elevated troponin by the end of hospitalization. If that is the case then it means some people with a medical history of CVD did not even have myocardial injury because there was not a measurable rise in troponin. Only a few people without preexisting CVD saw elevated troponin and their outcomes were still better. And honestly those people probably do have some sort of heart problem like an undetected valve or conduction issue
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morrowasted
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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 [Re: Guy1980] 2
#26569677 - 03/31/20 05:58 PM (3 years, 9 months ago) |
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Quote:
Guy1980 said:
So my heart damage (due to acute MI) doesn't make me a likely death candidate? CVD is minimal (LAD stented 2 years ago, no evidence of CVD other than stented area).
if you have dead heart tissue from it then unfortunately yes your risk is worse.
All that sentence was trying to was establish that the prognostics they came up with were directly related to covid in all patients and not related to a recent heart attack
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Guy1980
Registered: 09/11/12
Posts: 723
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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 [Re: morrowasted] 3
#26569698 - 03/31/20 06:11 PM (3 years, 9 months ago) |
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Quote:
morrowasted said: if you have dead heart tissue from it then unfortunately yes your risk is worse.
All that sentence was trying to was establish that the prognostics they came up with were directly related to covid in all patients and not related to a recent heart attack
Awww maaaan!
Ah well, it's still only 13% likelyhood of death
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morrowasted
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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 [Re: koods] 3
#26569700 - 03/31/20 06:12 PM (3 years, 9 months ago) |
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Quote:
koods said:
Exactly. 27.8% developed injury during hospitalization
No no the point is to say "We controlled for recent MI, so these people who died with the elevated troponins died because of the virus, not because their heart was already failing related to a recent heart attack."
They are trying to give information about prognosis. What they are saying, in effect, is, "People with elevated TnT are more likely to develop complications leading to death and need more intensive treatment. Most of the people who came in with elevated TnT had pre existing heart disease, but none of them had an elevated TnT because they just had a heart attack. A few people without any known history of heart disease also had elevated TnT, and while their outcomes were worse than those whose TnT never elevated, they were better than those with both elevated TnT and pre-existing heart disease."
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InfiniteDreams


Registered: 10/25/19
Posts: 1,224
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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 [Re: morrowasted]
#26569702 - 03/31/20 06:13 PM (3 years, 9 months ago) |
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I'm fuckin' peakin'; on this 'vid man.
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morrowasted
Worldwide Stepper


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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 [Re: InfiniteDreams]
#26569711 - 03/31/20 06:17 PM (3 years, 9 months ago) |
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I wonder how feevers' relative is doing
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tyrannicalrex
Strange R



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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 [Re: Niffla]
#26569747 - 03/31/20 06:31 PM (3 years, 9 months ago) |
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Quote:
Niffla said:
Quote:
Jokeshopbeard said:
I don't deny any of that.
But did you see the two videos and link that I posted that in response to? I mean, really..
No but I will check them out.
I do feel for the people of China though. There's a lot of hate going their way too just because they were unlucky enough to be from where it originated, and that could've been anybody. Like the UPS guy at work, who's Hispanic -- there's this woman who works at the company I work for who isn't even Chinese (she's Vietnamese) and the guy said something about how "this shit all started because of them". I mean some real racist overtones & hate were seeping right through how he said it. I'm sure there's a lot of that going on, unfortunately.
Fucking asshole Texan! 
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viraldrome



Registered: 09/21/18
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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 [Re: morrowasted] 2
#26569751 - 03/31/20 06:34 PM (3 years, 9 months ago) |
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This guy who died in my area was 34 and his only major health problem was asthma
https://www.cbc.ca/news/canada/edmonton/shawn-auger-alberta-covid-19-death-1.5515885
Avoid this bug like, well, the plague
-------------------- Lysergamides I have tried so far: 1P-LSD, 1cP-LSD, ALD-52, AL-LAD, LSZ, ETH-LAD, MIPLA, EIPLA, 1cP-AL-LAD
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Niffla



Registered: 06/09/08
Posts: 46,484
Loc: Texas
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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 [Re: tyrannicalrex] 1
#26569779 - 03/31/20 06:43 PM (3 years, 9 months ago) |
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HAIL OUR NEW OTD KING
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specialpeopleclub


Registered: 04/10/14
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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 [Re: Niffla]
#26569853 - 03/31/20 07:29 PM (3 years, 9 months ago) |
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Like I said, dirty culture that lacks responsibility or honesty. That's what communism does. Free markets allow exchange, communism steals and destroys.
That's why mainland China is a terrible, dirty, disease causing, rude, dishonest place full of kids that don't brush their teeth and people that don't wash their hands And Taiwan represents the best of current Chinese culture. That's why the CCP wants it. They burned their historical records on the mainland. a generation was told to defy any social convention.
I'll add, it isn't about race. There are plenty of things race can predict with some accuracy, and I've said extensive things about that. This is just communism doing what it does with any culture.
I didnt word my other post well. Asante is a leftist with fake morals and had to defend the most ethnocentric people in the entire world.
Chinese culture, and it's reverance for authority, along with it's want to 'save face' go well with communism's and rejection of the individual It creates the most evil government known to the world at any point in history.
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Crazy_Horse
I’m Rick James, bitch!


Registered: 08/15/16
Posts: 13,283
Loc: Hampsterdam
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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 [Re: specialpeopleclub] 7
#26569859 - 03/31/20 07:32 PM (3 years, 9 months ago) |
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Quote:
specialpeopleclub said: Like I said, dirty culture that lacks responsibility or honesty. That's what communism does. Free markets allow exchange, communism steals and destroys.
That's why mainland China is a terrible, dirty, disease causing, rude, dishonest place full of kids that don't brush their teeth and people that don't wash their hands And Taiwan represents the best of current Chinese culture. That's why the CCP wants it. They burned their historical records on the mainland. a generation was told to defy any social convention.
I'll add, it isn't about race. There are plenty of things race can predict with some accuracy, and I've said extensive things about that. This is just communism doing what it does with any culture.
I didnt word my other post well. Asante is a leftist with fake morals and had to defend the most ethnocentric people in the entire world.
Chinese culture, and it's reverance for authority, along with it's want to 'save face' go well with communism's and rejection of the individual It creates the most evil government known to the world at any point in history.
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Edited by Crazy_Horse (03/31/20 07:44 PM)
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LogicaL Chaos
Ascension Energy & Alien UFOs




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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 - A Global Pandemic [Re: viraldrome] 1
#26569882 - 03/31/20 07:42 PM (3 years, 9 months ago) |
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Quote:
viraldrome said: This guy who died in my area was 34 and his only major health problem was asthma
https://www.cbc.ca/news/canada/edmonton/shawn-auger-alberta-covid-19-death-1.5515885
Avoid this bug like, well, the plague
Fuck thats scary. I have a co worker whos in his 20's who has asthma. I hope he doesnt catch the Coronavirus
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feevers


Registered: 12/28/10
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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 [Re: morrowasted] 7
#26569906 - 03/31/20 07:49 PM (3 years, 9 months ago) |
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Quote:
morrowasted said: I wonder how feevers' relative is doing
She ended up diagnosed with COVID, Influenza B, and pneumonia, what luck . First night in the hospital she got up to go to the bathroom, passed out (less than 86% O2) on the way and literally broke her jaw, came to on a stretcher surrounded by nurses. No idea why she was allowed to walk in that condition
The next day she felt the same if not worse, with the added pain from her jaw. Today she's starting to feel better, they had her up in a chair for a a little bit, tomorrow they're gonna try a walk. Hopefully it's all on the upswing from here.
Not sure what treatments they've had her on, she's been a little too preoccupied to chat. Her sister and sister's fiance both are diagnosed now as well, but didn't get hit as hard as her it seems. They still got completely leveled though. I'm glad it seems like she'll come out unscathed, idk how it would've played out if she never went to the hospital though, she was basically choking for air.
This thing scares the shit out of me
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morrowasted
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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 [Re: feevers] 2
#26569925 - 03/31/20 07:55 PM (3 years, 9 months ago) |
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Glad she is okay
Quote:
No idea why she was allowed to walk in that condition
I can virtually promise you she wasn't, but generally all they do is put an alarm on the bed that signals if someone gets out of it. When you're really busy, coupled with the fact that most bed alarms are false alarms... mistakes happen. Nobody wants to restrain patients.
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Niffla



Registered: 06/09/08
Posts: 46,484
Loc: Texas
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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 [Re: feevers] 4
#26569931 - 03/31/20 07:57 PM (3 years, 9 months ago) |
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sheesh dude
good to hear that she's showing improvement though
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HAIL OUR NEW OTD KING
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koods
Ribbit



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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 - A Global Pandemic [Re: LogicaL Chaos] 2
#26569960 - 03/31/20 08:17 PM (3 years, 9 months ago) |
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Occassionally I will start following the stories of people who are sick. This one ended today. Sorry the order is backwards
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NotSheekle said “if I believed she was 16 I would become unattracted to her”
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specialpeopleclub


Registered: 04/10/14
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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 - A Global Pandemic [Re: koods]
#26569963 - 03/31/20 08:20 PM (3 years, 9 months ago) |
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Fuck, fuck, fuck...
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psilocybinjunkie
relaxin



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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 [Re: Guy1980]
#26570001 - 03/31/20 08:40 PM (3 years, 9 months ago) |
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Quote:
Guy1980 said: So my heart damage (due to acute MI) doesn't make me a likely death candidate? CVD is minimal (LAD stented 2 years ago, no evidence of CVD other than stented area).
Many ER doctors and Cardiac Specialists say that people with no prior history are showing serious Cardiac events from Coronavirus in the US. So any type of preexisting cardiac issue would be a higher risk than none at all.
https://nypost.com/2020/03/31/coronavirus-can-cause-heart-injury-even-for-those-without-underlying-issues-study/
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koods
Ribbit



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Re: Coronavirus 2020 aka Wuhan Coronavirus aka COVID-19 [Re: psilocybinjunkie] 1
#26570027 - 03/31/20 09:00 PM (3 years, 9 months ago) |
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http://texags.com/forums/84/topics/3102444/7
Quote:
In my 7 days on one of our (now 12!) non ICU #COVID19 units, I admitted 58 patients for COVID rule out, of whom 50 tested positive. Two died (DNR), 2 went to hospice, and 5 went to the ICU. That is not my typical gen med service week. Following, some clinical observations.
My experience perfectly matched published reports. Procal universally low. Ferritin, CRP, d-dimer elevated. Lymphopenia prominent. Patchy infiltrates on CXR. Diarrhea common. So, I want to share some other things I haven't seen talked about as much.
1st, I was shocked by the persistence of fevers. My patients had fevers every day, often all day, often >39, for days on end, not especially Tylenol responsive. And they had all had several days fevers before admission.
2nd, the fevers did not seem particularly related to outcome. In fact most of my ICU transfers did not have persistent fever. They did, however, make patients miserable.
3rd, this is not your usual sepsis picture. NONE of my patients, even the deaths/ICUs, developed meaningful AKI or liver failure (most had trivial transaminitis). There is no multiorgan failure. Just respiratory failure (I know reported later cardiac; I didn't see those).
4th I did have a bunch of mild troponin elevations, but mostly demand ischemia. No EKGs c/w myocarditis. Suspect too late a complication for me to see.
5rd, as noted by others, just about all of my patients had had symptoms for 7-10 days before needing admit for O2. This posed a conundrum for the few who were admitted with <5d sx (all on RA) keep to await nadir? Can't afford the beds. Had to discharge with warning.
6th, I found CRP and ferritin often to move in opposite directions (usually CRP while ferritin still ; CRP leading indicator?). This was confusing. Moreover, I had patients with ferritin >3,000 who did well and others with <800 who struggled. So, not universally helpful.
7th, as noted by others, these patients deteriorate fast. Really fast. I started calling ICU for any patient who went from RA to 6L in <24 hours; nearly all wound up at least on 100% NRB or high flow if not intubation.
8th I kept underestimating their exertional hypoxia. Learned my lesson when I transferred one pt to lower acuity floor and he had a syncopal event getting from wheelchair to new bed. Walked all patients with pulse ox prior to d/c.
9th On the topic of syncope, I admitted 3-4 COVID+ patients with presenting complaint of syncope (2 with head lacs), all early in course, with orthostatic hypotension without significant antecedent fevers. Could COVID be having some effect on autonomic system?
10th Our standard protocol right now is azithro/hydroxychloroquine/zinc but I have little faith in efficacy. For the patients I really worried about (fast O2 requirement rise, high inflammatory markers) I gave tocilizumab off label. Clinical trial of sarilumab starting this week.
11th Proning is now standard in our ICU and I tried hard to get my sicker patients to do it too to head off intubation. This is much harder than it sounds. Most patients couldn't get into position on their own, found it uncomfortable (back pain), refused.
12th Most of my patients didn't eat anything. Partly lack of taste/smell, partly misery with fever, partly hypoxia with exertion, partly lack of visitors/staff in room to encourage and help. Several asked me for soft diet to reduce effort of chewing. Must attend to nutrition.
13th Lastly, one of the biggest concerns for non-critically ill patients was persistent painful cough. Most had paroxysmal dry, wheezy coughing spasms, often precipitating desaturations. Tried cough syrup, albuterol MDI with spacer (avoiding nebs), codeine, with little effect.
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NotSheekle said “if I believed she was 16 I would become unattracted to her”
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