Discover and read the best of Twitter Threads about #ICU

Most recents (24)

If you are going to your first ICU rotation and you feel like you have no idea what to do:
I felt the same😄
I added a thread 🧵 with 8 tips for med students and new interns of #MedTwitter #IMG #ICU
Pls add your questions or tips in comments!
1️⃣ Ventilator skills are game changers! Review some basics before starting.
2️⃣Great resources for studying:
🔸️@OnePagerICU summaries of most important icu pearls in one page🥹
🔸️@MedCramVideos great videos 😎
🔸️Rebel EM
🔸️EMCrit project
🔸️Marino's ICU book🤠 Image
3️⃣Things to check for every ICU patient when pre-rounding:
🔸️Which drips/current rate
🔸️The RASS score
🔸️Ventilator settings (tidal vol., RR, FIO2, PEEP, mode)
🔸️Sedation and analgesics
🔸️Access lines and if they need to be removed
🔸️Blood gas
Read 9 tweets
What is meant my Pulsus Paradoxus ?
A one-stop pathophysiology thread you’d ever need 🧵

#MedTwitter #MedStudentTwitter #MedEd #FOAMed #CardioEd #USMLE #ICU #EMTwitter Image
To understand Pulsus Paradoxus in detail,

It is essential to realise for a fact that, 1. Pleural pressure, 2. Abdominal pressure, 3. Heart chamber pressures & 4. Lung pressures, are all interconnected, interact & react among each other.
As we inspire —> the diaphragm moves down, creating a more negative intra-pleural pressure & a more positive abdominal pressure —> this adds up to ⬆️ venous return to right atrium —> excess blood enters RV & ⬆️ right ventricular end diastolic pressure (RVED)
Read 14 tweets
🧵 Thread: The Future of Assessing Systemic Microcirculation in Cardiogenic Shock (CS) 🩺🫀

1/ Hey Twitterverse! Today, I want to talk about an exciting topic in cardiology & ICU: the role of evaluating systemic microcirculation in CS. 🌡️🫀 #ICU #Cardiology #Microcirculation Image
2/ CS is a life-threatening condition in which the heart is unable to pump enough blood to meet the body's metabolic needs.… Image
3/ Traditionally, assessment of the macrocirculation (e.g., BP, LVEF, CO) has been the focus, but new research suggests that assessment of the microcirculation is the next step.💡
Read 16 tweets
A summary thread from the great Emergency Medicine Australasia issue I finally read on the plane; @EMAJournal #foamed

Thom study in EMA: patients with unstable cervical #fractures can sit (29%), walk (63%), lack midline tenderness (27%), and have delayed presentation (20%).
@EMAJournal #emergencymedicine

surf injuries were mostly lower c-spine

NEXUS underperformed compared to Canadian C-spine.

#drowning and cervical CTs are not inextricably linked: don't automatically image unless signs of axial loading/very specific concerns
@EMAJournal [my $0.02 on immobilising (virtually) anyone prehospitally: cervical immobilisation is a myth: collars don't actually immobilise, and 'immobilisation' doesn't actually prevent neurological *does* however harm (eg aspiration and other harms)]
Read 31 tweets
1️⃣(Left) Ultrasound waves reflected at the pleural line creating A-line reverberation artifacts.🫁


#ICU #CriticalCare #IntensiveCare #IntensiveCarecommunity #FOAM #JCardenas_MD #MICU #CICU @JCardenas_MD
2️⃣(Center) As the interstitium thickens, the artifact pattern changes, with B-line artifacts obliterating A-lines. B-lines are hyperechoic vertical artifacts arising from the pleural line extending to the bottom of the field of view. 🫁

Read 4 tweets
I went to med school to be a medical geneticist (went off piste) but always been fascinated by it. One way the environment interacts with our genome is through methylation - the addition of methyl groups to certain points in the dna string
This physical/chemical manipulation changes how the dna string folds and how easy it is for transcription machinery to access it. We have the same genome as ourselves as an egg, but clearly have organs and limbs now - methylation helped the egg produce these changes
An ENT surgeon friend sent me this epigenetic study on Japanese centenarians - they show less age related methylation at expected genes such as cancer and neuropsychiatric but the surprise was they are undermethylated for anti inflammatory genes eg TGFb
Read 16 tweets
Dr. Martin Bogetz, a bereaved father, sharing the legacy of his daughter Alyssa:
- an MSW who cared deeply about wellbeing
- the first non-physician associate program director in Peds at Stanford, who focused on supporting trainees
- sister of @jbogetz, #pedpc wonder ❤️ #hapc23
The inaugural Alyssa Bogetz lecture: Dr. Susan Block talking about the state of integration of #hapc and #mentalhealth
Alyssa died of AN. The educational fund was started in her honor @AAHPM w the appreciation that our field needs to grow to support people like her. #hapc23
"I think it's a miracle how far we've come." - Dr. Susan Block

We are the 6th largest subspecialty of the largest specialty in the US! #hapc #pedpc #hapc23
Read 10 tweets
“Ten tips to optimize #vasopressors use in the critically ill patient with #hypotension.” #IntensiveCare #MedTwitter #CardioTwitter #sepsis #FOAMed #FOAMcc #CriticalCare #EmergencyMedicine #PedsICU #ICU #EMCCM
📚 Intensive Care Med (2022) 48:736–739
1. Set goals of mean or diastolic blood pressures.
2. Individualize the arterial pressure targets goals.
3. Vasopressors induce an endogenous fluid recruitment and may limit positive fluid balance.
4. Reassess fluid status and cardiac output after initiation of vasopressors
5. Consider agents with a different mechanism of action as a second line agent.
6. Consider adding hydrocortisone in patients on high doses of vasopressors.
7. Vasopressin is an option in patients with right ventricular failure.
8. There is no maximal dose of vasopressors.
Read 4 tweets
I often discuss Post Intensive Care Syndrome on Twitter - called "PICS" but what is it? Let's briefly unpack it in a 🧵 1/7
Coined by a thoughtful clinician, pioneering researcher, and winsome colleague @DrDaleNeedham in 2012 in an article that has been cited over 2,000 times. It refers to a condition that affects millions of survivors of critical illness/intensive care. @CIBScenter 2/7
PICS is a phenomenon in which individuals develop new or worsening symptoms/difficulties after the #ICU in one or more of 3 key domains - cognitive, psychological, physical. 3/7.
Read 7 tweets
🧵We often refer our patients for "neuropsychological" testing but what exactly is it, do you need it, and how does it add value? A thread. 1/10 @CIBScenter
Neuropsychological testing - also known as cognitive testing - aims to provide a comprehensive look at key areas of your cognitive functioning - aspects of your memory, attention, processing speed, executive functioning and more. It is a "deep dive." 2/10
Neuropsychological testing contrasts with cognitive screening (CS). Often 5 or 10 or so minutes in length. CS has a valuable place and a role to play but it provides a brief glimpse, has limitations especially in mild cases, and is not diagnostic. @CIBScenter 3/10
Read 9 tweets
So this has been making the rounds. I realize it’s probably meant to be a thought experiment & deliberately provocative, but still, philosophical arguments should be rooted in at least some amount of reality.

I will now rage tweet about everything wrong w/ this concept. Enjoy🧵
Let’s start w/ the author’s premise: if we’re ok w/ #organdonation after brain death, then we should be ok w/ “whole body gestational donation” (WBGD).

Even putting aside the part about this sounding like a horrifying, dystopian baby farm, they’re not even remotely comparable.
Here’s why:

#Organdonation after brain death typically happens very quickly (a few days or less). This is not simply because we’re uncomfortable keeping someone’s organs alive longer; it’s because it’s incredibly challenging & often not possible, despite the authors assertions
Read 21 tweets
🧵We've been leading support groups for #ICU survivors for nearly 10 years (over 2 years with #LongCovid patients). Across literally thousands of patient encounters, what have we learned? I'll unpack these insights in tweets to follow. Thanks for reading them. @CIBScenter 1/10
To begin, the ROI for support groups is enormous- they require minimal expenses, utilize few resources, allow you to touch the lives of sometimes dozens of people at the same time, and contribute to changed lives. An inexpensive way to make a big impact. 2/10
They require competent leaders who understand group processes. You can find such people or you can become one but make sure that for at least one group leader, this is not their "first rodeo." We don't all have to be experts but we owe members that much. 3/10
Read 10 tweets
PTSD is a common phenomenon in ICU survivors, impacting literally millions of people around the world, every year. What do we know about it? A 🧵 1/5
In the late 1990s, research on #PTSD after the #ICU first emerged, with early studies suggesting prevalence rates of 40 to 50 percent, far higher than in combat veterans and other high risk groups. Studies since then have documented rates of 10% to 20% - clearly a problem. 2/5
Risk factors for PTSD in ICU survivors vary but include female sex, young age, a history of delirium, and a history of psychiatric illness. The presence of delusional memories also plays a role. @CIBScenter 3/5
Read 5 tweets
1/3-💥 12 KEY TRIALS I teach on #ICU Rounds each week trainees must know!

BACK by request!

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

4. TRICC Trial @NEJM PMID: 9971864

5. SOAP Vasopressor trial @NEJM PMID: 20200382


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 continued…


11. Schweickert Early Mobility @Lancet PMID19446324

12. ABC Trial @TheLancet PMID 18191684

What others would you add?

#FOAMcc #FOAMed #SCCMSoMe #MedTwitter #MedEd #MedStudentTwitter
Read 3 tweets
"Every Canadian needs access to a family doctor. Governments need to step up and commit to doing what’s right for the system, instead of focusing on Band-Aid solutions."
"We need a true understanding that the best patient care is care in the community, and that in part, hospitalization for preventable illness is a failure."
I'd had we need a culture change from within and from outside healthcare.
Read 8 tweets
It's 🥶 & we're coming across many cases of peripheral ischemia/gangrene

🔢The semiology of seizures is what we are all taught, but gangrene is another condition where history is the king 👑

🔁It's essentially a demand≠supply mismatch

#MedEd #MedTwitter #RheumTwitter
The 📝 goes on & so that we can save ⏳ & 💰 on the tests, I like to broadly divide the pathology into:

1️⃣Luminal: atherothrombosis, thrombosis (APLA, DIC), cryofibrinogenemia

2️⃣Vessel wall: vasculitis (ANCA, PAN, SLE),vasculopathy (scleroderma spectrum)

3️⃣External compression
Q1️⃣: How was the onset?

🐌Insidious onset, gradual progression is the most common

➡️peripheral vascular disease

➡️most vasculitides


#MedEd #MedTwitter
Read 12 tweets
Is direct discharge to home (DDH) from ICUs safe?

1. Patients are usually transferred to hospital wards from the ICUs and discharged to home after another few days. However, there could be delay in getting a ward bed or patient might have significantly recovered while in ICU.
2. Moreover, some families find it difficult to afford longer duration ICU (& hospital stay) costs. This necessitates direct discharge to home (DDH) in some patients. In a recent study, the safety of DDH was evaluated and compared to those who were transferred to wards from ICUs.
3. For DDH from ICU, compared with ward transfers, there was no difference in the risk of-
*Emergency department visits at 30-days (22.4% vs 22.7%);
*Hospital readmissions at 30-days (9.8% vs 9.6%); or
*90-day mortality (2.8% vs 2.6%).
#MedTwitter #CriticalCare #ICU
Read 5 tweets
There is a decline in emergency & critical care peaks in #China's large cities, while small & medium-sized cities & rural areas will soon experience peaks in emergency & critical care, said Jiao Yahui, an official with the National Health Commission in a recent interview. 1/6
There will not necessarily be an increase in #COVID infections during Spring Festival. Still, there may be increase in emergency&serious illnesses in small&medium-sized cities&rural areas, Jiao noted, saying that infection rates have reached a certain level in these regions 2/6
Jiao said that "from the typing of clinical cases of #omicron in #China in 2022, the proportion of pneumonia in the common type of COVID-led illnesses is relatively low, less than 10%, which is about 8%." 3/6
Read 7 tweets
The Swan-Ganz Catheter 🦢🫀

AKA, the Pulmonary Artery Catheter or PA Catheter.

A thread discussing the basics of our PA Cath:
#MedTwitter #FOAMed #ICU
The PA Cath is a specialized venous catheter that can give us a whole host of values related to cardiac function, hemodynamics, and perfusion. 🧐
This cath is a long balloon tipped cath that enters the venous system. It is passed into the RA, through the tricuspid valve, into the RV, and then finally through the pulmonic valve with the tip resting in the pulmonary artery (PA). 🫀
Read 11 tweets
New to the ICU?

Osler's catalogue of modules is completely free, and you can even print off a certificate of completion for your records!

Here's 10 great modules to get you started

#intensivecare #intensivist #ICU #FOAMed #FOAMcc #medtwitter @CICMANZ @anzics @ANZCA @acemonline
If your're going to do invasive procedures, you need to get the basics right
If you're new to mechanical ventilation, this will give you the basics

Read 12 tweets
#Valproate (VPT) is still more efficacious and more cost-effective as compared to #levetiracetam (LEV) for treating generalized #Epilepsy (GE)

1. I see an increasing trend for prescribing LEV in emergency room, ICU & OPD for GE
#MedTwitter #neurotwitter…
2. In a recent study, LEV was found to be inferior for times to treatment failure, 2-year remission from seizures, and first subsequent seizure. In addition, LEV was not found to be a cost-effective alternative.
3. This is despite the fact the LEV is associated with a higher incidence of #psychiatric and #behavioral adverse effects.
This is a major problem in #ICU patients, as it adds to the burden of patients with #psychosis in ICU.
Read 5 tweets
An INCREDIBLY intimidating part of the ICU can be the patient exam in the AM:
A 🧵on what to assess at bedside while taking care of an intubated/sedated patient.

(Because @tammamtu made an excellent point on another 🧵)
#MedTwitter #MedEd #Medicine #CritCare #ICU #CriticalCare
1. Talk to the patient, no matter their mental status. You should introduce yourself & announce what you’re doing during a physical exam. Sometimes we forget that there’s a loved one surrounded by all those machines & forget to act the same way we would if they were awake. Don’t.
2. Mental status: If they’re relatively responsive this one is much easier. If they’re not, this one is tough.

Assess sedation level. RASS is a commonly used descriptor. Most patients (not all) should be +1 to -1. If they’re -5 and on max sedation, you should explore that. Image credit: https://inten...
Read 16 tweets
ICU pre-rounding tips:
I feel like early on, knowing what matters in the ICU is REALLY tough. So here’s what I typically do:
A 🧵 inspired by @akhadilkarMD’s pre-round thread (you should check that one out too!)

#MedTwitter #MedEd #CritCare #ICU #medicine #criticalcare
1. If you can get at least some of this information automated for a printout, that can be invaluable. Whether that’s an updateable .dotphrase or a printable page from EPIC/Cerner etc. — save the carpal tunnel for later and just make notes on the data!
2. Start with a page that allows you to trend vitals. Particularly helpful is one with vitals and vasoactive gtts :
Is the MAP the same all night but the levo is down OR struggle to get a MAP >65 & escalate to a second pressor?
The #’s are important, but the TREND is essential.
Read 14 tweets

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