COVID19 in Italy
We rarely declare one of our podcasts a ‘must listen’ but this is an exception. Please listen and share widely. Please think hard about the issues Roberto raises and PLEASE ACT NOW.
Dr Roberto Cosentini is an old friend of St Emlyn’s who works in Bergamo, in Northern Italy. He is right at the heart of the recent Covid-19 outbreak. He kindly found an hour to record a podcast with us on his experiences. Click on the link below to listen
There are so many essential lessons in this podcast. Please share with clinical and non-clinical colleagues, as we need to plan NOW. Roberto is quite clear that if we don’t train and get plans into place before the wave of cases hit us, then both ourselves and our patients will suffer.
Take home messages
In the interest of speed I’m not going to summarise the whole podcast. You have to listen to it all yourself to see what’s relevant to you. These are some of my takeaway messages.
- Divide your department into resp patients and non-resp patients.
- Wear PPE and know how to use it.
- You will need clinicians who do not usually work in ED. Train and orientate them now (before you need them).
- Most patients are hypoxic and this responds to O2 and CPAP. You’re going to need a lot of CPAP and how that happens could be tricky. They found hoods the best (Ed – but how many of those do we have?).
- Although hypoxic, patients have good lung compliance.
- They regularly saw diurnal variation with many patients presenting in the early afternoon.
- It’s emotionally exhausting. Prepare yourself and your team psychologically and support them during the pandemic. Roberto’s department has an embedded psychologist.
- Health care worker infections were quite low (because they wore PPE for all resp cases).
- Flow through the department and onto wards is absolutely vital.
- Flow out the the main hospitals to other units that can rehabilitate is vital.
- Decisions for ICU level care were similar to normal (in his hospital).
Also please note our call for papers at the EMJ on the link below. Also have a look at Salim’s link to a similar vodcast on ICU management from Italy. You can also use this link to the RCEM page on Covid-19.
Thanks Simon, very helpful- as always.
Can you ask him what type of PPE they were using to keep the staff safe. I am highly suspicious of our current move away from aerosol precautions down to droplet precautions here in the states.
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I am intrigued by their experience with NIV particularly helmet CPAP from an infection control point of view. Have they published their results e.g. inclusion/exclusion criteria, procedure, steps to prevent transmission, duration of therapy etc. There is little experience of this where I work and I couldn’t imagine our respiratory ward wanting to manage this.
From a pragmatic point of view, I would put it down near the list of heroic interventions such as split ventilators.
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do you have any documents to share including recommendations for doctors usually not in contact with respiratory distress/covid?
Thanks your Great work!
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I am also very interested in what PPE they were wearing to keep healthcare transmission so low. I feel the PPE being offered here in Australia is inadequate.
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Thank you Simon and huge thank you to Roberto Cosentini, encouraging to hear and that we are following very much in their steps as they went forward.
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same time,” Dr. Roberto Cosentini, a doctor in the northern city of Bergamo near Milan, said in a podcast for emergency room physicians. “It’s like a regular daily
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