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Severely suffering from the coronavirus, there are those who are reanimated and those who are not. This is due to the clinical condition and the prognosis. – In medicine, there is the so-called futile therapy protocol. A person who has no prognosis is not subject to any extraordinary interventions: no oxygen is pumped, no drugs are administered to improve and stabilize the circulation, ‘says Bartosz Fiałek, a doctor who popularizes the knowledge about COVID-19.
- On January 11, we crossed the border of 100 in Poland. deaths from COVID-19
- A person with COVID-19 can die from respiratory failure, most often due to pneumonia
- – We will never let a patient die of hunger, pain and fear. Even if the patient cannot be resuscitated, he still receives the appropriate preparations – says the doctor
- – At the HED, it happened that we intubated a patient and connected them to a ventilator while performing emergency procedures. Some of them could not be saved, i.e. spontaneous circulation could not be restored. They died – emphasizes Fiałek
- You can find more such stories on the TvoiLokony home page
Edyta Brzozowska, Medonet: The coronavirus still takes its death toll, we have up to several hundred victims every day. Over 100 have already died in Poland. people, including a growing number of those who have not been vaccinated. How do you die from the coronavirus?
Doctor Bartosz Fiałek: A significant cause of death in the course of the disease is respiratory failure, which occurs most often due to pneumonia. The virus enters the patient’s cells and begins to multiply very intensively in them. This stage is usually very rapid, especially in people without vaccine or post-infection immunity. Lung cells are damaged and they stop fulfilling their role – they do not carry out gas exchange.
It may be accompanied by shortness of breath, high fever, dry cough. This is the main cause and mechanism of COVID-19 dying. However, sometimes thromboembolic events also occur secondarily.
What happens to such a patient?
If we are talking about pulmonary embolism, it depends. We are dealing with low, medium and high risk embolism. In the first two cases, patients are usually conscious. However, they struggle with shortness of breath and increased heart rate. Some people experience hemoptysis or uncharacteristic chest pains. Sometimes some people lose consciousness.
Myocardial infarction or ischemic stroke may also be a consequence of thromboembolic events. In severe cases, the heart may also stop beating, which simply loses its ability to pump blood. This is called SCA, i.e. sudden cardiac arrest, which is the cause of most deaths, including those in the course of pulmonary embolism.
The rest of the article under the video.
Which patients go under a respirator?
It depends how much respiratory distress they are. We use various methods of oxygen therapy. We can give oxygen through the so-called whiskers – then the oxygen flows are lower. We can use an oxygen mask to increase oxygen flows or nasal cannulae – then the administered dose of oxygen is higher, high-flow. In extreme cases, we implement invasive mechanical ventilation. This method consists in intubating the patient, i.e. inserting an endotracheal tube into his trachea and connecting him to a ventilator. All this to force air into the lungs with the help of a machine. Then we treat the patient with known and authorized methods.
How long can a patient stay under a ventilator?
There is no data on the length of stay under a respirator. The sick person lies down until his body – as we say in medical jargon – “declares itself”.
Or else he will heal, become breathable and will not need invasive mechanical ventilation, and the ventilator will be disconnected. Or he will die.
This type of verification is not the time, but the clinical condition and prognosis of a patient suffering from respiratory failure.
What constitutes the patient’s clinical condition?
We assess the clinical condition on the basis of a medical history (interview – in conscious patients), physical examination of the patient, i.e. physical examination, and additional tests, such as laboratory tests, i.e. detailed test results: ionogram, parameters of renal, liver and lung function, lactate concentration or finally, the parameters specific for a given organism.
What are the doctors monitoring during this time?
Arterial blood gases are collected all the time. We observe its pH. We assess respiratory efficiency on the basis of parameters such as the partial pressure of oxygen and carbon dioxide. The monitoring methods are very detailed. They talk about whether the patient still needs a ventilator or not, because his condition has started to improve and the amount of gases ventilating the patient’s lungs can be gradually reduced. When recovery occurs, the patient is extubated, i.e., the tracheal tube is removed from the trachea and oxygenated passively via an oxygen whisker or mask if it still requires supplemental oxygen.
- Have you been infected with COVID-19 and are worried about the side effects? Check your health by performing a comprehensive test package for convalescents
What if the doctors see that there is no more chance for the patient?
In medicine, there is the so-called futile, persistent therapy protocol. In the face of a person who has no prognosis, no extraordinary interventions are used: no oxygen is pumped through the respirator, no pressurized amines, i.e. drugs used to improve and stabilize the circulation. These include adrenaline, noradrenaline, dopamine, dobutamine. In the event of SCA, resuscitation is often withdrawn.
Anesthesiologists and intensivists, who assess the patient’s prognosis, play a role here. There are some patients who are reanimated and some who are not reanimated – this is due to the clinical condition and prognosis.
Of course, we will never let a patient die of hunger, pain and fear. Even if the patient cannot be resuscitated, he still receives appropriate preparations to prevent the occurrence of the above-mentioned symptoms.
Why are ventilated patients unconscious?
The condition commonly referred to as pharmacological coma is necessary, first of all, for the patient to be safe and not to “fight” with the endotracheal tube. It should also be remembered that with the help of a respirator you breathe completely differently than physiologically, which is painful. In addition, the patient is sedated (sedation is the administration of sedatives and hypnotics – ed.), Because such pharmacological action does not allow the patient to worry or feel anxious. Pharmacological “amnesia” is important and even salutary in people who undergo long and unpleasant treatment that could be associated with suffering, pain, fear. Some people, however, die in this coma.
- Also Read: Why Do Young People Die From COVID-19? [WE EXPLAIN]
Have you dealt with many deaths from COVID-19 patients?
Of course. At the Emergency Room, it happened that during the rescue operations, we intubated the patient and connected it to a ventilator. Some of them could not be saved, i.e. spontaneous circulation could not be restored. They were dying. It started with shortness of breath, respiratory failure, followed by cardiac arrest. They were resuscitated, but to no avail. And although it is not a very common phenomenon in HEDs, because the seriously ill are treated and die mainly in wards, there are patients in such an advanced stage of the disease that they also die after being brought to the HED. Although, of course, there were also many who managed to restore their spontaneous heart rate and transfer them from the HED to the target ward.
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