Again, for us, it was a blood gas analysis, chest X-ray and lung ultrasound. The chest X-ray is very important: When it is very white, it's a clear positive result [for COVID-19]. When it seems to be negative, ultrasound has a huge capacity to better discriminate if lung involvement is present and to perfectly match the findings with the clinical approach to determine if the patient needs to go the stepdown unit or ICU. This has also been a huge solution to decide which patient we could discharge.
Dr. Mandavia: Any other advice to physicians?
The real answer is to be flexible, reinvent your daily practice and use whatever tools you have. Because you’ll have disproportion between ICU beds, ventilators, nurses, physicians, and the number of patients, you have to keep patients alive until you are able to give them the right standard of care (ICU, stepdown unit, normal ward). For example, we use CPAP and non-invasive mask ventilation extensively. You have to properly balance patients’ needs, priorities and try to free ICU beds, and then bring up the other ones who are waiting in the emergency department or in the stepdown unit. Otherwise, if you are too rigid in your protocols, you can't cope. Because we were first, unfortunately, we had to reinvent things without stopping hospital functionality. We managed to do that, but it's not simple. So whoever has one week ahead, think and forecast your needs. This is a very, very precious time.
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