Discover and read the best of Twitter Threads about #FOAMcc

Most recents (24)

Non-COVID teaching case: A middle aged woman with myelodysplastic syndrome presents with severe dyspnea and hypoxemia requiring intubation. She fails to improve with antibiotics. A chest CT is performed prompting a bronchoscopy. The results of BAL are shown:
#FOAMed #FOAMcc
1/
What is going on here?
2/
Pulmonary Alveolar Proteinosis (PAP) is a rare lung disease characterized by accumulation of surfactant-derived lipoproteins in the alveoli. This milky proteinaceous fluid impairs gas exchange and leads to hypoxemia and respiratory failure.
3/
Read 9 tweets
1/3-Back by request for new ICU residents!

💥 12 KEY TRIALS I teach on #ICU Rounds each week they must know!

Do you agree?
Any you would add?

1. ARDSNET @NEJM -PMID 10793162

2. LEUVEN Glucose 1 @NEJM-PMID 11794168

3. SAFE Trial @NEJM PMID: 15163774
#FOAMcc #medtwitter #MedEd
2/3 12 Key ICU trials I teach each week cont...

4. TRICC Trial @NEJM PMID: 9971864

5. SOAP Vasopressor trial @NEJM PMID: 20200382

6. NICE-SUGAR @NEJM PMID 19318384

7. Rivers EGDT @NEJM PMID 11794169

8. VAAST Trial @NEJM PMID 18305265

9. SMART Fluids @NEJM PMID 29485925
3/3 12 Key ICU trials I teach each week cont...

10. APROCCHSS @NEJM PMID 29490185

11. Schweickert Early Mobility @Lancet PMID19446324

12. ABC Trial @TheLancet PMID 18191684

What others would you add?
#FOAMcc #FOAMed #SCCMSoMe #medtwitter #MedEd #medstudenttwitter #ICU
Read 4 tweets
1/ @STARRTAKI now published in @NEJM nejm.org/doi/full/10.10… – an updated thread follows below
#starrtaki #aki #FOAMcc @nephjc

@DrRonWald @CCCTG_ @anzicsctg @UKCCRGroup @ICCCTN @CIHR_IRSC @NIHRresearch @nhmrc @HRCNewZealand 🇨🇦🇦🇺🇦🇹🇧🇪🇧🇷🇨🇳🇩🇪🇫🇮🇫🇷🇮🇪🇮🇹🇳🇿🇨🇭🇺🇸🇬🇧
2/ Current CPGs do not make strong recommendations (Not Graded) on when to start RRT in ICU patients with AKI, in the absence of urgent indications, due largely to discrepant findings from prior RCTs (bit.ly/3fKqEZy) (bit.ly/39etR0N) @goKDIGO @NICEComms
3/ The @STARRTAKI trial is the largest multinational trial (168 sites, 15 countries) to address whether an accelerated (early) strategy compared with standard (delayed) strategy impacts mortality and kidney recovery in ICU patients with AKI #generalizability
Read 14 tweets
Pt-Bilat LE pain/swelling 5 days.Prior hx of unprovoked DVT/PE years ago but off meds due to insurance. See thread. POCUS DVT #POCUS #IMPOCUS #FOAMed #FOAMus #MedEd #FOAMcc @ACEP_EUS @medpedshosp @cianmcdermott @jminardi21 @grepmeded @siddharth_dugar @msiuba @NephroP @SonoStache
What POCUS DVT protocol to use? 2-point or 3-point or extended? With or without Doppler? Meta-analysis showed good performance of 2 and 3 point POCUS but need to understand POCUS compression limitations if only compression used: pubmed.ncbi.nlm.nih.gov/31145304/?from…
Adhikari and colleague article showed 6.3% false neg rate due to prox isolated DVT with 2-point compression. Limitations of POCUS prox compression DVT exam go beyond just missing isolated/focal DVT. pubmed.ncbi.nlm.nih.gov/25465473/
Read 9 tweets
[THREAD]

We just published the largest, most detailed case series of mechanically ventilated #COVID19 patients with ARDS in a western country and with the longest follow-up.

Read our infographic & the article on @CCRJournal bit.ly/2SiXYgD

#COVIDFOAM #FOAMed #FOAMcc
2/7
Mortality of ICU mechanically ventilated patients with #COVID19 ARDS is as high as 23% at the 20 days follow-up.

#COVIDFOAM #FOAMed #FOAMcc
3/7
Acute kidney injury (75%) and secondary bacteremia (37%) are the most frequent complications of #COVID19 ARDS.

Also, pneumothorax, pneumomediastinum, and thromboembolic complications were relatively common.

#COVIDFOAM #FOAMed #FOAMcc
Read 7 tweets
I was feeling overwhelmed by all the laypress articles about #moralinjury and #burnout in frontline health care workers during #Covid_19 so I decided to do a deep dive into the literature on the mental health of workers during pandemics.

Here's what I found. #thread

1/
Seriously, so many laypress articles.

What evidence do we have on this, and further, what evidence do we have on strategies that mitigate these mental health issues in health care workers?

I presented these data the @UChicagoMed @UCCancerCenter grand rounds last week.

2/
@UChicagoMed @UCCancerCenter But first, some definitions to set the stage:

Burnout, initially described by Dr. Maslach as the prolonged physical and psychological exhaustion related to a person's work. Not specific to medicine, although the definition has been honed for medicine (see slide). #burnout

3/x
Read 44 tweets
Thank you @NSWOC who have produced a great powerpoint, summarised below, on Prevention and Management of Skin Damage Related to Personal Protective Equipment (PPE) 👇👇nswoc.ca/ppe/ #FOAMed #FOAMcc #COVID19 #PPE
Read 5 tweets
Can you be in shock and HYPERtensive?

I think so. Our patients teach us many lessons

#FOAMed
#FOAMcc
@UVMEmergencyMed

👇
A patient presents with 7 days of dyspnea, LE edema and fatigue. They have run out of all meds 2 weeks ago #COVID. They had an MI with ishcemic cardiomyopathy EF ~30%, also has a-fib.
Exam:
Afebrile, BP consistently >160/110, HR 110 afib, RR 30, POx 86%-> 94% 4LNC

Mild confusion
JVD+
Mild resp distress, crackles BL
No murmur
Hands, legs COLD and mottled to knees, toes and fingers purple, cap refill delayed
Pitting LE edema
Read 8 tweets
Thank you to @ICNARC who have published data on the first 5578 critically ill patients in the NHS. I've summarised some of their publication in this thread below: #covid19 #covid19foam #foamed #FOAMcc Original here: icnarc.org/Our-Audit/Audi…
The data does not include Scottish ICUs - but does for Eng, Wales and NI. To date (yday) there have been 6664 ICU admissions due to COVID19. The largest cohort being in London. There is also cumulative data of numbers by date. #covid19 #covid19foam #foamed #FOAMcc
You can see the *current* distributions of cases across England, Wales and NI #covid19 #covid19foam #foamed #FOAMcc
Read 9 tweets
Massive variceal bleed and no EGD at your hospital?

Be ready to place a blakemore/balloon tamponade device in uncontrolled variceal hemorrhage.

Tips from prior cases

#foamcc
#foammed
After ABC's...

1. Place the device like an OG

2. Check position by xray (may need little air ~50 ml in balloon to see)

3. Inflate gastric balloon with ~ 250 mL air

4. X ray

Don't over inflate

👇

Image: overinflated and improperly positioned causing gastric distension 😯
Deflated & repositioned w/ balloon at the GE junction to tamponade the variceal origins

Apply light traction w/ kerlix->IV pull->1 L fluid
Read 4 tweets
Welcome to the @esicm webinar on renal issues in #COVID19 including AKI & CRRT esicm-tv.org #COVID19foam #foamed #FOAMcc
Low rates of AKI and CRRT initially thought. Does this marry up with the current picture?
AKI and CRRT data in #COVID19 currently. Real world data. #foamed #foamcc
Read 13 tweets
OK! As promised, here’s my very first #Tweetorial on #ketamine. It comes to you in 6 parts:
1 Mechanism
2 Intermittent bolus dosing
3 Procedural sedation
4 Low dose IV infusion
5 High dose IV infusion
6 Contraindications/warnings
#medtwitter #pharmacy #FOAMed #FOAMcc
Because I’m a hospital pharmacist, we’re going to focus on IV ketamine. Ketamine has other modes of administration (looking at you nasal-spray-for-depression) so feel free to add your own experiences below!
PART 1: MECHANISM
When an injury occurs, the dorsal horn releases glutamate which binds to the NMDA receptor. In some patients, this signals a cascade which eventually leads to the nervous system being stuck in a state of “high reactivity."
Read 35 tweets
Front-line providers need to consider anti-coagulating their rapidly deteriorating COVID-19 patients. Could it be that severe endothelial dysfunction, resulting in microvascular thrombosis, is playing a major role in the rapid deterioration that we see in days 7-10?
1/
There are a number of anecdotal reports of coincident pulmonary emboli and other clots, and subsequent rapid improvement with anticoagulation and even thrombolysis. commented on here: bit.ly/3c1drZN here: bit.ly/2VaSwwP, and here: bit.ly/2xZk4Nx
2/
Recent Italian research in this Webinar by ESICM posits two phenotypes, a type 'L' and a type 'H' Type L could be due to pulmonary microthrombosis and leads to a biphasic course with severe deterioration as clots hit multiple organs.
3/
Read 16 tweets
From experience in our #COVID19 ICU so far:

What started as an HFNC ICU has quickly turned into an ARDS unit treating iatrogenic ALI from patients being intubated

#COVIDfoam #FOAMed #FOAMcc @cameronks @PulmCrit @ThinkingCC @srrezaie @First10EM @gattinon @precordialthump

1/12
As physicians we see a low SpO2 combined with a low PaO2 & the knee jerk reaction is early intubation instead of assessing patient's overall clinical picture including their work of breathing & mental status. Here's a walk through what happens after...

2/12 #COVIDfoam #Covid_19
Following intubation, patients are put on higher PEEPs which combined w/ACE-receptor effects of virus worsens their already slightly elevated creatinine. Higher PEEPs causing increased thoracic pressure understandably leads to hypotension so patients are then given fluids

3/12
Read 12 tweets
(1/) I want to bounce around a disease model for #COVID19. This is hypothesis, some parts are hand-wavy, but I'd like to think a lot is also based on evidence. I'll try to clearly distinguish knowns from assumptions as we go...

#COVID2019 #SARSCoV2 #medtwitter #FOAMcc #FOAMed
(2/)First, whatever #COVID19 is, it doesn't sound like #ARDS. Physiology doesn't line up
1-Easy to vent, but hard to oxygenate. Normal lung compliance
2-Deteriorate rapidly
3-Responds to proning, PEEP, & prolonging I:E
4-Tendency to suddenly de-recruit

atsjournals.org/doi/abs/10.116…
Read 23 tweets
RT: INFOGRAPHICS #COVID #COVID19 #COVID19BE @UZBrussel @VUBrussel in Dutch via @ElisabethWaele. We use them at #ICU infopoint for Call Centre and Health Care Practioners (non-ICU)
Special thanks to Angelo @ShortcutAd #FOAMed #FOAMcc Image
INFOGRAPHICS - symptoms - #COVID #COVID19 #COVID19BE @UZBrussel @VUBrussel Image
INFOGRAPHICS - incubation period - #COVID #COVID19 #COVID19BE @UZBrussel @VUBrussel Image
Read 9 tweets
Welcome to #COVIDMarathon from @ESICM - follow this thread for the content coming up over the next 7 hours. #FOAMed #FOAMcc #COVID19 #COVIDfoam
A general update #covidmarathon
Evolving insights into increasing cases over time, globally. Very few reported cases in Africa over time. #covidmarathon
Read 43 tweets
Anyone that took the #EmergencyMedicine ITE last week knows that we got approximately 220 out of 225 questions on LVADs, and I’m pretty sure I got 85% of those questions wrong. So here’s a #tweetorial on LVADs

#FOAMed #CardioTwitter

1/
LVAD Basics

🔺They dont have pulses‼️due to linear flow device
🔺How to assess perfusion? Mental status, cap refill, warm extremities
🔺Auscultate (more on that later)
🔺Pulse Ox can be unreliable due to lack of pulsatility➡️get ABG if poor waveform
🔺Do bedside echo early

2/
Blood pressure with LVADs

✅MAP goal: 65-80mmHg
🔺Measure BP using manual cuff and doppler (95% accurate) as opposed to standard automated BP cuff (~50% accurate)
🔺Put in A-line if critically ill for continuous BP monitoring

#FOAMed #FOAMcc

3/
Read 13 tweets
1/#Ogitorial No21 Real Patient with Consent. 42M, previously healthy collapses upon entering ED
A ok
B clear, bag/maskFiO2
♥️ BP 60/, HR80 Epi drip
D avPu
E punctate skin marks, diaphoresis, ashen skin, L eyelid swell
U - dark ages
L Hb10, WBC6,K 2, Na146, HCO3 12, Lact 2.4-4.5
You place (just in case) DC pads, replace K/Mg. ED volunteer says: prior to collapsing, the patient mumbled “bees”. You speed up fluid (5LNS/1h), add steroid & H1/H2 blocker with ⬆️BP but severe rigors, anxiety & delirium. The risk of future PTSD is best ⬇️ by:
#FOAMed #FOAMcc
3/ #Ogitorial No21 answer
Psychological sequelae of critical illness are common & important
ncbi.nlm.nih.gov/pubmed/25449881
Dex is not safe in patients on Epi drip & no evidence it can help.
Diaries ncbi.nlm.nih.gov/pubmed/30431494 &
Post-ICU clinics ncbi.nlm.nih.gov/pubmed/25731633
are of limited help
Read 6 tweets
What is CORONAVIRUS? How might it affect ICU? Let's go back to basics and look at the emerging evidence bases, protocols and risks. #FOAMed #FOAMcc #WuhanCoronavirus #CoronavirusWho
Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). #FOAMcc #FOAMed
A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans.... which is what the virus that is widely reported on the media, and via the WHO and CDC etc are talking about. #FOAMed #FOAMcc
Read 52 tweets
What is going on with VITAMIN C in Critical Care? From basics to current day conundrums. #FOAMed #FOAMcc #VitaminC You can use the @threadreaderapp to read this Tweetorial!
First - let's look at what Vitamin C is. Unlike most mammals, we can't actually synthesise it! It's a water-soluble vitamin: lpi.oregonstate.edu/mic/vitamins/v…
Which is why it needs ingested, or... supplemented.
It's most important function (from a critical care perspective) likely comes from its function as an anti-oxidant. #FOAMed #FOAMcc intechopen.com/books/vitamin-…
Read 34 tweets
Thematic talk today about the ROLE of RCTs in Intensive Care Medicine. **TWEETORIAL** #ESICMphysio #FOAMed #FOAMcc
Randomised controlled trials (RCTs) are the most rigorous way of determining whether a cause-effect relation exists between treatment and outcome and are an integral component in the hierarchy of evidence which guide current clinical practice. #ESICMphysio ... but...
There are some problems... ncbi.nlm.nih.gov/pubmed/20413119
Read 14 tweets
Today we're going to take a look at BIOENERGETICS in ICU in this quick Tweetorial :-) #ESICMphysio #FOAMed #FOAMcc
Bioenergetics = biochemistry concerned with the energy involved in making and breaking of chemical bonds in the molecules found in biological organisms. It can also be defined as the study of energy relationships and energy transformations and transductions. #ESICMphysio
Mitochondrial functions incl production of energy, activation of programmed cell death, and a number of cell specific tasks, e.g., cell signaling, control of Ca2+ metabolism, and synthesis of a number of important biomolecules. ncbi.nlm.nih.gov/pmc/articles/P…
Read 37 tweets
So - the candidates from #ESICMphysio are off to engage in their workshops - so I thought... let's hold a virtual workshop here on MECHANICAL VENTILATION! #FOAMed @ESICM
Let's start off at the very beginning. This is a HUGE topic... obviously not going to cover everything. But let's start off at the very beginning and look at my Tweetorial from yday from Prof Barnes talk on the physics of ventilation... #ESICMphysio
@MedCramVideos do a REALLY good series for beginners - for free - on YouTube - 5+ videos on Ventilators and how they work: youtube.com/results?search…
Read 30 tweets

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