Discover and read the best of Twitter Threads about #ICU

Most recents (24)

“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
🧵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
MAPSE in #IntensiveCare (with examples)🧵#FOAMcc #FOAMed #MedTwitter #Hemodynamic #POCUS #EchoFirst #CriticalCare
Take homes:
1⃣ Redefining "the hyperdynamic heart" with #MAPSE
2⃣ MAPSE is better than EF in the #ICU
3⃣ Linking MAPSE with supply/demand-ischemia
1⃣ Can MAPSE redefine "the hyperdynamic heart?
The term "hyperdynamic LV" - EF > 55% - is misleading. It has no relation to a hyperdyanmic circulation; SV/CO. Someone bleeding to death has a hyperdynamic heart, but the circulation is life-threatening hypodynamic.
MAPSE is cardiac motion, and defining the hyperDYNAMIC heart as good cardiac motion makes perfect sense. Recent geometrical analysis of cardiac pumping shows that MAPSE is the main determinant of SV. Fig from @mugander:
Read 17 tweets
🧵 #LivingLongCovid

Some maybe already know me probably% and maybe my story.

I am a #HealthCareWorker and since before and at the beginning of #COVID19 I have worked in the #ICU saving lives and learning about #IntensiveCare

I've had #COVID19 3 times so far this pandemic.
I developed #LongCovid from my 2nd contagion that was serious at the time, I required hospitalization in #ICU and oxygen therapy.
Since Dec 2020 I have lived with #LongCovid since then and when I understood the Multi-organic gravity of #LongCovid
And I still do it daily.

A few days ago I had a 2nd #InfarctionSilent a year ago I had a multiorgan failure accompanied by #infarctionSilente

We know that #COVID19 can cause #myocarditis and that is possibly the case, I don't know yet.

I tell you now.
Read 19 tweets
🧵 #LivingLongCovid

Algunos quizás ya me conocen probable% y tal vez mi historia.

Soy #HealthCareWorker y desde antes e inicios de la #COVID19 he trabajado en #ICU salvando vidas y aprendiendo sobre #CuidadosIntensivos

He tenido #COVID19 3 veces en lo que va de pandemia.
Desarrollé #LongCovid desde de mi 2do contagio q fue grave en ese entonces, requerí hospitalización en #UCI y oxigenoterapia.
Desde Dic 2020 q vivo con #LongCovid desde entonces y cuando comprendí la gravedad Multi orgánica de #LongCovid
Y sigo haciéndolo a diario.

Hace unos días tuve un 2do #InfartoSilente hace un año atrás tuve una falla multiorganica acompañada de #infartoSilente

Sabemos que #COVID19 puede causar #miocarditis y posiblemente sea el caso, no lo sé aún.

Les cuento ahora.
Read 18 tweets
Nur damit sich Außenstehende das Wort "Personalmangel" mal bildlich vorstellen können:
Auf unserer Station ist vor ein paar Wochen ein Pat. gestorben, weil seine kreislaufunterstützenden Medikamente leergelaufen waren.

Weil in der Hektik niemand den Perfusor hat alarmieren
hören. Weil die betreuende Kollegin noch 2 andere, ebenfalls instabile Pat. zu versorgen hatte.
Weil der Monitor an der Zentrale, der anzeigen soll wann Medikamente leer sind, seit Wochen kaputt ist und die Reparatur zu teuer sei.

Gäbe es genug Personal, hätte nicht so eine
Hektik geherrscht.
Gäbe es genug Personal, hätte die Kollegin max. 2, bestenfalls sogar nur einen (weil sehr instabil) Pat. zu versorgen gehabt.
Hätte wir dem digitalen Zeitalter angemessene und funktionierende Technik, müsste man nicht permanent die ganze Station ablaufen,
Read 6 tweets
A good thread with thoughtful discussion of the idea of anesthesiology "backing up" other departments (e.g. ICU, ED) in their own efforts to manage airways. Knotty issues, but a few general observations (🧵)...

#medtwitter #FOAMcc #icu
1. In almost all cases, anesthesiology will be the most-experienced, most-trained people to manage an airway.

2. Out-of-OR airways almost always have relatively high risk of complications.

3. Some centers interpret #1 and #2 as meaning anesthesia should handle ALL airways.
4. However, other departments ARE trained to do this, and whether they routinely do depends heavily on the institution and its culture.

5. It is *not* always true that the *most* trained person should do everything; a hierarchy with appropriate "calls for help" is commonly used
Read 7 tweets
In 2009 I was involved in an Intensive Care Unit adverse event where our ICU team #failed in its goal and a person died as a result. This set me on a path to thinking about how to respond to these traumatic experiences and how to prevent them at a professional and personal level.
I was given an opportunity to explore this by @theMJA with "A personal reflection on staff experiences after critical incidents."
Knott CI. A personal reflection on staff experiences after critical incidents. Med J Aust. 2014;201(9):550-1. Med J Aust. 2014;201(9):550-1.
I got involved in clinical simulation-based education as a way of developing team-based methods for the 'next generation' to avoid my mistakes with thanks to @NHETSim, @anzics, @sganzics, @ASSH_simaust, @MonashRural. I was able to explore the safe conduct of clinical simulation.
Read 14 tweets
1/3- 🙋‍♂️12 KEY TRIALS I teach on #ICU Rounds each week residents & fellows must know!

BACK by request for July!

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 continued…

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
1) Finally, seems IMF progm being shortly revived, wth more taxes.
GDP growth to slow down-may be 3%- more increase in petrol prices & utilities- significantly higher inflation may be 15%. In this 🧵 I cover 2 strategic options country has to choose n/1…
2) With #IMF revival, default averted in near term, but economy to remain in #ICU . How will the govt address fiscal & currnt acnt deficits, ensure servicing of huge stock of external debt, improve forex reserves, enhance exports & restore investor confidence? n/2
3) How will the energy crisis, its mounting debt, SOE crisis be addressed? How will we improve our human development indicators?
Above 3 questions require major change in mindset wth regard to governance & public financial management . n/3.
Read 5 tweets

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