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Leading a COVID-19 Battlefield at a Border Hospital ICU

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Update time : 2020-11-26 16:27:31


Intensive brood units are somewhat alike affair hotels can that they eat a successive turnover of patients. They were no intended during extended stays, alike hotels with kitchenettes. besides this spring, that changed dramatically.

COVID-19 patients are landing can intensive brood during since hope during 28 days or more. ago the pandemic, a natural ICU remain frequently lasted three to four days.

This is placing intense stress can medical professionals and exacerbating staffing lack issues can hospitals, specially those can rim regions.


"It's nothing alike we've prepared during -- this is no something I grew up with and trained during can ICU medicine," says Dr. Dennis Amundson, medical director of the ICU can Scripps pity Hospital can Chula Vista, California. "These are critically evil nation who lack colossal amounts of rehab. We're dealing with long-term ramifications that are unusual."

[Read: ICU nurse 'Prescribes' Mindfulness to assist COVID-19 Survivors Cope.]

Amundson has overseen brood during some 80 patients with COVID-19 can a hospital that's impartial 7 miles from the U.S.-Mexico rim can San Diego County.

A pulmonologist who served can the U.S fleet during 38 years, including multiple deployments to Vietnam and Afghanistan, he is no foreigner to intense battlefield conditions. He used to guide an ICU aboard a ship, and has accompanied mutual specific Operations order troops can missions. He finds what's occurrence now identical though to the battlefield.

"I was with domain teams and JSOC, and can that surroundings we nurse to project besides proceed can knowing the plans could completely convert once you're in," he recalls. "I feel the too brood with this pandemic now, during we commerce with a tricky, unpredictable virus."

Amundson, who is 70, came out of a nine-year retirement back he left the fleet to spearhead the ICU three years ago can Chula Vista, a rim city that's family to a important amount of underserved minorities. Many of them eat tiny or no access to symbol health care, consequently they're frequently no can the best health when they vary can to be seen and many eat chronic conditions.

"I feel alike we're making a difference with our patients and their families. It's a good manner during me to goal my vocation can medicine," says Amundson, explaining why he chose to answer to medicine, and to this specific area. "I grew up can a tiny city can Iowa, and it seems much more alike a family down here."

[Read: A physician Treating the Hard-Hit Navajo country Seethes can Structural Racism.]

With the recent extended hospitalizations, he and his team are getting to learn both the patients and their families really well, something that didn't happen before.

When San Diego County shut down can March, many local Mexican Americans lost their jobs and went to remain with family south of the rim can Tijuana. besides when they caught the virus, some becoming pretty ill, they returned stateside seeking treatment.

Among the most evil are nation with chronic underlying conditions -- diabetes, kidney disease, hypertension -- which complicates COVID-19.

"Initially, the median epoch of our patients was can their 50s, besides the ones that stayed and didn't win improve were older, can their 60s and 70s," he says.

His ICU unit has 24 beds placed can Isolation Rooms, sum of them being used to medication COVID-19 patients now. He and two other physicians and two nurse practitioners cover the engagement shifts, supplemented by per diem or temporary physicians can night. The unit also has 90 nurses.

The Chula Vista hospital is one of five Scripps hospitals, besides it has half of the health system's patients being treated during the virus. Staffing has been a challenge, specially with some colleagues reducing their hours, and Amundson and his team eat been stretched thin. Workers and machinery from sister hospitals eat been brought can to fill the gaps.

Like little other hospitals can the San Diego area, his unit did accept critically evil patients who were transferred from hard-hit Imperial County, a rural rim area two hours east of San Diego.

"We started to cry on an uptick can cases from Brawley and El Centro and when they reached out to us, we filled sum our beds, then we referred them to hospitals up north," he says.

His natural engagement starts about 5:30 a.m., when he arrives to accept can from the evening transfer staff. He does rounds -- visiting patients to determine their place and coordinate a brood project -- and notes who needs the most immediate help, then label teams with a nurse practitioner. One person stays outer the isolation units can instance of emergency elsewhere can the floor, consequently they can respond quickly without having to anxiety about decontaminating themselves.

Amundson draws can his military deployment undergo -- and a more contemporary excursion to Liberia to assist out during the Ebola outbreak -- to be strategic can how his team copes with treating high-risk, contagious patients. This helps bring brood levels down.

"We place everything we lack to proceed into a room can a mop flexible bag consequently we can quickly discover it," Amundson says. "As the SEALs say, we doff and don. We learn exactly where our gear is, we place it can carefully besides we also learn how to conduct it quickly."

When he enters a patient's room now, he pauses to ponder of everything that needs to be done and tries to win it done without leaving the room.

Typically, ICU doctors used to intubate a patient and leave, besides now he stays can the room during up to two hours, putting can a catheter queue if needed, consequently lab technicians don't eat to enter the room and nurses can tug blood, which reduces the amount of nation who step inner the Isolation Room and limits their exposure. Once he place these measures can lay can his hospital, other hospitals can the Scripps system picked up these tips and are now changing their procedures.

In the afternoons he meets with pharmacy cane and others, and ends his transfer changing out lines of tubing during patients, ago decontaminating and heading home.

The Father of six hasn't seen any of his children can person during the pandemic began. "We frequently win together often, besides now we impartial conduct Zoom each Sunday. It's been difficult to remain can isolation and no cry on them," he admits.

[Read: Pathologist Discovers Coronavirus Causes Extensive Blood Clotting.]

Initially, Amundson and the other clinicians did shifts of seven days on, seven days off, besides realized their efficiency dropped back four days due to exhaustion. Now he switches to a evening transfer midway, consequently there's improve work-life balance.

Like many other hospitals, he has been preparing during a surge, which he expects will happen if the uptick can cases continues.

He is identical concerned about how weak recovering COVID-19 patients are and the colossal amount of rehabilitation they will lack ago life returns to ordinary during them. Many of them tolerate strokes, tremors, lung scarring and center damage.

"There's really no lay during them to go, when they transition from the ICU and lack rehab, specially can the rim (region)," he worries. "What we lack is post-ICU device to assist patients become functional again."

But he is grateful to the community, which has reached out to demand how it can help.

"The battle brings out the best of nation and the worst of people," Amundson says. "It's no a sprint, it's a marathon now. It's no a fight besides a war. God voluntary we will eat a vaccine that's durable. precise now the microbe is classify of winning and we impartial eat to hunker down and include the battlefield and win ready during a longer war."


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