Discover and read the best of Twitter Threads about #ICUliberation
Most recents (5)
So the problem of MD shortages is so very real. ❤️ the timely article, agree with so much of it, but only partial solutions discussed here. A thread for some more color to this 🧵 1/8
time.com/6199666/physic…
time.com/6199666/physic…
As the MD numbers don’t add up from supply-demand curves, we started a “fellowship/residency” for NP/PAs in critical care & then pulmonary @RKleinpell is a pioneer in this space.
ncbi.nlm.nih.gov/pmc/articles/P…
ncbi.nlm.nih.gov/pmc/articles/P…
At some point #Telemedicine has to be considered to leverage technology & scale expertise. @ADVISSOR_One is trying to lead this on a national scale
liebertpub.com/doi/pdf/10.108…
liebertpub.com/doi/pdf/10.108…
#COVID19 🧠 ALERT:
Tom Petty’s famous 1998 editorial was prescient & never more important than now as we struggle to adapt ICU care to a long & brutal ARDS w added DENSE delirium. READ 📚 3 HIGHLIGHTS!
👀 attached stream
CHEST: bit.ly/2BTvK78
#MedTwitter #pulmcc
Tom Petty’s famous 1998 editorial was prescient & never more important than now as we struggle to adapt ICU care to a long & brutal ARDS w added DENSE delirium. READ 📚 3 HIGHLIGHTS!
👀 attached stream
CHEST: bit.ly/2BTvK78
#MedTwitter #pulmcc
“But what I see these days are paralyzed, sedated patients, lying without motion, appearing to be dead, except for the monitors that tell me otherwise.” Petty 1998
“Why have we regressed to these critical care practices?” Petty 1998
BRAIN 🧠 #Covid19 #Delirium: Neurotransmitters go awry in sepsis. Acetylcholine depletion & Dopamine excess are linked. EXCELLENT paper by Hshieh/Inouye explains how they are connected. Schizophrenia lit helped us understand hallucinations. bit.ly/2BkhJyF N 1/3 tweets
Neurotransmitters 🧠
Brain
#Delirium: Dopamine+Acetylcholine system & receptor pharmacology are interconnected. In animals, blocking excess DA allows ACH depletion to improve (historical Delirium hypothesis). We tested DA-blockade hypothesis and more in MIND-USA.
N 2/3 tweets
Brain
#Delirium: Dopamine+Acetylcholine system & receptor pharmacology are interconnected. In animals, blocking excess DA allows ACH depletion to improve (historical Delirium hypothesis). We tested DA-blockade hypothesis and more in MIND-USA.
N 2/3 tweets
🧠 Take home: You’ve seen 2018 data. DA/ACH hypothesis may be correct even though Antipsychotics don’t reduce delirium. bit.ly/2AWg1TJ We HAVE TO realize that #ICU patients need our 👁 on all their human needs. Take time & comply #A2Fbundle #ICULiberation N3/3 tweets
SMART MEDICINE 1: #COVID19 Chaos has us abandoning things we know & ditching protocols. Colleagues may say they know better? Truth: Well-designed, tested, & proven-to-work protocols are based on knowledge, derived from experience & yield understanding. But it takes YOU #A2Fbundle
SMART MEDICINE 2: Why use a protocol? To help communicate better & “find the person in the patient.” Navigate patient care better through treacherous waters 90%...& 10% you can deviate to get around icebergs. That’s SMART MEDICINE. #ICULiberation read here bit.ly/2YuoRlC
SMART MEDICINE 3: Episteme is Knowledge. Phronesis is understanding. To design #A2FBundle, we used >400 studies of episteme and phronesis & proved a better way. Look at figures. Higher compliance bit.ly/3dH9kDP yields ⬆️ human outcomes. Capeesh? #A2Fbundle #ICULiberation
I'm not a big #tweetorial person, more a #bitesized learning guy.
But important topic + healthy peer pressure =
Let's talk about #Delirium in the ICU (#DICU)!
For the most part, this is applicable to most patients.
Q: Do you regularly assess for #DICU?
But important topic + healthy peer pressure =
Let's talk about #Delirium in the ICU (#DICU)!
For the most part, this is applicable to most patients.
Q: Do you regularly assess for #DICU?
What does delirium look like?
<5% "hyperactive": EASY TO JUDGE these pts
95%: "hypoactive" or mixed: somnolent, not accepting feeds, withdrawn:
EASY TO MISS these pts
What's the big deal?
Vent time 🔼 8d
Hosp LOS 🔼 by 8d
Cognitive impairment at D/C: 50%, long term: 33%
<5% "hyperactive": EASY TO JUDGE these pts
95%: "hypoactive" or mixed: somnolent, not accepting feeds, withdrawn:
EASY TO MISS these pts
What's the big deal?
Vent time 🔼 8d
Hosp LOS 🔼 by 8d
Cognitive impairment at D/C: 50%, long term: 33%
WHAT is delirium:
😣 Altered level of consciousness (hyper/hypoactive) +
🙄 Inattention
With either:
😇 Change in cognition (who, you?, what is life?) OR
🤓 Change in perception
Easy to miss in a patient that isn't "belligerent" or "climbing out of the bed". It can be SUBTLE!
😣 Altered level of consciousness (hyper/hypoactive) +
🙄 Inattention
With either:
😇 Change in cognition (who, you?, what is life?) OR
🤓 Change in perception
Easy to miss in a patient that isn't "belligerent" or "climbing out of the bed". It can be SUBTLE!
