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Chapter 1

COVID: Lessons Learned and First Hand Account From Kirkland, WA.

Patrick Reinfried, MD and Rob Orman, MD

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Kirkland, Washington was the first U.S. city with reports of a large-scale COVID-19 outbreak. In this special edition of ERcast, Dr. Patrick Reinfried, an emergency physician practicing at Kirkland’s Evergreen Hospital, gives a first hand account of what happened in his community, how his hospital has responded, and lessons learned. In this episode: difficult decisions that might not have been made before the outbreak, testing, what factors go into deciding admission vs. discharge, how to limit exposure to COVID patients and save PPE,  re-ordering the emergency department with an area dedicated to fever and respiratory illness, patient flow, utility of BiPAP vs intubation, lab ordering, X-rays, and psychological impact.

Don Z. -

I have a few questions. Thanks for this podcast
1. do they have a limit on the amount of tests they order. How do you decide who to test since almost any cough or st or fever could be covid. Even if they go home anyway isn't it helpful to know?

2. When they send a test and get result in 4 hours do they ever keep the patient around? Is your unit a ward or individual beds? In the possible covid unit do you wear n95 or just sure mask

3. when going from patient to patient do you just change gloves or gown too

4. is the test they use a special test developed by them? if not wonder why we wait days?

Rob O., MD -

Hey Don. We will have Patrick back later this week to answer these questions in one of our covid updates

Michael D., DO -

Thank you Patrick.
I'm not sure Patrick has time to respond but I'd like to restate how I interpreted his PPE use since our department doesn't want to run out of PPE but we don't want to be cavalier.

He uses droplet precautions (surgical mask, goggles, gown, & gloves) unless he is doing an aerosolization procedure. He uses airborne precautions (N-95 or PAPR, eye protection, gown & gloves) for nebs, swabs, intubations, etc.,. For intubations he uses PAPR not the N-95.

Rob O., MD -

Hey Mike! That is correct. We are having Patrick back to answer some follow ups later this week

Krishnaraj J. -

Thank you for all the hard work.... I'm the FMD up in Skagit Valley and gearing up for this... your insights are fantastic and I will definitely be implementing some of these plans.

Raj Jayarama

Rob O., MD -

Thank you Raj!

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