Discover and read the best of Twitter Threads about #SEPSIS

Most recents (24)

Und da ist es mir passiert: Ein Patient mit Unterarmphlegmone, bestehendem Drogenabusus und ungepflegtem Zustand steht zur OP im Dienst an. Eine kurze Fallbeschreibung als Reminder💡
Er kam fahrig, unruhig und tachykard in den OP.
🧵(1/4)
Schublade: entzügiger Drogi, na toll 🙄
Narkose gut überstanden, im AWR weiter tachykard und unruhig, RR nach Volumenstubstitution normwertig aber weiter tachykard und kaltschweissig. Na toll: Entzug geht richtig los. Methadon von Station besorgt und…
(2/4)
Clonidin - Patient jetzt etwas entspannter: ab auf Station, ist ja jetzt auch schon spät. 🥱🕐
Stunde später Anruf von der Dienstärztin von Station: Patient weiter tachykard, jetzt hypoton und BZ schlecht ➡️ Übernahme auf ICU. Labor mit akutem Nierenversagen, PCT hoch, …
(3/4)
Read 4 tweets
Al parecer Emmanuel Rivers tenía conflicto de interés en su estudio de EGDT, en 1997 había mandado a la oficina de patentes de 🇺🇸 un dispositivo para medir SvO2 continua (🧵 1/4) #FOAM #FOAMcc #sepsis #Emergency
Sus metas tempranas como sabemos consistían entre otras en mantener una SvO2>70 (con monitoreo continuo🧐) ya sea con líquidos inotrópicos o hemoderivados, excluyeron 27 pac 13 del grupo EGDT y 14 del grupo control porque “no completaron 6 hrs” (2/4)
Sus resultados fueron biológicamente improbables, el perfil hemodinámico de SvO2⬇️ con TAM⬆️ en sus datos basales es atípico para sepsis, casi todos los sépticos tienen SvO2 ⬆️ (3/4)
Read 4 tweets
🐸 Super Freak 🐸

Snakes are messy lovers. They want to a quick and dirty romance with the prey. Other predators like birds, or whales can stun prey by throwing or slapping it physically, or with sound. Mammals with sharp teeth and claws rip into it starting the onset of shock.>
and bleeding. Snakes have to rely on venom for all of these factors. Their venoms evolved around their prey availability, for cobras and kraits: fish, amphibians, rodents, other snakes, slippery characters. Venoms need to be quick to shock or stroke out the prey and render>
it immobile. It accomplishes this by forming simple messy "freak" clots quickly in the blood. Presumably these would work in concert with adrenaline, tire the prey out as it struggles, eventually cause a large clot, inducing a stroke or heart attack for a peaceful meal.>
Read 8 tweets
Shake Senora

Consonance of Symptoms
Shake, shake, shake, Senora, shake your body line
Shake, shake, shake, Senora, shake it all the time
Work, work, work, Señora, work your body line
Work, work, work, Señora, work it all the time
Read 7 tweets
sssomething sspartacus ssaid Image
What is acute sepsis, septic shock? Image
Where else do we see septic shock?
bmcemergmed.biomedcentral.com/articles/10.11…
Read 15 tweets
🐍 The Snake 🐍

"Snake venoms stimulate the ACTIVATION OF MAST CELLS WHICH LEAD TO HISTAMINE RELEASE, INDUCING VASCULAR PERMEABILITY AND VASODILATATION LEADING TO EXTRAVASATION...
the patients presented with local pain and swelling. Disseminated Intravascular Coagulation was>
observe along with Acute Kidney Injury...The in-flammatory response has relevance in the evolution of tissue damage; it is associated with edema, pain, leukocyte infiltration and release of several mediators. Pathogenesis...is multifactorial and complex; it is characterized by >
local and systemic alterations. Several studies...have demonstrated release of interleukin-6 (IL-6), nitric oxide (NO), IL-5, tumor necrosis factor-a (TNFa), IL-4, IL- 10, prostaglandins and leukotrienes, with distinct time courses in production post venom exposure">
Read 6 tweets
#Sepsis hat keine Lobby. Ist das ein Problem? Klar!
#Sepsis tötet! Und das gar nicht selten. Die Sepsis gehört zu den häufigsten Todesursachen in D.
Die gute Nachricht: d. Verlauf einer Sepsis kann durch frühes Erkennen & rasches Behandeln positiv beeinflusst werden.
Thread 1/23 Image
Deshalb ist es wichtig, dass alle mal was davon gehört haben und zumindest grob wissen, worum es hierbei geht.
Also gibt es jetzt und hier für Laien und medizinisch Interessierte diesen kleinen Thread zum Thema #Sepsis. #einfachMedizin
2/x
#Sepsis wird auch als Blutvergiftung bezeichnet. Sie kann durch jede Infektion ausgelöst werden; also z.B. Lungenentzündung, Entzündungen im Bauch, den Harnwegen od. auch Infektionen, die entstanden sind, weil man sich verletzt hat & Erreger in d. Körper eingedrungen sind.
3/x Image
Read 23 tweets
#Pneumonia is the #1 infectious killer of kids – killing > 40,000 in #Somalia, #Guinea, #SouthSudan & #Chad in 2019

Introducing #PCV 💉would dramatically save lives - 92,000 by 2030!

What must be done: bit.ly/3ggUA1g

#EveryBreathCounts #VaccinesWork #AUSummit
🧵 1/
More than half of child #pneumonia deaths are in countries with < 60% #PCV coverage. These kids are paying with their lives!

These govts👇must introduce & protect >90% children with #PCV by 2025

More 👉 bit.ly/3ggUA1g

#EveryBreathCounts #VaccinesWork #AUSummit
2/
Introducing the #PCV 💉in #Somalia could avert 32,600 child deaths from #pneumonia, #meningitis & #sepsis

Prevention is key where just 23% of kids with pneumonia symptoms are taken for care. bit.ly/3ggUA1g

#EveryBreathCounts #VaccinesWork #AUSummit @MoH_Somalia
3/
Read 6 tweets
Do you know all of these nuances of #pleuraldisease? Why is an #empyema distinct from a complicated #parapneumoniceffusion? What is #contarinisyndrome #explosivepleuritis #chyliform #pseudochylous? Are all #chylothorax milky? #pccm #pulmcrit #pulmonary
#pleuraldisease is fascinating and nuanced. First step is #lightscriteria which give favor to finding #exudates which tend to be more urgent. You only need one criterion, which maximizes #sensitivity. Meaningless statement: "It's an exudate only by protein." One criterion=exudate
(Like on Tinder, the more criteria you require, the more you narrow your pool, compromising sensitivity for specificity.) Transudates I will skip over. Most common #exudate is #parapneumoniceffusion #PPE. If there is or is likely to be #pneumonia, it's PPE. Next task is to...
Read 26 tweets
Looking for more #sepsis resources? Start here! 👇🧵

#SurvivingSepsis #SCCMSoMe
Download the full guidelines for free from @CritCareMed: bit.ly/30c1UGM

#SurvivingSepsis
Review the Executive Summary to see how the updated guidelines were developed and how they differ from the 2016 guidelines: bit.ly/3wuDOmw

#SurvivingSepsis
Read 9 tweets
As #MedTwitter regulars, you may have already heard that the #SurvivingSepsis Campaign has released the updated 2021 version of the International #Guidelines for Management of #Sepsis and #SepticShock!

But have you gone thru the updates yet?

A #Tweetorial (1/x):
There are 93 #recommendations made in the new publication. I don’t have time to write (or read) that kind of #Tweetorial and neither do you. That’s what the publication is for -> journals.lww.com/ccmjournal/Cit… !

But let’s hit the ✨highlights✨ starring Table 1: (2/x)
Why we care (and we care so much!): Sepsis and septic shock affect millions of people globally each year, and kills somewhere between 1/6 and 1/3 of those diagnosed with the #syndrome. 1/3!!! 😳😢 (3/x)
Read 25 tweets
(Knopfzelle 1/6) Leider kommt es immer wieder zum Verschlucken von Knopfzellen durch Kleinkinder. Eine Knopfzelle ist eine kleine runde Batterie. Relativ große Knopfzellen haben einen Durchmesser von über 2 cm und sind besonders gefährlich #Batterie #Kinder #sepsis #vergiftung Image
(Knopfzelle 2/6) Oftmals bleibt die Knopfzelle in der Speiseröhre stecken. Knopfzellen haben meist eine Spannung von 3 Volt. Durch das feuchte Gewebe in der Speiseröhre kommt es zu dauerhaften Stromfluss.
Knopfzelle (3/6) Folgen sind meist Verbrennungen und Verätzungen. Das Gewebe in der Speiseröhre kann so sehr verletzt werden, dass die Speiseröhre undicht wird. Bakterien können den Blutkreislauf sowie Herz und Lunge erreichen.
Read 6 tweets
Die vor 20 Jahren publizierte "Rivers"Studie hat die #Sepsis Therapie grundlegend verändert. Sie definierte Therapieziele, die innerhalb von 6h erreicht werden sollten. Sie zeigte eine Mortalitätssenkung von 46,5 auf 30,5% (1/4)
nejm.org/doi/10.1056/NE…
In den letzten Jahren wurden die Parameter angepasst, der zentrale Venendruck spielt z.B. keine große Rolle mehr, ebenso wird die großzügige Flüssigkeitsgabe zunehmend kritisch gesehen. Die Indikation zur schnellen Bluttransfusion wurde ebenfalls revidiert. (2/4)
Warum also bahnbrechend? Die Studie hat die #Sepsis als einen zeitkritischen medizinischen Notfall behandelt. So schwer nachvollziehbar das heute ist, davor war das nicht immer der Fall. Die #SurvivingSepsisCampaign wurde gegründet, mit dem Ziel, die Mortalität zu senken. (3/4)
Read 4 tweets
Today is #WorldSepsisDay

Q: What is #sepsis?
A: Sepsis is a life-threatening medical emergency. It occurs when a person has an infection, and the body’s response causes injury to its own tissues and organs.
Sepsis affects millions of patients 🌍

bit.ly/2X12EN2
#Sepsis is estimated to kill 1⃣1⃣ million people each year, including almost 3⃣ million young children. It disables millions more.

who.int/news-room/fact…
Anyone with an infection can develop #sepsis, but some people are more at risk than others:

🔸Pregnant women
🔸Newborns
🔸The elderly
🔸People with chronic diseases or immunosuppression
🔸Hospitalized patients

bit.ly/2X12EN2
Read 10 tweets
Our #systematicreview and #metaanalysis on the association of #sepsis with long-term #CVD is out now in @yourICM ! Surviving sepsis was associated with ⬆️#cvMI, #heartfailure, and #stroke over 5+ years. Take-home points below. tinyurl.com/p5n634jy
1. Many studies have examined the risk of #CVD after #sepsis, but variable population and outcome selection has complicated generalizability. We estimated the risk of #cvMI, #heartfailure, #stroke, and composite #CVD after sepsis relative to hospital and population controls.
2. 12,649 citations identified, 27 (25 cohort, 2 case-crossover) studies included. Median of 4,289 (IQR 502–68,125) sepsis survivors and 18,399 (IQR 4,028–83,506) controls per study. We assessed cumulative incidence and relative risk of #CVD from 30 days to longest follow-up.
Read 11 tweets
1/🧵Fluids in sepsis: When a patient’s blood pressure is too low and they are in shock, as happens all the time with #COVID19 viral #sepsis, we give fluids. This @bmj_latest figure👇makes a bit of sense of where the fluid goes. Let me unpack a bit more…

bit.ly/3lvrL50
2/ 👇 @bmj_latest
We talk about 2 categories of fluids: Crystalloids & Colloids. For crystalloids think “thin fluid like salt water with sugar.” For colloid think “thick fluid with lots of protein like albumin.” The figure shows that crystalloids leak out of the blood vessels…
3/ while colloid stays in the blood vessels. But there are several other important teaching points beyond what the figure shows.
✅ If a person has a lot of edema, as we see in heart, kidney & liver failure, colloids pull fluid into our vessels & ⬆️ blood volume to end shock…
Read 8 tweets
1/🧵 The Road to #LongCOVID:

In her @ScienceMag piece, @Dr2NisreenAlwan teaches that @Twitter & FB served a purpose but can’t remain our authority in defining devastating disability suffered by millions after #COVID19. We must have more science!

bit.ly/2Wv8Lcf
2/ In 2020 the main support for pts with prolonged symptoms came from online testimonials and absent community testing sites, people were left to guess as to whether or not their crazy symptom profile was due to COVID.
3/ “A common theme emerged: lack of recognition by the medical profession. Patients, including doctors, w #LongCovid consulted healthcare providers & their symptoms were commonly minimized, dismissed, or labeled as anxiety.”
 
#Stigma #Discrimination #MECFS
Read 10 tweets
1/🧵#SEPSIS is URGENT. Here it was caught way too late! Sepsis is marked by WBCs (White Blood Cells) either too high OR too low. If someone’s WBC drops from 14k to 6k to 3k WITHOUT antibiotics, that’s a total catastrophe & usually means death is closing in.👇

#MedTwitter
2/ So hypothetically (& I’m changing details to make this situation unrecognizable to the real patient my comment is based on)…if a month after a knee replacement someone comes in complaining of NEW knee pain and no fever…

#COVID19 #nursetwitter #TipsForNewDocs #nurse
3/ …with a WBC count of 14,000, scans & xrays not showing an abscess, an infected prosthetic joint is still my #1 Dx unless there is a completely obvious other cause of infection. Said another way, this is sepsis due to an infected knee until proven otherwise.
Read 10 tweets
1/🧵The Nightmare of #COVID19 & #LongCOVID
 
Im a doctor who is now spending more & more time daily caring for #LongHaulers (pts w LongCOVID). I just got a TINY dose of what it must feel like to be unheard and unseen…AND I want to apologize to you.
 
#MedTwitter #NurseTwitter
2/ I just keep hearing you say, “Doc, why doesn’t anyone believe me? My friends look at me and think I’m fine, even as I feel further and further adrift. I’m not myself and I can’t tell if I ever will be again. #COVID has ruined my life.”
3/ Yesterday as my plan landed, my phone vibrated. It was the wife of a former ICU #COVID pt, now trached & living on a vent in an LTAC, asking how she can get his new docs to understand & carefully manage her husband’s ongoing #LongCOVID & Post-Intensive Care Syndrome (#PICS).
Read 13 tweets
If you want to predict clinical phenotypes using #MachineLearning, check out our systematic review on ML-based #sepsis prediction. A THREAD with take-aways that could be relevant to #AI in #healthcare in general. (--> = hints for practitioner) 1/n
bit.ly/34pIvRs
1) Motivation: why should we even care about #sepsis? For decades clinicians have a) struggled to detect it in its early stages where organ damage is still reversible and b) failed to find a robust and early biomarker for sepsis. 2/n
--> Make sure that your problem (as well as your solution) *actually matters* (e.g., how is it helping doctors if you just foresee that a patient won't make it?) and ensure that it cannot be easily solved by conventional approaches.
3/n
Read 13 tweets
Here is the #PedsICU #BestOf2020 collection.
Jointly chosen by
@Dr_Hari_Krishna @sgdambrauskas and myself
Pubmed collection 40 articles: bit.ly/pedsicubestof2…
Infographic (clickable PDF) in English: bit.ly/bestof2020eng
Spanish: bit.ly/bestof2020esp
#PedsCICU #NeuroPICU
This will be a bilingual tweetorial in Spanish/English!
Infographics are available in both languages in Tweet #1

El hilo será en Español/Inglés. El resumen infográfico está disponible en los dos idiomas en el primer Tweet
1/What are the outcomes that matter to children, to families and to #researchers/clinicians? @ericka_fink et al & @PostPICU_PALISI investigators identified COS using a delphi process. @CritCareMed bit.ly/381cfq8. Developmental and functional outcomes were important.
Read 44 tweets
#Tweetorial
Llegó colección de lo #Mejor2020 en #PedsICU &
@Dr_Hari_Krishna 🇬🇧@MiguelrrMD 🇪🇸 @sgdambrauskas 🇺🇾

Pubmed: bit.ly/pedsicubestof2…
Versión infográfico español: bit.ly/bestof2020esp
Version inglés: bit.ly/bestof2020eng

#SoMe4MV #neuroPICU #delirium #PedsCICU
English #BestOf2020
The #Bestof2020 #PedsICU pubmed collection will also be available in the FREE #PICCHub app (sponsored by @PICSociety) as the latest monthly #PICUJournalwatch collection:
Download links: Android: play.google.com/store/apps/det…
iOS: apps.apple.com/gb/app/picchub…
3/ La FUNCIÓN como nuevo paradigma
@ericka_fink et al POST #PedsICU investigators & @PALISInet hicieron consenso Delphi
Qué es lo importante como resultados al alta #PedsICU?

En @CritCareMed lo que encontraron con precioso infogràfico
bit.ly/381cfq8
#PedsICU #PICSp
Read 42 tweets
Here is the #PedsICU #BestOf2020 collection.
Jointly chosen by @Dr_Hari_Krishna @sgdambrauskas @miguelrrMD
Pubmed collection 40 articles: bit.ly/pedsicubestof2…
Infographic (clickable PDF) in English: bit.ly/bestof2020eng
Spanish: bit.ly/bestof2020esp
#PedsCICU #NeuroPICU
The #Bestof2020 #PedsICU pubmed collection will also be available in the FREE #PICCHub app (sponsored by @PICSociety) as the latest monthly #PICUJournalwatch collection:
Download links: Android: play.google.com/store/apps/det…
iOS: apps.apple.com/gb/app/picchub…
.@sgdambrauskas and @MiguelrrMD will be simultaneously sharing their thoughts about the #PedsICU #Bestof2020 collection in a tweetorial.
Read 40 tweets

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