So…do they really need ICU?

The Media (both CBS and NBC) tell us that Covid Hospitalizations are rising and that staffing at the healthcare Facilities is low….

And that (implied but not stated), due to covid the ICU beds are in short supply. Both media outlest stated that people wait DAYS for an ICU bed….Which makes me wonder….do these folks really need an ICU bed? Is it necessary to survival? (we aren’t being told that they are DYING  because they can’t get an ICU bed) so…..do do they really need to be in ICU?

I’m not a health care professional  nor a doctor (but I have played one) so I am unable to determine when and how, exactly, the folks decide when an ICU bed is needed, but I have noticed that people in hospitals follow “procedure” like automatons, and seldom bother to think, they just Do What the Procedure says….So do these folks that are somehow surviving without being in an ICU room really need the ICU????  Or is that assignment to ICU just “Procedure”?

 

 

 

20 thoughts on “So…do they really need ICU?

  1. Procedure and ‘income’… My question is, where are the biohazard markers for the trash cans with PPE in them???

  2. Yes, they really need an ICU bed.

    I’ve been a nurse for 25 years, 20 of them in Emergency, and not just “I don’t feel good” Emergency, but the busiest trauma centers and mega-hospitals in not just Califrutopia, but the busiest ERs in the entire civilized world, in the most densely populated region of the United States. Depending on where you ask, between 10-15% of the entire US lives in my county or the bordering ones.
    120 hospitals in L.A. and Orange County. Almost as many as there are in the entire states of Oregon, Nevada, New Mexico, and Utah, combined.

    What happens to that system which usually runs right on the ragged edge of capacity 24/7/365 in normal times, when you throw a pandemic at them?

    In the ICIU, they have an intensivist MD right there, most of the time. (The floors seldom have a doctor anywhere, for anything.) The patients are either 1:1, or 1:2, which means the nurse can handle 1 patient, and at most 2, at once. I do 4 in the ER normally.

    But If I have ICU patients, and there’s no bed for them there, I can now only do 1 or 2 as well.

    I had one last month, who was on 7 different medication drips, which all had to be titrated multiple times per hour to fine tune keeping the patient alive, and in certain parameters of vital signs.

    I set my monitors to go off on the dot on the hour, and at :15, :30, and :45.
    On the hour, I logged my vital signs. Then began doing the literally 57 things for that one patient I needed to be doing. Including not just doing everything I had to do, but charting that it was done. Picture Han Solo flying the Millenium Falcon through an asteroid field. Blindfolded. By the time I was finished, it was usually :50 minutes past the hour, or more. Meaning I had 2-10 entire minutes to do all the less-than-immediate tasks for that one patient that needed doing. Then it was top of the hour, and start all over again. Lather, rinse, repeat.

    For an entire shift.

    I wasn’t the only nurse so burdened with ICU patients who couldn’t get to the ICU. Which means if anything happens (like someone’s heart stops) there’s no one free to help anyone else. (A cardiac arrest or a major trauma can suck in 3-6 staff members just from the nursing staff alone, for an hour or more). But with all of us being ad hoc ICU nurses, that ain’t happening.
    So a nurse is supposed to bag the patient, do chest compressions, start an IV, pull meds, give them, record all the interventions, all simultaneously and single-handedly? Sh’yeah, when monkeys fly outta my butt. That patient? They came in dead, and they’re going to stay that way. And even if, by some miracle, you get a pulse back, that’s another ICU patient, which you don’t have a bed for, or a nurse for, who’s shortly going to be on 2-7 medication drips, and on a ventilator, leaving the nurse scrambling to keep up the rest of the night…stop me if you’ve heard this one.

    Which means my other 3 beds were empty, because there was no one to staff them. That turns a 32-bed ER into an 8 bed ER.

    Which closes the hospital to ambulances.
    Which sends the ambulances to other hospitals, which closes them.
    You understand how one overload takes out a sector of the power grid, which can cascade into taking out an entire region over multiple states, right?
    So now, imagine that with sick and injured people.
    Except now, a blackout means people die waiting for care they cannot get.
    And makes people wait in the waiting room until they’re literally trying very hard to die too, just to get into a bed.
    If you’ve just sunk the Titanic or anything like it, and you have lifeboats for 2000 people, but 3500 on the ship, at least 1500 are going to die. but if, each time a lifeboat gets overloaded, all those people swim to the next lifeboat, you swamp each next boat in turn, and everyone dies.
    That’s where we were headed when the last COVID wave broke, just about exactly 3 weeks after people all got together for New Year’s Eve and New Year’s Day get-togethers, and until they started acting like maybe we weren’t fooling about this thing being a problem.

    And with my decades of ER experience, I’m a critical care nurse. I don’t like ICU, but I can pull it off, rough around the edges (meaning it isn’t pretty, but I don’t kill anyone or let them die through negligence or inexperience), for a shift or three.

    But there were ICU patients on telemetry floors ( a lot less intense than the ED, and two levels of severity below the ICU). And ICU patients on Med/Surg floors (three levels below ICU). Where nurses never titrate a single drip, let alone 7 simultaneously, for an entire shift. And almost never manage ventilator patients in any way. they literally don’t know what they don’t know. because they’re not supposed to be doing the most critical patients in the entire hospital on the least severe wing of the hospital, with the newest nurses.
    Some of those nurses were freshly graduated nurses weeks before COVID kicked into high gear last fall.

    And they normally handle 6 or 8 far less serious patients, not 4, 2, or 1.
    So now their 40-bed floor ward can handle 5 patients. That means you’ve just wiped 80% of the hospital’s capacity on those floors out, from the get-go.
    200 beds is now 40 beds.
    And it’s put the most seriously ill, critical patients, into the hands of the least-experienced nurses in the hospital.

    Imagine throwing 5 year-olds into the 40-foot waves on Oahu’s North Shore with a pool noodle, and you’re not too far off.

    Now see if you can figure out why some of those 600,000 people died from COVID in the last 18 months or so.

    The nurses who regularly care for the sickest ICU patients are freaking rock stars, and they can only handle at most, 2 at once.

    In the last serious COVID wave, from about Labor Day to the end of last February, half the nurses who worked in our ICU said “F**k it, I’m out!“. Forever. Burned out by 1 or 2 mega-critical patients like I had, every shift, every day, for weeks and weeks on end, understaffed, under-equipped, and ender-supplied with basic equipment and supplies. No lunches, no breaks, just a 12-hour endless slog from 7 to 7, every day or night, and the same thing tomorrow, and the next day, and the next day, ad infinitum.
    The ER and other floors lost upwards of 1/3 of our staff, for the same reasons.
    Replacements can’t be whistled up, and they can’t be trained in less than years, to a minimum level of competence.

    So hell yes, people die because we’re out of beds, out of supplies for the patients, out of PPE for the staff, and out of the staff to even show up.

    In simple terms: how many games are the Dodgers or Yankees going to win in a season if they can only put 6 or 4 players on the field?

    And what you’re asking, I assume legitimately, is “But do they really need 9 guys on the field? Do they really have to be major league players? Can’t the kids from Little League, high school, or maybe even Single-A suck it up and pull the load instead?

    So, my sincere question back to you is, what do you think the answer to that question is?

    • Aesop: I let this get posted so others would understand why I hold you in such contempt.

      You told us all here how important you were, and how much smarter and better trained than everyone else but you really didn’t say all that much.
      Nor did you really answer my question.
      But hey, you got to blow your own horn again, so I guess you made yourself feel special.

      Please, next time you comment, let it be either in answer to the post, a useful comment to the post, but please not so self serving, MMKAY?

      • Aesop pointed out why a rush on ICU beds cascades downward to the ER and to the med/surg floors. Didn’t you read it?

        When you fill the ICU and are forced to turn the ER and the med/surg floors into jury-rigged ICUs, you necessarily reduce the number of patients that a nurse in those units can keep alive.

        That cuts the capacity of those ER and med/surg units, forcing incoming patients to bounce to the next hospital, which then fills up rapidly in the same way. Don’t you see the pattern?

        Don’t you understand why ER & med/surg nurses can’t maintain an ICU level of performance when they haven’t got ICU equipment, ICU experience, or even ICU training? Don’t you understand that even some ICU nurses can’t maintain their performance for months on end when the ICU is swamped 24/7?

        • Did you not read the original post? We aren’t hearing of excess deaths because the ICU is full. Nor are we hearing that others are dying because the ER is full.
          Back to the original question: Do these folks really need to be in ICU care? ‘Cause, if so, why are they not dying in droves since they can’t be in an ICU?

  3. I rally think the ICU is important and needs highly trained folks in there doin’ what they do. I recently visited our local trauma team with a GSW. I can only describe them as medical ninjas. They are a team of pros and act that way. You don’t learn that cohesion and perfection in a two year program. Jusayin’ Ohio Guy

    • But do all the Covid Patients need an ICU? Especially if they seem to be surviving even when “All the ICU Beds are Full” as the Media says?
      My question is not “do we need the ICU for some people”. My question is “do the Covid patients need to be in an ICU bed”?

      • Now, with the complexities of covid (personally, I think it’s a manufactured bioweapon) some may, others, not so much. The enemedia and most doctors and pathogenic physicians can’t (or won’t) provide factual details about strains, variants, etc. for fear of running afoul of the state sanctioned narrative. This covid, I believe is a common corona that has been fiddled with right here in the USA and weaponized to target certain folks. The patsy for all this is China. Don’t believe anything you’re told unless you see it with your own eyes. Even then, be a skeptic. I think with all that said, the medical community is trying their best without putting their ass out in the wind. Just my two cents.

  4. I have been a nurse since 1993 in a variety of settings, including critical care.

    SOME but not ALL Covid patients absolutely need an ICU bed.
    ICU’s provide the highest, most intensive level of care available.
    Patients in an ICU would die if cared for at a lower level of care.
    When do patients need an ICU bed? They can’t breath well enough by themselves to get oxygen into their bodies. Their heart can’t pump strongly enough to get blood and oxygen to their brain to keep them alive. They have organs that are in failure. They need multiple very time and skill intensive nursing interventions.

    If a hospital can not provide the required care either in a formal ICU bed, or some jury rigged simulation (such as an ED, and the risk is much higher), the patient WILL DIE.
    ICU’s typically are 95% full 365 days a year.
    Do the math if there is any sort of local, regional, or world wide surge … systems collapse and many people die.

    AESOP described exactly these things.

    • Don_RN:
      I did some checking on the Indiana website along with some math–this is just Indiana so mileage may vary in other states or in other areas, however, at the peak, Indiana still had 20% of its ICU capacity available statewide. On 12/1/20, with a statewide capacity of 2186, 1001 beds were in use for covid patients and 442 were in use by non-covid patients.

      Right now with a slightly higher bed capacity (2243), Indiana has 347 covid ICU patients (as of 8/12/21) and 1341 non-covid ICU patients. With the FDA emergency authorizing REGEN-COV the bed need for covid patients should go down.

      This in addition to the fact that it is possible that some covid patients in ICU really don’t need to be there right now. The payment system is rigged for hospitals to declare covid due to getting more money for those patients.

      As a side note, Aesop tends to hyperbole. Per the CDC’s own numbers, 600,000 people died with a positive covid test–and we now know those PCR tests were crap. The number of people with no other factors or co-morbidities was actually around 10,000.

      • But you never hear or read a report on staffing levels. I seriously doubt they have the manpower to cover all those beds.

        B were you edumacated in the public school system?

        • Probably better educated than you.
          What of it though?

          And yes, I do hear about the staffing levels for hospitals.

      • Appreciate your sharing the local state data.

        As far as ICU occupancy, I am looking at it from an inside POV, tertiary hospitals, and several health systems. The day to day operational experience I’d suggest gives a better perspective than what is ‘reported’ to the various states. May be off some, as certainly have a somewhat limited sample size.

        Agree that Aesop does tend to hyperbole which has great entertainment value. Doesn’t decrease the truth under his attitude.

        Don’t fall into the trap of comorbidities vs covid as cause of death.
        Most people who die have multiple contributing causes, no different here, and for most who are covid positive, the covid infection likely was what pushed them over the edge (a big push, not teetering on the cliff edge push).

        • So far, Aesop’s record is slightly poorer than Fauci and the CDC. Remember the Ebola thing? And many other of his predictions?

          I mean, he makes a TV weatherman look like a prophet…

          • You mean, when Fauci and the head of the CDC both said Ebola would never get here, and I said it would?
            When Fauci and the head of the CDC said we had protocols that would deal with it, and I said we didn’t?
            When Fauci and the head of the CDC said our first world medicine would triumph and stop it cold, and I said it wouldn’t?
            When Fauci and the head of the CDC told you any hospital could handle Ebola, and I said that only the four BL-IV hospitals were trained or equipped to handle it?
            You mean when, after they were both 100% wrong, and I was 100% right, on every one of those predictions, and Ebola in a Dallas ICU, using the CDC’s protocols, multiplied at the exact same rate it does in the wild, with no precautions, they ended up moving every Ebola patient in America – including the two ICU nurses they managed to infect with it in exactly 21 days, just like it multiples in the wild – into those exact BL-IV beds, taking up all but one of the only 11 such beds in North America, leaving us a red hair away from becoming West Africa?
            Yeah, I remember that pretty well, since you mention it.
            Everything I posted then (summer to winter 2014) is still up on my blog, in case you care to check it.
            Now, tell me about your local weatherman with a 100% accuracy rate on his predictions and prophecies.
            I haven’t made many predictions, as such. But the ones I have have panned out pure gold.

          • If yer gonna crow, you’d better learn to like the taste, you self serving turd.

            You told us how tens of thousands would die from Ebola, and as many as tens of millions from Covid. So far, you’ve been less right than Fauci. You preached panic, and fear, and them tried to get out of those predictions with weasel words. You are a scaremonger and a turd who won’t ever admit you are wrong, which I find contemptible and cowardly.
            You area blowhard, who claims to be much more well informed than you really are, who like to try to show the rest of us how smart you are….I think you do it out of a sense of inferiority. It makes you look like a weasel and putz.

            Go away back to you blog where your adoring readers will tell you how smart you are.

        • “and for most who are covid positive, the covid infection likely was what pushed them over the edge”
          How would anyone know that? Is there a test that will determine that one factor caused their death?

          • I make that statement based on my 28 years experience as an RN, and having read the charts of hundreds of covid patients.

            The same concept applies when looking at most deaths (multiple comorbidities, ALL of which contribute to the death). However, when there is an acute, short term illness or event, then the vast majority of the time, that is the strongest cause of death, with the the comorbidities as contributing causes.

  5. its a taxpayer rip-off. the hospitals admit folks that would normally be sent home. they add covid to the chart, they get full reimbursement from uncle sugar, exponentially more for icu. yeah, some are actually sick, many more were dying of other causes already so they shove a respirator down their throat, boom! double the billing. meanwhile i know nurses that are remanded to part time hours for lack of patients. maybe things are that bad where aesop works, but everywhere i go, its just not.

    • The government “reimbursement” amounts to the cost of only two days of the average 10 days stay in ICU, to live or die. And Medicare only pays 2¢ on the dollar for that $15,000/day bill. Nobody gets “full reimbursement”. We’re now losing “only” $117,[email protected] instead of $147,[email protected] The hospital eats the balance of that cost, and whenever they can, passes it on to people under 65, who have jobs and private insurance. Like they have for 50 years. The only people getting ripped off are those under 65, with a job and a co-pay. Which, coincidentally, are also the only people paying the taxes that pay for the other free riders. People sucking the government teat, including illegal aliens and the homeless, along with those over 65, are riding for free on employed people’s backs, since the 1960s.

      Sorry if no one ever explained this to you, but that’s how it works.
      If you feel like a cow that’s been milked too often, join the club. The Medicare system was designed as a taxpayer ripoff. When you rob Peter to pay for Paul, you can always count on Paul’s vote. That’s why the AARP is one of the most solid Democrap voting blocs in the country: everybody wants their “free” government cheese when they retire.

      And nobody gets an ICU bed that would “normally be sent home”. That’s about as likely as getting a sirloin Big Mac from McDs instead of ground chuck. The very idea is simply recockulous. We don’t have enough ICU beds any 5 days out of 7, and we sure as hell don’t have spare ones to waste on not-sick patients, let alone when the pandemic was raging last winter.
      Meanwhile, I’m pretty sure I only pointed out about 50 times in the last year and a half that what was happening in Boston, NYFC, L.A., Atlanta, or Nawlins when they were getting a sh*t sandwich wasn’t anything like what was happening in most anywhere between I-5 and I-95, when most of that swath had never even had many COVID cases.

      A number of areas bypassed earlier are singing slightly different tunes now, but that’s how it goes. Pretending it doesn’t exist at all is how you put the “pan” in “pandemic.”

      And I hope you never see how bad even a weak-ass pandemic (which is what COVID is) can get, anywhere. A 98.5% survival rate (which is what the COVID survival rate is in the US right now) is spiffy – for the 98.5%.
      But that means if COVID goes from 11% infected, where we are now, to even 50%, you’re looking at 2.4M dead, instead of 600K. Hand-waving doesn’t change the mathematics. I’d like to see it stay around 11%, thanks, rather than seeing how many dumbasses we can infect, just to set a new record.

      And handwashing and an N95 at work has a 100% success rate for me. But suture self.

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