But this would be the exact concern is that all HCP are at risk at all times in a large room during NIV, intubation, and codes.
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problem is that BiPAP is much more aerosol generating where as vented patients are fine aside from intubation/extubation and puts HCW in higher risk.
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That’s what I said... Large rooms would work for covid unit, not requiring more than 6LNC.
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agree with you, should have hit the reply button for the tweet above yours. It would be one thing if we all had plenty of bunny suits and PAPRs, quite another to have the same N95 for a whole week...
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might there be a way to safely throw a drape/makeshift helmet /tent over CPAP patients? Personally I would hate to go straight to intubated+sedated (and then possibly dead) without at least a trial of NiV..
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In any other circumstance, you’re not wrong, this simply not worth the risk.
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i worry about the staffing ratios of all of these intubated +sedated patients... will we have the healthy bodies + meds to monitor them all safely in ICU? CPAP you can give them a mask and leave them alone for a bit...
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This is where your logic falls apart. An intubated patient is a much more stable situation with a secured airway. CPAP/BIPAP is an impending airway. I’d much rather manage intubated patients from afar than someone on NIV.
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Sorry I have limited experience with this personally but interview w Italian intensivist said half his patients do well on CPAP if they don’t immediately fail within the first 2 hours, those that respond well do so quickly.https://clinicalproblemsolving.com/2020/03/18/episode-71-on-covid-19-a-conversation-with-colleagues-from-italy-part-1/ …
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If we get to the point of being out of ventilators, NYC may already be there, this makes sense. Otherwise, I don’t see how CPAP is less risky from a total perspective. Im not opposed to cpap, but I am opposed to virus exposure to an already thin workforce.
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appreciate your perspective doc. As a hospitalist worry we don’t have enough intensivists so wondering how we can shift burden onto our side more. Scary situation all around. Be safe 


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How is your institution handling rule-outs? That’s how our hospitalist service is responding. Took a gen med floor, made it covid rule out. Needs to meet admission critieria and make sense to be tested. If greater than 6LNC go to MICU. This is subject to change with volume Im sur
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we have some testing capacity so we do test and dc from the ED. One dedicated unit for confirmed+, similar escalation ICU. They stay on regular floor airborne until PUI ruleout. more capacity expected next week hopefully <24h. Manageable currently but worried about scaling...
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