Doctor, you brought to the hospital patients already diagnosed “coronavirus pneumonia” or just guess?
Roman Sergeyevich: Bring it in, as required by regulations either with a computer scan, which showed the presence of pneumonia, or positive smear at COVID-19.
But if the pneumonia was not caused by the coronavirus, there is a risk that in a hospital a patient can be infected?
Roman Sergeyevich: According to international standard, if hospitalitynet patient with community-acquired pneumonia that is visible on CT, but the test system of the pathogen does not specify it needs to be examined for any other infection that could cause pneumonia: pneumococcus, Mycoplasma, fungus, etc. But these opportunities we have. So hospitalitynet all, and no one can argue that it is precisely the coronavirus. As a result, some patients may be cowed-negative and also issued kovid-negative. Or do kovid-negative, and in the hospital they have positive tests. But it may be that the first analysis was incorrect, it is impossible to either confirm or reject. Think nosocomial infection also takes place. As for the staff in addition to kovid infection is a danger and this “cocktail” of different infections.
Can such a “cocktail” increasing the risk of severe forms of the disease?
Roman Sergeyevich: In our hospital complied aperiam: patients are 2-4 people in the house and did not come out. Yeah, this house can be its own virus “kit,” but carried away by the hospital he can’t. I am sure that in other hospitals observed the same mode. In addition, the corridors run UV irradiators and the half-open window – there is a constant ventilation.
How to treat those patients with pneumonia who do not need resuscitation?
Roman Sergeyevich: Treat as spelled out in the recommendations of the Ministry of health: upon admission are assigned to the new antibiotic and antimalarial drugs. In some cases our doctors “know your head” – try to choose therapy with minimal harm. For example, brought a patient who has recently undergone serious heart surgery – of course, he was not prescribed anti-malarial drugs that have serious side effects. We use high-molecular-weight heparins – are they performing well. There is a certain classification of the degree of lung lesions on CT. And if the patient is determined by the phase CT-3, although it seems and feels good, then he immediately prescribed anticoagulants. When coronavirus pneumonia starts a systemic inflammatory reaction – in fact, it is sepsis. And the use of LMWH in this situation quite well andTUCANO and justified. Here we have the impression that if a person begins to obtain when receiving heparin, it is faster out of a difficult situation. However, the Ministry of health recommendations change frequently, may be found and more effective treatment regimens. But what is very important – not to self-medicate and not to use those drugs that are not recommended by experts. For example, when the temperature rises you can not use the glucocorticoids (hormones) and non-steroidal anti-inflammatory drugs like diclofenac, and the like. It seems that patients who ignored these recommendations get in serious shape.
What percentage of hospitalized, according to your observations, “heavier” and needs resuscitation?
Roman Sergeyevich: We only see patients who were brought to the hospital – it already means that they are not the easiest course of pneumonia. And any of them can suddenly “utilise”. Here he is, and everything seems to go fine, but suddenly it becomes dramatically worse. Therefore, the starting point for determining the condition of the patient is control saturation, i.e. the saturation level of blood oxygen. It is a pulse oximeter – a small device that is worn on the finger. It shows the heart rate and blood oxygen saturation. If the vitals are normal, everything is fine. If it starts to decrease appointed breathing exercises, translate to pron position, that is, the patient lies on the stomach. This allows you to use the entire lung capacity, and oxygen concentration increases. If this doesn’t help, give oxygen. Well, and then transfer to the intensive care unit through the use of artificial lung ventilation (ALV).
is There any indication of who is likely to need critical care?
Roman Sergeyevich: difficult to Say in advance. But in ICU most male patients with overweight and various chronic diseases.
the Doctors and nurses communicate with many patients. High are the risk of infection?
Roman Sergeyevich: I am absolutely convinced that with proper use of personal protective equipment Contracting is impossible. But in your clinic, and many others, the staff is already infected with coronavirus.
what happened?
Roman Sergeyevich: I Think the main part is the staff, who did not observe the algorithm behavior in the “red zone”. For example, touching a hand to my face or removing a mask. The fact that a few hours of wearing her gum so badly cut ears that at some point, and pulls to remove it even for a minute. The other part could be infected and the “clean area”, communicating with each other. Because some employees moved n�� quarantine mode and lives in the hospital, and the other after a shift and goes home. Also possible violation of the “red zone”.
Tell us about this mode, please.
Roman Sergeyevich: In the room allotted to me was to sleep in I wear over surgical suit jumpsuit – either a rubberized or non-woven material, respirator and medical mask, Shoe covers, two pairs of latex gloves, safety glasses. Clean surgical suit and a new mask in the package set aside in the clean room of the gateway. On return from the “red zone” we are at the gateway of the first spray from a garden spray bottle with a disinfecting solution. Then I clear the rules off all protection, leaving her in the first room (it is then disposed of according to all rules). Take a shower, I’m going to clean the room where put on fresh scrubs, new medical mask and go out in the “clean zone”.
So, re-personal protective equipment not used? Them enough?
Roman Sergeyevich: Initially, protection was not enough, and we tried to find an option to reuse costumes. It turned out that it is impossible to sterilize them. To work in a suit of non-woven material, of course, easier to carry it easier, he’s breathing. Rubberized, or rather impregnated with plastic, it is safer – it’s airtight, but work a whole shift hard. Special deficit, except that sometimes lack of Shoe covers. But we found out – a piece of non-woven material wraps the foot like a helmet, and fasten with tape. Therefore, the tape now is the most scarce material in the infectious ward.
Much tired during the time?
Roman Sergeyevich: Perhaps we are working almost seven days a week. When you take a shower, it seems that tired not so much. But have dinner and pass out completely. But heavier, I think, nurses. They spend all day on the run – injections, put a dropper, handing out boxes of food, then collect them, pass, re-make the bed, help heavy patients. It’s a hell of a job.
was it important for the staff that promised bonuses anyone who works with COVID-19?
Roman Sergeyevich: I Think that in the West the doctors first thing asked would be: what will be the salary, what guarantee is insurance, what happens if I get sick or die? We have said, it’s voluntary, but it is necessary, although it was possible to give. We wrote a statement: I agree to work in an infectious diseases hospital. Some of the staff immediately weed out those who were older than 65 years who have chronic illness. Some refused, but now I look back, work where you want – who in the “clean area”, who in the usual place. Supplements are important, especially for middle and Junior pers��Nala, of course. But, on the other hand, neither the personnel Department nor the accounting Department still don’t understand how to apply these days how to count and calculate wages, etc.
Where treated those who still have it?
Roman Sergeyevich: In our hospital. Well treated… for Example, if the doctor gets sick, but in the form of light and feels good, it hospitalitynet, but he continues to work. And then the question arises: how it work pay? As sick leave or as working days? The scheme is pretty stupid – promise, of course, to pay the entire salary, but how is unclear. The result is someone just hiding – has coved-positive test, but lives in the “clean area” and running.
But these are risky and for colleagues and for other patients?
Roman Sergeyevich: of Course, but we have done much ill-conceived. Why, for example, you cannot gather people who know how it’s all done – military virologists, dental hygienists, so they quickly developed precise algorithms for different situations? And then go on TV far from the topic people say all the time different: the virus immediately dies in the external environment, it lives for weeks. The lady on the radio recommends treating the surface five minutes with antiseptic alcohol – then the virus dies. But I remember the basics of medical education that the fat structure of the virus in alcohol decompose instantly. And then five minutes – it’s just an animal, not a virus. Or recommendations of the staff after work, to rinse the throat with 70% alcohol! This is pure madness. First, this drug have long gone. Second, maybe some of the men-doctors to do it and could, but how do you imagine a woman with alcohol rinses throat? Or that watered the road with a soap solution – utter nonsense, not likely to survive on the street. And if you live, it should say a virologist and to give an indication of what streets need to be processed. If passed the General leadership of military medicine, in my opinion, it would be more organized with far fewer errors.
how is the General mood in your team?
Roman Sergeyevich: People can tell a laugh, a particular fear I have not seen. Although it is said that tired, it’s time for these pages to stop.
