How Coronavirus Kills: Acute Respiratory Distress Syndrome (ARDS) & COVID-19 Treatment

How COVID-19 causes fatalities from acute respiratory distress syndrome (ARDS) by pulmonologist and critical care specialist Dr. Seheult of https://www.medcram.com
This video illustrates how viruses such as the novel coronavirus SARS-CoV-2 can cause pneumonia or widespread lung inflammation resulting in ARDS.
Includes evidenced-based ARDS treatment breakthrough strategies: Low tidal volume ventilation, paralysis, and prone positioning.

Our more recent COVID-19 updates can be accessed free at our website https://www.medcram.com/courses/coronavirus-outbreak-symptoms-treatment or here on YouTube: https://www.youtube.com/playlist?list=PLQ_IRFkDInv_zLVFTgXA8tW0Mf1iiuuM_

Here are the links referenced in this video on coronavirus outbreak:
https://www.nejm.org/doi/10.1056/NEJM200005043421801?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dwww.ncbi.nlm.nih.gov

https://www.nejm.org/doi/10.1056/NEJMoa1005372?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dwww.ncbi.nlm.nih.gov

https://www.nejm.org/doi/full/10.1056/NEJMoa1214103

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Speaker: Roger Seheult, MD
Co-Founder of MedCram.com
Clinical and Exam Preparation Instructor
Board Certified in Internal Medicine, Pulmonary Disease, Critical Care, and Sleep Medicine.

MedCram = More understanding in less time

Topics from our COVID-19 pandemic series include: =Ibuprofen and COVID-19 (are NSAIDs safe?), trials of HIV medications, Rapid coronavirus Spread with Mild or No Symptoms, How Hospitals & Clinics Can Prepare for COVID-19, Global Cases Surge, The ACE-2 Receptor – The Doorway to COVID-19 (ACE Inhibitors & ARBs), Flatten The COVID-19 Curve, Social Distancing, Hospital Capacities, New Outbreaks & Travel Restrictions, Possible COVID-19 Treatments, Chloroquine & Zinc Treatment Combo, Italy Lockdown, Medication Treatment Trials, Global Testing Remains Limited, Coronavirus Epidemic Update 32: Data from South Korea, Can Zinc Help Prevent corona virus? Mortality Rate, Cleaning Products, A More/Less Severe Virus Strain? More Global COVID-19 Outbreaks, Vitamin D May Aid Prevention, Testing problems, mutations, COVID-19 in Iran & more.

MedCram.com has medical education topics explained clearly including: Respiratory lectures such as Asthma and COPD. Renal lectures on Acute Renal Failure, Urinalysis, and The Adrenal Gland. Internal medicine videos on Oxygen Hemoglobin Dissociation Curve / Oxyhemoglobin Curve and Medical Acid Base. A growing library on critical care topics such as Shock, Diabetic Ketoacidosis (DKA), aortic stenosis, and Mechanical Ventilation. Cardiology videos on Hypertension, ECG / EKG Interpretation, and heart failure. VQ Mismatch and Hyponatremia lectures have been popular among medical students and physicians. The Pulmonary Function Tests (PFTs) videos, novel coronavirus in china (wuhan virus), 2019-nCoV, 武汉 肺炎, CDC, infectious disease, MERS, SARS, how coronavirus causes morbidity and mortality, world health organization, and Ventilator-associated pneumonia lectures have been particularly popular with RTs. NPs and PAs have provided great feedback on Pneumonia Treatment and Liver Function Tests among many others. Mechanical ventilation for nursing and the emergency & critical care RN course is available at MedCram.com. Dr. Jacquet teaches our EFAST exam tutorial, lung sonography & bedside ultrasound courses. Many nursing students have found the Asthma and shock lectures very helpful. We’re starting a new course series on clinical ultrasound & ultrasound medical imaging in addition to other radiology lectures.

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#coronavirus #COVID19 #ARDS

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Transcript

welcome to another medcram lecture so
I hear this question a lot how does thecorona virus actually kill people
there's a recent article in The Lancetthat showed that of 41 people that were
admitted to the hospital six of themdied and all of them were on ventilators
and they died with something called aRDS and a RDS is how the corona virus
kills it's not just the corona virus butmany other viruses including the
influenza virus that we have every yearhow is it that this happens it's through
acute respiratory distress syndrome andI'm gonna explain to you how that
happens so you first have to understandlung Anatomy and to understand that I
like to show you a tree so a tree has atree stump and then it branches and then
those branches branch and then furtherthose branches branch until finally you
get to the leaves and these leavescapture the sun's rays and that's what
gives you photosynthesis and that's howthe tree lives and so what happens is
that this tree and the branches increasethe surface area of the leaves on the
tree so that if you were to pluck offall of the leaves and you were to put
them on the ground next to each otherthe surface area that is represented by
those leaves would be larger than theshadow that is produced by the Sun on
that tree well it's the same exact thingthat happens with your lungs you've got
an airway and then that airway dividesinto a right mainstem bronchus and into
a left mainstem bronchus and then youhave a right upper lobe you have a right
middle lobe right lower lobe left upperlobe and you have a left lower lobe so
this is the left side this is the rightbecause you're looking at the patient
and then these things of course divideinto much smaller branches and instead
of leaves at the end of all of thesethings what you have is something called
an alveoli which is a tiny little smallgrape like structure that the air gets
into and the air of course has oxygen sowhat does this look like on a large
scale here's what an alveolus looks likehow many alveoli
are there in the human body well there'sabout 600 million of them these are very
very small so what happens isdeoxygenated blood comes by and its job
is to pick up the oxygen that comes into the alveoli and then when that oxygen
comes in it oxygenates the blood andthen that blood goes back to the heart
and then to the body and all yourmuscles that's how you get oxygen and so
you can imagine that this is very verythin because the oxygen which comes down
here has to diffuse into the bloodstreamso far so good
but what happens well just like when youhit your finger in the door your finger
swells that's because there'sinflammation occurring where you hit
your finger in the door and inflammationcauses a leakage of fluids into the
tissue space so what happens here isthat you get a viral infection the virus
affects your lungs and with a RDS theentire lung becomes inflamed not just in
one area like you would have with apneumoniaor one particular area for instance on
your finger and it would just stay inone particular finger in your whole hand
wouldn't swell no with a RDS the entirelung goes crazy with inflammation and so
what happens air instead of having anice thin area inflammation goes
everywhere and you get a large barrier afluid that goes into the interstitial
space furthermore these capillariesstart to become leaky and fluid starts
to leak into the alveolar space as welland this starts to fill up with liquid
proteinaceous liquid liquid thatprevents oxygen from getting into the
bloodstream and so instead of havingnice oxygenated blood this blood becomes
hypoxic and you become hypoxic if youhave a RDS and you have a hard time
breathing and that's when you get placedon the ventilator there's really nothing
you can do to speed this up there'snothing that you can do to slow it down
you have to be supported on theventilator so that you're getting enough
oxygen and that the Machine can breathefor you until just like everything else
after you hit your finger in the doorand the swelling goes away this fluid
will eventually go away as well the keythough is keeping you supported during
that period of time until the fluid goesaway and then once again the oxygen will
be able to go back into the system andyou will get oxygen back to your tissues
so here's another look at that we getoxygen that's going down into these
criminal structures called the alveolithey go in to these alveoli and they
cause deoxygenated blood to turn intooxygenated blood and then go back to the
heart so I'm going to show you threethings today that we have learned in the
last 20 years that can improve survivalin these patients who are on ventilators
to help them beat coronavirus or forthat matter any other virus whether it
be influenza whether it be respiratorysyncytial virus any other kind of virus
for beating and getting better if youhave a RDS and you're on the ventilator
so the first thing thatlook at is what they noticed back in
2000 and actually before is that when weput people on the ventilator and the
ventilator puts a breath into theirAirways what we were trying to do is we
were trying to make sure that we wereventilating patients well and that's
important in some situations because theblood that is poor in oxygen also has
carbon dioxide which is given up fromthe muscles
well this carbon dioxide would need tobe ventilated to be taken out on
exhalation so co2 would be coming outwell in order to do that we got to make
sure that enough volume of air was goingback and forth back and forth the
problem with that though is that we wereinflating these alveoli and then when we
were releasing the pressure and lettingthe air out these alveoli would collapse
down and nothing was keeping them openso they would be opening and closing
opening and closing shutting and openingand so that was causing a lot of shear
stress and of course what's the wholeproblem here that we've got inflammation
is what's causing the whole problem herein the first place and that's causing
these membranes to become very thick andthe oxygen can't get in there and so by
ventilating these patients with largetidal volumes we were causing the
inflammation to actually get worse thanit would have been if we hadn't done
that and so the scientists started tolook at this and say wait a minute
what happens if we just put a lot ofpressure down here to keep these alveoli
open and only use a small amount oftidal volume to ventilate these patients
and yes we won't be able to get as muchcarbon dioxide out of them but we don't
really care so long as we're not addingmore inflammation to it and so that
first thing that we looked at this isback in the early 2000s that is came out
is low tidal volume and that wouldalmost certainly cause the pco2 or the
partial pressure of carbon dioxide inthe blood to go up so this was called a
low tidal volume strategy and sureenough paper was published in 2000 in
the New England Journal of Medicine thatshowed that we could affect change
and we could decrease the mortality atthe time from 40 percent down to about
31 percent mortality so that was a hugedrop in mortality and all we did was we
just ventilated people differently usinglow tidal volume now when you're
ventilating people with low tidal volumeit's not very comfortable they're trying
to breathe more because they don't likethat increased carbon dioxide levels and
so they would try to breathe over theventilator and it would try to breathe
differently than what the ventilator wastelling them to do and in these cases we
would usually sedate the patients but ifwe sedated them too much bad things
could happen to them they could getblood clots their blood pressure would
go down and so the second thing thatthey came up with was actually
paralyzing these patients usingmedications so that they were in perfect
sync with the ventilators and so thatwas paralysis paralysis requires pretty
intensive care in the intensive careunit you need good ancillary services
you need good respiratory therapists youneed good nursing something that you
might not get if there's a huge outbreakbut you could get if attention was made
to this so this paper also published inthe New England Journal of Medicine and
by the way I'm gonna give links to allof these papers in the description below
they were able to drop the mortalityfrom 41 percent down to 32 percent and
this paper was published in 2010 so farso good what we also started to realize
is that patients in the hospital forwhatever particular reason if you ever
look at them in bed they're on theirback and what we decided to do was flip
them over and there was a number ofreasons for this so that their belly was
down and that their back was up we callthis prone positioning and if you do
this for about 17 to 18 hours a day youcan actually decrease the mortality they
found from 33 percent down to 16 percentand this paper was published back in
2013 and so you can see here threebreakthroughs in
treatment of a RDS the final commonpathway for morbidity and mortality in
the coronavirus that we're talking aboutbut the other thing about this that's
interesting is we can do a lot if wecatch it early and we get people into
the hospital and we get them in theintensive care unit and we get them on
ventilators and we're able toappropriately treat them with good
quality medical care and three thingsthat really make a difference then we've
got a good chance so that they're notanother statistic of mortality but they
survive this and so really the purposeof putting these updates on is to make
sure that people understand the medicalbackground of what's going on sometimes
these stories about how brakes can bevery scary and for good reason
but we need to understand medically whatit is that's going on because knowledge
is power if you have any other questionsabout this please visit my site at make
cram comm thanks for joining us

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