New York 4/4/2020 Samantha Heavrin

KyANA CRNAs on the COVID-19 Front lines in the HotSpots
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Day 4: Getting Real! I started these posts for my family. I wanted to offer them insight and to give them a glimpse of our journey in the war against covid. I discovered that my friends and coworkers were sequestered at home, desperate for an understanding in this new world. So they have been reading my posts too. I have to say that I am honored to have anyone read what I write. Thank you to anyone who wants to share my posts. I cannot imagine any higher praise. As most of you know, I have switched deployments from a nursing based public hospital system to an anesthesia team for a group of private hospitals. Over the next few weeks, I intend to share my experiences. Be prepared to read scary and upsetting information. I’m not intending to sugar coat this story. I believe that we are starving for facts. Our greatest fear is of the unknown. If we can illuminate the covid beast then we can face him fearlessly. I intend to educate my fellow crnas on current practices in covid infested situations. I want the rest of my crna family to be prepared. Most importantly, I want everyone to know that we can no longer hide behind false comforts. We are NYC. We will be exactly where they are today, in a matter of weeks? Months? Nobody knows! We must be prepared! Now that I have probably scared my family to death, I want to add a caveat. We can win this war. Thru all of the death and destruction and financial ruin, we will overcome. I believe in every one of us. We have what it takes to survive! Now to business.... Today we met with our fearless Anesthesia leader, who from now on will be known as Dr. Awesome (Dr. A for short). Salle and I went to his suite where he has boxes of supplies for us. We received ppe, snacks, backpacks and a ‘gym in a bag’ for in-room workouts! Today, there are a dozen of us in this hotel. Within the week, we will number over 100-150! Our jobs will vary from intubation teams to icu management to line placement. Today Salle and I are resting. I brought a bunch of reference books and we are reviewing them. For those of you who don’t know, the medical field of information is so broad that picking up a book to refresh your knowledge is important from time to time. We have learned a great deal since we arrived from both our studies and from Dr. A. I’m going to share this information....

1) Cardiac Arrest You may have heard about EMS discontinuing resuscitation and any advanced life support on cardiac arrest patients. We learned that young adult patients are more likely to experience cardiac arrest. The resuscitation methods only work for a short duration and are ultimately unsuccessful. The very difficult decision to not resuscitate these patients was based on its futility. Running a code takes great manpower and supplies. Unfortunately, these things are not easy to come by today. I want to pray for the individuals who had to painfully make that decision. It will weigh on them throughout their lives. I also pray for the patients and their families subjected to this decree. I hope they do not feel abandoned.

2) Covid and the Lungs The lungs contain tiny, balloon shaped air sacs that sit at the end of a respiratory tree. These sacs are called alveoli. The alveoli function is to exchange oxygen and carbon dioxide molecules to and from the bloodstream. Any impedance between the alveoli’s ability to exchange oxygen and carbon dioxide results in respiratory distress which can lead to respiratory collapse then cardiac death. Covid causes the alveolar wall to thicken. The thickening makes transport of oxygen into the alveoli and carbon dioxide out of the alveoli difficult. Respiratory distress happens when the patient becomes hypoxic (can’t get enough O2). The treatment for hypoxia is to place the patient on the ventilator. The vent will force the air into the alveoli and oxygenate the patient. CRNAs The vent settings to start... FiO2 100% Do not worry about oxygen toxicity! Peep 8 to start. Peep can be increased to 25. However, we are seeing frequent cardiovascular collapse after 15. TV should be set to limit peak pressure to NO more than 30mmHg. Many of these patients are on low TV to accommodate the peak pressure and peep. Weaning....If you’re so lucky... Wean FiO2 first. Once it’s weaned you 50% then start to back off peep. This way we don’t lose recruitment. Once FiO2 is 50% and peep is 8, we can start to discuss extubation. Do your best but do not feel like a failure if you cannot save the intubated patient. We have been informed that less than 5% of the intubated patients are surviving.

3) In Conclusion I want to conclude my post today by reminding everyone to be kind to each other. Each of us is faced with stresses and difficulties. Help each other! Are you working? Check on those who are not working! Find a place to donate food! We can face this together! Let us pray to God for guidance and support. Let us pray that God will use the healthcare workers to save lives. And, to instill within us the ability to comfort those who’s lives cannot be saved that they may find an everlasting life. Stay prayerful my friends!

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