KyANA CRNAs on the COVID-19 Front lines in the HotSpots
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Day 14: Mask Warnings

I’m writing from my hotel bed. It’s very fluffy and I have about 8 pillows. I love my off days!  I stopped by Salle McAfee’s room and we started discussing Louisville.  Apparently, healthcare providers are working with ‘any’ mask. And, N95s are not available. Healthcare providers have been told that the hospitals ordered the N95 masks and they were absconded for NYC.

First of all, it’s ridiculous that we are limited in N95s. With millions unemployed, START MAKING THEM! Stop blaming NYC.

Secondly, a traditional mask or cloth mask with a filter is NOT for work with covid suspected/confirmed patients. It only provides ‘some’ protection. Those masks can be used for limited public exposure. Additionally, this will be our new normal every time we exit the house until we have immunization. EVERY TIME!! Our lives have officially changed...it’s a fact.

However, healthcare workers with suspected/confirmed covid patients must have N95. All healthcare workers must have N95. There are no exceptions here! If you are not provided with an N95, DO NOT WORK!

Healthcare workers are getting sick. The theory is that they contract covid then continue to be exposed, increasing their viral load. The higher viral load is suspected to cause greater illness.

Don’t work!!! You cannot help patients if you’re sick. Hospitals that cannot provide N95 need to figure it out. Not your problem. There are solutions for these hospitals but risking YOUR life is not one of them.

Thirdly, I have heard gossip that some people have their own N95 masks and are not being permitted to wear them. I can sum that up in one word....LUDICROUS!! Here in NYC, you can bring your own or wear the N95 provided. Some healthcare workers have respirators (I never thought I would have respirator envy :flushed: but I do). There are many different options and everyone should be free to make their own decision. The only exception is any mask that does not provide covid particulate filtration.  Please pray that we find an immunization soon. Pray for the scientists working long hours to fight this beast. May God enlighten them.  Peace and health my friends!

Same day:  Covid Education: Patient Proning for the Lay Person

There are many treatments being used for Covid patients. I plan to cover several of them this week. And, this is education for the layman. Meaning, it’s simple because that’s how I like to learn.

Everyone is talking about Proning. What does it mean? How does it work for Covid patients?

Let’s begin...

The two body positions are prone and supine.  Prone means lying on one’s stomach. Supine means lying on one’s back. We remembered this is nursing school by saying ‘when you’re supine, you can hold a bowl of soup in your hands’.  Proning a patient is how we optimize oxygenation. Naturally, when lying on our backs we experience some degree of VQ mismatch. Illness makes it worse.

VQ is a reflection of V-ventilation and Q-perfusion of the lungs from the heart. The amount of pressure our body uses to move blood from the heart into the lungs is low. As a result of the low pressure, the body also utilizes gravity to move the blood.  When a patient is supine (lying on their back), gravity causes the blood to move to the lower areas. In this case that would be the back/the area closest to the patient’s bed. So, the richest, most highly oxygenated blood goes to the alveoli furthest down.

Unfortunately, the act of lying supine causes the alveoli to become squished and incapable of using that good blood. We call it atelectasis. So, where are the big fluffy alveoli? On the top of the chest. It’s not fair!! That’s the VQ mismatch.

In order to match the big fluffy alveoli with the good blood we.....flip the patient like a pancake! We put them prone!  After a few hours the body adjusts and the alveoli closest to the bed start to squish and become atelectic. The fix?? Flip them supine!!

Covid causes hypoxemia ( lack of O2). Optimizing the patient’s ability to use the oxygenated blood helps with the hypoxemia.  Proning teams have been used in the hospitals to optimize the patients ability to use that good, highly oxygenated blood. Ideally, we would flip them every 4 hours. However, the number of patients and available team members only permit 8 to 16 hours between flips.

If we use pronation and supination in the hospital, where else can we use it?? AT HOME! If you are suffering with Covid (or any oxygenation issue), make sure to flip yourself onto your stomach then back again every few hours. (Of course, this is not to be confused with medical advice. Discuss with your doctor).  Let’s pray for patients who need pronation. They are struggling to survive the Covid beast.  Thank you friends.