During this unprecedented surge of COVID-induced lung injury, many critical care providers have been brushing up on their ARDS management. But one physician is being be a little more proactive. In recent weeks, Pulmonary/Critical Care fellow, Al Veelus, has taken to proning all hospitalized patients – not just those in the ICU with hypoxia, but all patients on the floors, all consults, and all obs patients, especially those without any pulmonary problems.

“We all know about proning the sickest patients”, said Veelus, “But why stop there?”

Initially ridiculed for his low threshold to flip the script, Veelus is now gaining hospital-wide recognition for his early intervention. He’s been known to flip cellulitis patients, invert nose bleeders, and flatten even the healthiest of DVT cases. For pregnant patients, he employs a rotisserie-style, continuous rotation to ensure even proning on all sides. He even sent an enterprise-wide email recommending that janitors and cafeteria workers self-prone while on breaks.

One nurse reported that Veelus even proned a patient who was dressed and standing in his room waiting for discharge. “I had never seen anything like it!” she said, “The man’s a human spatula!”

Widely praised for his stewardship in saving PPE, Veelus downplays his role. “I’m just fighting back against the disease”, he states, “After all, you can’t spell ‘stewardship’ without ARDS.”

NEW YORK, NY – In a truly last-ditch effort to prevent U.S. stocks from crashing, the Federal Reserve Bank of New York has asked Pharmacy for 1 amp of bicarb.

“I’M LOSING A PULSE, WE NEED ONE AMP OF BICARB, STAT!”

As health care professionals know, 1 amp of bicarb (short for sodium bicarbonate) can be the difference between life and death, more so than any other invention: CPR, oxygen, epinephrine, treating reversible causes, you name it.

The U.S. and world economies had plunged last month as a result of the continuing spread of the pandemic coronavirus, which has brought daily life for Americans to a screeching halt. The Federal Reserve pulled out its policy “big guns” by cutting interest rates to nearly zero and buying back over $500 billion of securities. Unfortunately, these had little to no effect on investors.

“PUSH THE BICARB, HURRY!”

Like the rest of the nation and our readers, Gomerblog has its fingers crossed and hopes this 1 amp of sodium bicarbonate is what prevents us falling into a recession. Maybe, just maybe, the Federal Reserve’s move will deflect total economic fallout and possibly even cure the scourge that is COVID-19.

And if it doesn’t work? Health care professionals know the answer and hopefully the Fed does too: MORE BICARB.

NEW YORK, NY – When COVID-19 cases in Manhattan started ramping up, local orthopaedic surgeon Brock Hammersley knew he wanted to help however he could. 

So he went to the ICU at Elmhurst Hospital and offered to help in any way that he could.  An ICU nurse gave him an N95 mask, a gown and size XXL gloves. The nurse then asked Hammersley to help her with an intubated patient. 

I said “it’s time for pulmonary toilet” RN Patrick Marsh told Gomerblog. “Then Doc Hammersley took off running out of the room and said ‘I’ll get it!’ That was the last time I saw him for 5 hours.”

Hammersley apparently spent the following 5 hours searching for a “pulmonary toilet.” In every bathroom inside and around the ICU. 

“At least he took off his PPE and washed his hands as soon as he left the patient’s room before beginning his misguided walkabout” RN Marsh noted. 

“So apparently ‘pulmonary toilet’ is just a fancy way of saying pulmonary hygiene. I don’t remember learning that in any of my ortho coloring books and it definitely wasn’t covered in the GI Joe cartoon or books,” Hammersley admitted ashamedly. 

As COVID-19 continues to spread through the population, we are increasingly finding the availability of PPE to be limited. Hospital staff are told to reuse disposable masks and to consider wrapping scarves around their faces to protect again a deadly virus. Healthcare professionals have turned to the Internet, asking that people who have supplies of PPE at home to consider donating to their area hospitals.

A few members of the “prepper community” have spoken out against this. A man who asked only to be identified as “’MERICA DUDE” responded, “What harm could the 19 cases of N-95 masks I bought last year do? I like to make a couch out of the boxes and watch Red Dawn and not that remake you know I only watch the original. WOLVERINES!!!!!!!” Another popular Internet poster, “FreedomRockEagle194”, wrote “Listen to the whiney little doctors and nurses cry that they weren’t smart enough to stockpile equipment that someone else would need and would be of limited utility to them.”

Surgeon General Adams has responded to the members of this community by releasing the first ever downloadable Home ECMO PDF. In the file, there are a list of suggested household items to put yourself or loved one on V-V or V-A ECMO. Recognizing the fierce spirit of independence that Americans have, the Office of the Surgeon General wanted to give the prepper community the ability to provide themselves with advanced extracorporeal oxygenation and circulatory support from the comfort of their own bunkers.

Critical Care Attending Dr. Carla Sanchez commented, “Trying to cannulate your own IJ with a sharpened snorkel may seem difficult, but at least you’ll have gloves to do it!”

GREENEVILLE, TN – St. Indignant’s Health Care System has announced a new partnership with the U.S. Department of Health & Human Services to pilot an innovative drive-thru intubation clinic in the parking lot of their main campus. This new service is in accordance with new Centers for Disease Control & Prevention (CDC) guidelines for outpatient management of high-acuity patients in areas with limited available ICU resources. The new CDC guidelines also outline fashionable fabric and pattern recommendations for front line providers tasked with cobbling together their own personal personal protective equipment (PPE) for in hospital use (spoiler alert, plaid is out like beards!).

“Whelp, it’s here, well not where I’m at thank Jesus but where the hospital is- and it’s kicking our butts,” CFO Glenn Gilded reported via email from his vacation home in St. Martin when asked about the new initiative. “Frankly, it makes sense. We don’t have any ICU beds and so the patients are probably more comfortable and better isolated in the comfort of their own living rooms than some grimy hallway. Plus, we’d be using less of that sweet, sweet PPE! We’re always thinking about employee safety.”

“We originally intended to include portable ventilators with the service,” Gilded added. “But, turns out we’re reaaaally low on those too. So, we’re including a BVM and multiple ETT extenders in the care package so that patient can use their own thighs to squeeze the bag while they’re chilling on the couch and enjoying their paid vacation from work. They’ll live – and they’ll have shapely thighs on the other side of all of this.”

When asked what these patients should do for sleep, Gilded added “They can show a family member how to do it or something; it’s just squeezing a friggin’ bag every 5 seconds.”

As for a system to manage extubations after the courses of treatment are complete, Gilded offers that hospital administration doesn’t anticipate a significant need. “We’ll stay attuned to the needs of our community and partners in this time of incredible difficulty. If we get funding, maybe we’ll throw something together to get those tubes out, too. In the end, we’ll all get through it. And, we’ll throw a hell of a pizza party when it’s all said and done.”

NYC, New York – The recent coronavirus outbreak has devastated New York City to say the least. Their infection rate almost out numbers the rest of the United States combined. With a shortage of ICU beds on the horizon and the lack of ventilators the CDC has decided to “just put the whole city on a ventilator.”

“This is unprecedented,” Dr. Fauci told reporters Thursday. “We are running out of options so I decided to recommend the whole city get ventilated.”

A large glass dome was constructed immediately. It was then airlifted over the city to effectively intubate New York City. “All new ventilators coming into the state, can now be dispersed to other citizens throughout the state,” Governor Cuomo proudly told reporters. “This ‘Fauci dome’ as we like to call it, is saving millions of lives.”

The citizens seem to be rounding a corner right now in the world’s largest ICU.

This story is breaking so continue to refresh for updated news.

San Diego, CA – In light of the ongoing COVID19 Pandemic, physicians of all walks of life are preparing to be called upon to work outside of their comfort areas. Orthopaedic surgeons have largely been quarantined to gyms but a few brave Orthopods are venturing out trying to “re-learn” ICU medicine so that they can help if the time comes.

One such orthopod is our own Naan Derthaal DO, FAAOS. The results have been….um…interesting.

SPOKANE, WA – Sometimes you have to think outside the box. That’s exactly what a rapid response team did this morning: In a last ditch effort to prevent intubation, the team has cranked up their patient’s nasal cannula to 4,000 liters/minute.

“The patient is hypoxemic but placing an endotracheal tube ain’t no picnic for the patient either,” screamed respiratory therapist Max Davenport, barely audible over the high oxygen flow. He was wearing ear muffs like the rest of the rapid response team. “I imagine this is what being in a wind tunnel feels like.”

The patient was admitted for shortness of breath two days ago, presumed secondary to acute on chronic systolic heart failure, and had been responding to diuretic therapy before becomingly acute hypoxemic. The patient does admit to feeling a little better compared to the measly 2 liters she was on before, though complains her face is slowly detaching from her skull. Of note, the patient did have urine output of 1.5 liters prior to the urine being blown away by the gale-force oxygenation.

“But at least her oxygen saturation has come up to 78%,” Davenport insisted, as the patient’s IV pump and monitor were knocked over by the force of the nasal jet stream. “Besides the face mask and the intubation kit are all the way over there.” He gestured to the crash cart that was all the way on the other side of the patient’s bed. It was an understandable scenario. “Maybe let’s crank it up to 5,000 liters.”

Anticipating this next move, two of the floor nurses were already wheeling in a second jet engine to help power the oxygen tank.

ATLANTA, GA – In the same way patients can be progressively difficult sticks from the venous standpoint, the same holds true for their arteries. Thankfully one determined ICU resident didn’t let this stop her as she was able to emergently and successfully place an arterial line into the circle of Willis.

“Only one word can describe this performance and that’s clutch,” said pulmonary critical care attending Dr. Max Mathiason, praising third-year medicine resident Gina Richter. He points towards the patient’s monitor. “Excellent waves forms, we’ve been able to get crucial ABGs and routine labs to help with management. Again, clutch.”

The patient was brought in by EMS after being found down, and initial work was concerning for septic shock. In the emergency room, patient had a central line successfully placed. However, the radial arterial line clotted off.

“I attempted a few more arterial lines, but couldn’t get them,” Richter told Gomerblog. “The patient was cool and clammy and the blood pressure cuff reading was unreliable. We needed that A line. I knew what I had to do.” In one try, Richter successfully placed the catheter into the patient’s circle of Willis. Not bad for a first try.

The patient is currently in stable condition.

“The good thing is that an arterial line is a safe procedure, granted that’s when dealing with arteries outside the brain,” explained Mathiason. “Talk about threading the needle. But she did it. The patient has no evidence of complications: no infection, meningitis, stroke, aneurysm, intracranial hemorrhage. Even our neurosurgeons said they couldn’t have done a better job. If that’s not a compliment, I don’t know what is.”

ER STATION – All aboard! Health care professionals, have your tickets and IDs in hand as you get ready to step aboard the Hot Mess Express! This is the Hot Mess Express #4139 at ER Station making 12 stops with final destination ICU City!

This express train makes the following stops: Altered Mental Station, Los Chest Pain, The Twin Cities of Hypoxemia & Hypercapnia, ATN Park, Shock Liver Land, Troponin Town, San Anemia, Can’t Peeville, Sepsis City, Intubation Station, Pressor City, and ICU City!

This express train DOES NOT make stops at Double Portions or Narcoticos.

Please watch your step as you board the Hot Mess Express! We apologize for all the tangled Foleys, telemetry wires, IV lines, central lines, rectal tubes, as well as the paperwork saying “Full Code.” Again, please watch your step!

This is a fast-moving express train – the Hot Mess Express doesn’t wait for anyone – so please find your seats quickly, buckle up, and hang on tight!

Do take a moment to read the safety pamphlet found in the seat pocket in front of you should this Hot Mess Express experience a train wreck.

Just a reminder that only the first four cars of this train platform at both Troponin Town and Shock Liver Land. Additionally, students and interns are allowed on this train but require 24/7 adult supervision. Finally, any members of Palliative Care can ride this express train for free, just show your conductor your ID badge!

Departing ER Station in 2 minutes, estimated arrival at ICU City in 3 minutes! ALL ABOARD!!