Ας δούμε τι συμβαίνει στην Ιταλία και πως να το αποφύγουμε εδώ:
Coronavirus, doctor in Bergamo: "It's like a war, we have to choose who to treat and who not"
:
https://www.corriere.it/cronache/20...ra-196f7d34-617d-11ea-8f33-90c941af0f23.shtml
So it's true?
«"Indeed it is. In those beds we are admitting only women and men with Covid-19 pneumonia and suffering from respiratory failure. The rest of them at are at home.' »
Then what happens?
«We put them in non-invasive ventilation, which is called NIV. That's the first step. »
What are the following steps?
«I come to the most important one. In the early morning, the person in charge of resuscitation passes by with the emergency room personnel. His opinion is very important." »
Why does it count so much?
«"In addition to age and the general state, the third element is the patient's ability to recover from an intensive care operation." »
What are we talking about?
«"This Covid-19 induces interstitial pneumonia, a very aggressive form of pneumonia that impacts much on the oxygenation of the blood. The most affected patients become hypoxic, that is, they no longer have sufficient amounts of oxygen in the body." »
When comes the time to choose?
«Soon after. We need to do it in a couple of days, at most. Non-invasive ventilation is only a passing phase. Since unfortunately there is disproportion between hospital resources, intensive care beds, and critically ill people, not all are intubated."
What happens then?
«It becomes necessary to ventilate them mechanically. Those you choose to continue are all intubated and pronated, or put on your stomach because this maneuver can promote ventilation of the lower areas of the lung ».
Is there a written rule?
« At the moment, no. As a rule, even if I realize that it is a bad thing to say, patients with serious cardio respiratory pathologies, and people with severe coronary artery problems, are carefully evaluated, because they tolerate acute hypoxia poorly and have little chance of surviving the critical phase". »
Anything else?
« "If a person between 80 and 95 has severe respiratory failure, you probably won't proceed. If you have a multi-organic failure of more than three vital organs, it means that you have a one hundred percent mortality rate. And he's gone. »
Do you let him go?
« "This is also a terrible sentence. But unfortunately it is true. We are not in a position to attempt what are called miracles. It is the reality of the situation ».
Isn't that always the case?
«"No. Of course, even in normal times it is evaluated on a case-by-case basis, in the wards we try to understand if the patient can recover from any intervention. Now we are applying this discretion on a large scale ».
Are these patients dying from Covid-19 or of previous pathologies?
«βThis is that they don't die of coronavirus is a bitter lie. It is not even respectful of those who leave us. They die of Covid-19, because in its critical form, interstitial pneumonia affects previous respiratory problems, and the patient can no longer bear this situation. The death is caused by the virus, not by anything else ».
And you doctors, can you endure this situation?
«Some come out crushed. It happens to the department heads, and to the newly arrived boy who finds himself in the early morning having to decide the fate of a human being.».
Doesn't it bother you to be the arbiter of the life and death of a human being?
«For now I sleep at night. Because I know that the choice is based on the assumption that someone, almost always younger, is more likely to survive than the other. At least, it's a consolation ».
What do you think of the latest government measures?
« "Maybe they're a bit generic. The concept of closing the virus in certain areas is correct, but it arrives at least a week late. What really matters is another thing. "
Which is?
"
Stay home. Stay home. I don't get tired of repeating it. I see too many people on the street. The best answer to this virus is not to go around. You don't imagine what's going on in here. Stay home. "
Is there a shortage of staff?
«We are all doing everything. We anesthetists perform support shifts in our operating room, which manages Bergamo, Brescia and Sondrio. Other ambulance doctors end up in the ward, today it's up to me ».
In the big room?
"Exact. Many of my colleagues are accusing this situation. It is not only the workload, but the emotional one, which is devastating. I saw crying nurses with thirty years of experience behind them, people who have nervous breakdown and suddenly tremble. You don't know what's going on in hospitals, that's why I decided to talk to her. "
Does the right to general care still exist?
"Right now it is threatened by the fact that the system is unable to take on the ordinary and the extraordinary at the same time. So standard treatments can have serious delays ».
Can you give me an example?
βNormally the call for a heart attack is processed in minutes. Now it can happen that you wait even for an hour or more. "
