Back Pay

So now the military wants to reinstate those who were kicked out for refusing the vax, complete with back pay. So what happens to those who were kicked out, but whose normal EOAS date has since passed? Do they still get their checks? Or is it only the ones who agree to be reinstated?

But who says that any of them want to serve under the freak show that is their chain of command?

This One is a Better Example

Everyone who reads this blog knows that I don’t think that the collapse of Damar Hamlin had anything to do with the vax. However, if you want to see a great example of the collapse of a young athlete, look no further than the collapse of Old Dominion sophomore point guard Imo Essien. He collapsed about halfway through the first half a basketball game after having trouble catching his breath.

The team will be sending him to see a cardiologist before allowing him to return to play. Twenty year old collegiate athletes don’t typically collapse from idiopathic cardiac events. Granted, there is no evidence either way as to his vaccine status, but it would certainly be something to keep an eye on.

The pro vaccine folks are already calling it fake news because it isn’t like the collapse of Hamlin, but in my opinion the fact that it isn’t like the collapse of Hamlin is exactly WHY it needs to be looked at.

What is Commotio Cordis?

Athletes are more prone to sudden cardiac death and arrhythmias than nonathletes. Sudden cardiac death in athletes is rare in the absence of heart disease, with the exception of commotio cordis. It is common enough amongst athletes that commotio cordis should be suspected if an athlete collapses suddenly after a chest impact and is unresponsive. So what is commotio cordis?

The heart is driven by the movement of electrolytes across the cardiac cell membranes. That movement is controlled in part by electrical signals, in part by pressure differences, and in part by small channels in the cell membranes that open and close, called ion channels. This complex dance can be measured by watching the electrical impulses that are caused by the movement of those electrolytes. That organized movement of charges causes organized muscle contraction, causing the heart to pump blood. It looks like this:

In the above diagram, note that each peak is labeled, and each of the small squares in the horizontal plane represents 40 milliseconds. You will note that the normal cardiac cycle lasts about 360 milliseconds in our example.

An impact to the area of the chest that includes the cardiac silhouette during the 10 to 30 milliseconds before the highest peak of the T wave that causes a pressure wave to wash over the heart, if that pressure wave is between 4.8 and 9.6 psi, can stretch some of those ion channels to the point where some will open when they are not supposed to. (Mostly the K+atp channels) That in turn causes some electrolytes to move, creating random movement of electrical charges. It changes a heart rhythm from the organized one we are all familiar with to the one below:

In order for this to happen, the impact has to occur within a narrow timeframe (20 ms wide out of 360 ms total) and within a narrow pressure range. Too low, and nothing happens, too high and you get a cardiac contusion and tissue damage.

With these rather strict parameters, the phenomenon still manages to happen about 20 times per year in the US, usually with fatal results. It’s mechanism is well documented and mostly understood. More than 90 percent of the time, the victims are men. More than 85% of the time, the victims are between the ages of 13 and 20. This is mostly because the vast majority of people who participate in contact sports are males between 13 and 20 years old.

There is a genetic correlation. People with known long QT syndrome in their family history are known to be more susceptible to this- for example, Brugada syndrome. We all have heard of athletes periodically dropping dead during and after practice. It’s one of the reasons why high school and college athletic facilities are equipped with AEDs and why some states require that athletes be screened for long QT before they can compete in school sports.

Look, the vax is certainly causing some unexplained deaths. If you want to be convincing, you have to be able to tell the difference between what is a sudden death and what is normal background. You aren’t going to convince people if you are sounding like an ill informed moron with a political axe to grind. Think of how the anti-gunners look when they start talking about “shoulder things that go up.”

Be informed. Don’t come across like a paranoid moron.

Sources for this post:

Athletes and Arrhythmias. Journal of Cardiovascular Electrophysiology. 2010

Commotio Cordis: Ventricular Fibrillation Triggered by Chest Impact–Induced Abnormalities in Repolarization. ADVANCES IN ARRHYTHMIA AND ELECTROPHYSIOLOGY, the American Heart Association. 2012

Fatalities in High School and College Football Players. The American Journal of Sports Medicine. 2013

Incidence of Sudden Cardiac Death in National Collegiate Athletic Association Athletes. Circulation, the American Heart Association, 2011.

Pathophysiology, Prevention, and Treatment of Commotio Cordis. Current Cardiology Reports. 2014

Sudden Cardiac Death in Athletes. Methodist Debakey Cardiovascular Journal. 2016

Not the Jab

Not every person who died in 2020 died of COVID. That was ridiculous, and the claims of COVID deaths made those claiming them look stupid. Similarly, not every sudden death happening now is because of the COVID vax.

Yet I have seen many on the right this morning claiming that the collapse of Damar Hamlin was due to the jab. No, it likely wasn’t. For those who aren’t aware, an NFL football player took a hit to the chest in a game last night before collapsing in cardiac arrest.

What likely happened was a phenomenon called commotio cordis. This condition is caused by an athlete taking a blow to the chest while the heart is in its relative refractory period. The heart enters an arrythmia called “ventricular fibrillation” and the person has no pulse. The condition is usually fatal without immediate CPR, followed by immediate access to defibrillation and Advanced Cardiac Life Support. (ACLS)

A similar thing happened in the NHL to Chris Pronger, who collapsed during a 1998 hockey game after taking a blow to the chest from a hockey puck. He went into cardiac arrest. You can see a video of it here (I would embed it, but YouTube doesn’t allow this video to be embedded). Events like this are more common than you would think.

I have been watching tons of conservatives on social media being just as dogmatic as the left was about COVID on this topic. Don’t make yourself look stupid by trying to pontificate on things that you have no knowledge of, simply so you can make a political point. It weakens your argument and makes you look like a tool.

So many people are trying to use this event to springboard their agendas. I saw an NFL player on TV saying that this is why they make millions, because they are putting their lives on the line to play football and this is why the salary cap for the NFL should be raised. He is saying that most players don’t get many years to play, and the risk is high. Keep in mind that the league minimum salary is $705,000 a year, the average player salary is $2.7 million a year, and the highest paid player makes $31 million a year. When you say things like that, you make yourself look stupid.

RSV, Influenza, and COVID

Joe asks in comments if I have heard anything about this article referencing a “tripledemic” of RSV, COVID, and Influenza.

Respiratory syncytial virus, or RSV, is a common respiratory virus. It usually causes mild, cold-like symptoms. RSV usually strikes children before the age of 2, and is also known to have a severe effect on those over 65 and with weakened immune systems. In the United States, nearly all children have been infected with RSV by age two. This virus has a season, and in the United States, Florida and Hawaii’s season begins in mid September, with the rest of the country’s RSV season beginning by mid-November. The incidence of RSV peaks each year by mid-winter. It is an airborne virus that can also be spread by fomites.

A fomite is a surface that is contaminated because a virus that can live for a time outside of its host is on the fomite’s surface. A person touches the fomite and then touches their face. The average person touches their face 4,000 times a day. Kids even more so. This is why frequent handwashing can be effective in preventing illness.

Influenza also has a season, as we all well know. It also strikes the immunocompromised and the elderly.

Until 2020, patterns for RSV in the United States were predictable. The patterns of RSV and other common respiratory illnesses have been messed up since the lockdowns in 2020. The number of RSV infections began to rise in the spring of 2021 and peaked in July. Why? I mean, this is usually a winter virus.

In 2020 and into 2021, there weren’t many cases of seasonal illnesses because kids were largely kept out of school during the peak RSV and flu seasons during the winter of 2020-2021. In most states not named Florida, the same happened during the 2021-2022 season, so all of the kids who would have brought the virus home to their younger siblings weren’t in school to do so. That means all of the kids born in 2019, 2020, and 2021 have not been exposed to RSV and this will create a heavier than usual RSV and flu season. It makes total sense.

The same is true of the flu. This year, the season appears to be starting a bit earlier than usual, but that is not surprising, considering what I discussed above. The past couple of years have been unusually light for the flu, and I think that we are going to have a rebound year.

So what does this mean? Nothing. Most people who get it have a bit of a cold and then soon recover.

As far as COVID: granted that this is anecdotal, but we don’t seem to be seeing any more COVID than we have been seeing for the past year, at least not in my hospital. It’s just a constant background now. I have had it twice, and I don’t even bother to wear a mask when I treat COVID patients any more. The CDC is not really reporting a high number of COVID cases right now.

I don’t think that there is anything to make a big deal out of right now. That may change, but for now I don’t think it’s anything to get in a lather over.

Med Rotations

JKB over at gunfreezone asks why medical training requires doctors to do rotations in specialties that are not their own, pointing out that engineers in one field don’t have to also do internships at a civil engineering firm, a mechanical engineering firm, a structural engineering firm, and a chemical engineering firm. He states that it looks like a complete waste of the student’s time. The reason that medicine does that is actually pretty simple, so let me give a simple explanation.

It isn’t likely that a mechanical engineer will do something that will have a direct effect on a chemical engineer’s job. That chemical engineer isn’t likely going to have an issue with avoiding the problems that a structural engineer is having. Imagine if a mechanical engineer tightened a screw a quarter turn, and this caused the hydraulic fluid to become acidic and then the building collapsed. Not so in medicine. Sure, people in medicine tend to specialize, but the human body is a complex system, and changes to one system have profound effects on the others.

Let’s say that I am in cardiology and I have a heart failure patient who is in fluid overload. There are a number of drugs that one could choose from to get rid of those fluids. I could try furosemide, or perhaps bumetanide. Perhaps torsemide, or even hydrochlorothiazide. Any of those medications would likely solve your patient’s issues, but which one of these is going to be detrimental to the patient’s kidneys? Do I want to choose a potassium sparing or a potassium wasting diuretic? How will that react with the patient’s preexisting autoimmune dysfunction? I could consult a nephrologist, an endocrinologist, and an immunologist, but doctors largely don’t stand around most of the time having huge arguments. That only happens on TV shows, not because there are no egos involved, because there are. Medical people are just too pressed for time to keep doing that, so wouldn’t it be easier if I already knew?

So for that reason, most in medicine learns a little about every system and specialty before going on to gain a deep understanding of their specialty. Nurses, doctors, PAs, NPs, all of them.

The first comment on that post complains about sterile fields and how they are “superstition.” Sterile fields are there to prevent post procedure infections. You can’t see infectious agents. Perhaps you didn’t touch anything. Or maybe you bumped into something that was covered in S. aureus and didn’t notice. How do you know? Can you be sure? If you are wrong, you will know in couple of days when your patient goes septic. You can’t bet a patient’s life on “the ten second rule.” Certain behaviors are high risk, so procedures get written in to the process to reduce or eliminate those higher risk behaviors. That includes treating everything that “breaks field” as though it was covered in an infectious agent- because it might be, and there is no way to know for sure. So you toss the offending object aside, and use one that you KNOW is sterile.

As an example, the most common cause of hospital caused infections is a CAUTI (Catheter Associated Urinary Tract Infection). It’s caused by a catheter introducing a pathogen into the urinary tract. That can affect the kidneys. It can cause Acute Kidney Injury. In some cases, that can cause Chronic Kidney Disease and ultimately kidney failure, or it can cause septicemia (a blood infection), which leads to death. Because of this, there are procedures that need to be followed when inserting, caring for, and ordering indwelling catheters. Can you violate that procedure and get away with it? Sure. A few times. Maybe only once. But one thing is sure, you will eventually wind up with a septic patient. So the procedure is there to prevent that.

Misinformation

I am sick of hearing people talk about how this person or that one is spreading misinformation, and how people who do should be silenced, deplatformed, or even jailed, when this is the timeline of COVID vaccines, as told by the MSM:

November of 2020: Moderna said Monday that early analysis from its Phase 3 trial shows its Covid-19 vaccine is 94.5 percent effective at preventing the illness, offering hope of a second breakthrough in as many weeks. The news comes a week after pharmaceutical giant Pfizer said early analysis showed its vaccine candidate was more than 90 percent effective. NBC NEWS (emphasis added by me, in red)

March 4, 2021: Both the Pfizer/BioNTech and Moderna vaccines were primarily evaluated for their ability to prevent symptomatic COVID-19, with the former having a 95% efficacy and the latter having a 94% efficacy in the clinical trial data submitted for the original authorization by the Food and Drug Administration. This means your risk of getting sick is cut by 94% or more if you are vaccinated. The final phase 3 data showed an efficacy of 91% for Pfizer/BioNTech and 93% for Moderna. A quote directly from factcheck.org (emphasis added by me, in red)

April 28, 2021: The Pfizer and Moderna vaccines were 94 percent effective in preventing hospitalization for COVID-19 among people age 65 and older, according to a Centers for Disease Control and Prevention (CDC) study released Wednesday. The Hill.com (emphasis added by me, in red)

March 28, 2022: Three doses of the Pfizer or Moderna vaccines were 94 percent effective in preventing death or the need for a ventilator during the omicron surge, according to a new study. The Hill.com (emphasis added by me, in red)

Note that the goalposts continue to move. At first, it was two doses were 94% effective in preventing the illness, then it was preventing symptoms, then it morphed into preventing hospitalization in people over 65, then it became three doses preventing death or a ventilator.

So who exactly is spreading misinformation? My guess is, everyone. Simply because some people are lying, some don’t know anything, and no one really knows the truth. Well, someone does, but they aren’t telling anyone.

The Effect of Cost Cutting

Five days ago, I posted about the hospital where I work trying to save money by cutting out the shift bonuses that were being used to entice the staff to work 50 and 60 hour workweeks. Today was the first day where I worked and there were no overtime people. Where a 50 bed ED normally needs 14 nurses to operate? We had 10 for most of the day. Meaning that we should have 5 patients to each nurse.

Nope, we were too busy for that. We tried to tell EMS agencies that we couldn’t take any more patients (it’s called being “on divert”). It didn’t work. At one point, we had 90 patients. For ten nurses.

I work a swing shift, which is supposed to be 11am to 11pm. Most of the ED works 7-7. By 9pm, my patients were:

  • A 37 year old female who kept having seizures. She had 6 of them the first 2 hours she was my patient.
  • A 26 year old male fentanyl overdose.
  • A 76 year old with a bowel obstruction that is vomiting coffee grounds.
  • A 35 year old who came to our facility two weeks ago complaining of chest pain and went into cardiac arrest. He is complaining of chest pain and has elevated troponin levels.
  • A 78 year old woman with perforated diverticulitis.
  • A 56 year old intoxicated woman who is with us for altered mental status and is covered head to toe in her own feces.

For those of you who don’t know, most of those patients need to be in a unit that offers a higher level of acre than what we can provide in the ED. The problem is that all of those units are already full.

In the meantime, there are 22 people in the waiting room, waiting for us to have room to treat them. At one point, there were 7 ambulances lined up at the door, waiting to drop off patients. So I wound up ordering Wendy’s through DoorDash at around 8pm, and eating it at the nurses station while I wrote notes on patient’s charts.

Needless to say, everyone was getting testy, patients AND staff.

As 11 o’clock approached, the charge nurse asked me to hold over because we still had more than 60 patients, and three of us were scheduled to go home at 11, which would leave her with no techs and only 8 nurses. Because I like her and she always does me favors, I agreed to hold over for a couple of hours.

Right at 1, when I was planning to go home, all hell broke loose. An intoxicated woman was brought in by EMS, who claimed they were unable to get an IV. Ten minutes after they dropped her off, she vomited about a 1.5 liters of blood.

So a third of the remaining nurses spent the next 45 minutes trying to keep her alive. All of their patients were getting ignored in the meantime.

One nurse remarked, “As long as we keep doing this, they will keep making us do it, until it becomes the ‘way we have always done things.'”

I finally left the place at around 2 am, having worked a total of 15.5 hours. But think of all the money they are saving by not having to pay those bonuses.

Shortages

Last month, I mentioned that the hospital where I work is bringing Philippino nurses in to fill vacant positions for less money than hiring Americans. There is more news on that front.

We have been short staffed for nearly three years. They have made up the shortfall by paying huge bonuses to get nurses to work extra shifts. They tried foreign workers. Still, they don’t have enough. Determined to save money now that the COVID funding has dried up, hospital administration announced on Saturday that there will be no more bonuses offered. Once the shifts that are already promised bonuses are paid out, they will be no more. Nurses who were making $2500 a day for working a 12 hour over time shift are now being asked to work the same overtime hours, but for $600-$900 each 12 hour shift.

I know that I was working 60 hours or more a week. I was making good money to do that, but now that the money has dried up, I am not working those kinds of hours for a fraction of the pay. No one that I know is willing to do that.

So now the entire staff of the ED is not taking any extra shifts. They are working their contracted hours, and that is it. Me? My contract says that I have to work 4 shifts a month. That is all I am doing. Everyone else is doing the same. So now the hospital is even more short handed.

Here is what was texted out to us this morning by the ED department head:

Hello team
We know this week has definitely had its ups and downs already and we appreciate all the hard work done by everyone. While we all fight this same battle we still have patients who are expecting the best care we can provide.
Starting tonight through the weekend we could use anyone on any shift to assist your fellow team and patients.
Please any help is appreciated.

As if guilt tripping us will get us to work all of those extra hours for a third of what we were making before. I want to help my patients and coworkers, but at the end of the day, this is a financial arrangement. It’s business.

So now the hospital is getting desperate. A third of the ED beds were shut down today for lack of staff.

The hospital where I work can only fill itself to somewhere near 60% capacity because they don’t have enough nurses, and that was when people were working extra shifts for bonus money. That means that patients often stay in the ED until there is an open bed on the inpatient floors. Our ED is frequently more than half filled with patients on “admission holds” awaiting beds. Couple that with the fact that the ED is also short nurses, and you have a problem.

Picture a 50 bed emergency room. To staff a 50 bed ED takes 14 nurses, 4 paramedics, 4 general technicians, 3 doctors, a nurse practitioner or PA, a respiratory therapist, secretary, three registration clerks, two lab technicians, three radiology techs, and two janitors. Every shift.

Now picture that you only have enough nurses for 10 per shift. Now you can only handle 40 patients at a time instead of 50. Now also picture that you have 30 admit holds, taking up beds and waiting for an inpatient bed- some for more than 48 hours. Now you can only handle 10 patients because your staff is busy caring for holds. So the waiting room backs up.

This means you have people sitting in the waiting room for 4, 5, or even 6 hours as they wait for treatment. And all of that was happening before you cut off the bonus money.

Now instead of 60% staffed, you are more like 45% staffed. Instead of 10 nurses, you only have 7. Now picture that across the entire hospital. A 600 bed hospital with a 50 bed ED requires 100 nurses or more each shift. You only have 50 or 60. Now what do you do? There aren’t enough foreign workers to fill that many spots.

My hospital can’t be alone in this. Here is the warning: there is a potential collapse of health care coming. It takes 3 to 4 years to train a nurse to the point where they are licensed, and another 2 years or so for that nurse to be proficient enough in their job to staff an ED, even longer for places like the ICU.