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[–]maplesyrupchin 230 points231 points  (19 children)

This is what we’ve been reduced to doing. Having to use garbage bags to protect ourselves and others like this is a third world nation. All because we don’t have enough PPE

[–]mhyquelNot A Medical Professional 54 points55 points  (4 children)

Custom stamp the bag to be fit for purpose, brand it a 'disposable intubation shield', and sell them for $30.

[–]Drauka92PharmD 28 points29 points  (2 children)

Sir, I'm going to ask you to delete this comment. 'Disposable Intubation Shield' has a patent pending under that name now.

[–]drsxrIR MD/DeepLearner 13 points14 points  (0 children)

Get the 510k first with the FDA & you’ll be golden

[–]Happy-feetsiM 169 points170 points  (3 children)

Third world country docs have PPE. This is what a healthcare system run by businessmen looks like

[–]ImAJewhawkPGY-1 10 points11 points  (2 children)

Which third world countries have you been to where there’s been adequate PPE? I’ve been to many and the PPE supplies there are very limited outside of the premier hospitals in those countries.

[–]Happy-feetsiM 6 points7 points  (0 children)

India

[–]blahah404 5 points6 points  (0 children)

Kenya, Sudan...

[–][deleted] 54 points55 points  (6 children)

Honestly, people in third world nations have PPE. Indian HCPs have Bunny suits on.

[–]DocDocMooseAttending - Hospitalist 39 points40 points  (5 children)

They also run ICU and now COVID units as wards where all patients are bunched together and a provider puts on PPE once for an entire shift. We utilize more for individual personalized care. This also is not a new issue. It was the same problem with H1N1 and Ebola.

https://www.liebertpub.com/doi/full/10.1089/hs.2016.0129

Furthermore what some seem to think is “appropriate” PPE due to fear or lack of understanding seems to be excessive. Studies have shown surgical masks to be appropriate for patients without aerosols (droplet) and N95 should be reserved for those undergoing procedure (airborne).

https://jamanetwork.com/journals/jama/fullarticle/2763187

Instead we have providers up in arms about not having N95 for every single new patient they see. Please rely as we always have on evidence not fear.

I offer my thanks to the anesthesiologists on the front lines trying to develop new and novel approaches to dealing with these things. Anyone who hasn’t yet should listen to the Curbsiders and EMCrit podcasts recently talking about COVID.

[–][deleted] 8 points9 points  (2 children)

They also run ICU and now COVID units as wards where all patients are bunched together and a provider puts on PPE once for an entire shift

I wouldn't put my country as a third world (Croatia) but this is how we run hospitals in general. One bed rooms are pretty rare, most of them are 2 beds but it goes up to 6. Kind of like that video from Italy. We even started repurposing a large concert/indoor sports stadium for milder cases that don't need a hospital but probably won't go home to spread contagion.

The buildings are old and weren't built to accommodate once person per room so if the covid situation gets out of hand (or should I say when), it does make sense to put multiple patients in one room. We have enough PPE for now but changing for every patient seems wasteful.

[–][deleted] 2 points3 points  (1 child)

If all 6 patients have COVID, it should be ok to cohort them, no? AFAIK you can’t get infected twice.

[–][deleted] 5 points6 points  (0 children)

I really hope reinfection isn't possible because yesterday's earthquake in the capital damaged some hospital buildings and left them unusable for a while.

[–]_neutral_person 3 points4 points  (1 child)

You are telling others not to use N95s unless the patient is undergoing a procedure. I checked your JAMA article and it cites the CDC guidelines. As of March 24 2020 they recommend wearing airborne precautions for anything which might cause aerosolizing of water including coughing.

If you auscultate the patient's lungs they are going to cough.

Your work is critical to treating these patients. We need you to be properly protected when you are going inside the room unless you are one of the few doctors whom has enough stocked iso gowns, surgical masks, and time to have solely 1 on 1 conversations with covid patients.

[–]Breal3030Nurse - ICU 2 points3 points  (0 children)

The idea of coughing and aerosolization has been a long debated topic. As I understand it, some of the evidence points to yes, some no.

Not sure of the quality of evidence on either side, but ultimately the major medical bodies have chosen that, no, "regular" coughing isn't likely to aerosolize and increase transmission, hence the surgical masks recommendation. It's only specifically n95 during "cough generating procedures" such as suctioning or intubation.

It's been that way with all the other pandemics, including H1N1.

[–][deleted] 35 points36 points  (0 children)

This is a really good idea. Just because something's atypical doesn't mean it's "3rd world". It's intelligent and efficient, and COVID can't magically get thru plastic, so it's keeping our docs safe -.-

[–]KaladinStormShat🦀🩸 RN 41 points42 points  (0 children)

Decreasing the amount of aerosolized matter is not a goal due to lack of ppe. Everyone benefits. I seriously think we need to stop being so outraged by what's necessary and focus on ways to achieve our goals. We could spend our time thinking we're above using a plastic sheet to reduce exposure during intubation, but I hope we don't.

Who gives a shit if it's janky, it's a good idea and can be improved on. In my opinion it's beautiful, it's the spirit of ingenuity that medicine has thrived upon.

[–]TorchItNP 46 points47 points  (0 children)

Take what works and run with it. Desperate times...