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Simulation in ICU - #Empathyš
A doctor volunteer trying to understand what itās like to be tied down & sedated.
More & more we must dive down into what we do to others to understand their experiences
To improve our careā¦#A2Fbundle
A doctor volunteer trying to understand what itās like to be tied down & sedated.
More & more we must dive down into what we do to others to understand their experiences
To improve our careā¦#A2Fbundle
Asking:
āWhat is causing their agitation? How can you respond to it? Do they have contraindications to mobility? How do you start?ā
āWhat is causing their agitation? How can you respond to it? Do they have contraindications to mobility? How do you start?ā
She @DaytonICU gives complex scenarios & walks us through the process of asking, āWhat is their RASS? Why are we concerned about delirium? What are their risk factors for ICUAW? Why are we concerned about ICUAW? Do they have an indication for sedation?ā
āNow what do you doāļøā
āNow what do you doāļøā
1/š§µCOVID & Death: #JAMA
Ā
šN=1,846 pneumonia patients w versus w/out COVID
šCOVID didnāt āinventā a new lung disease
šWe freaked out saying vents needed to be so different
šDocs erred as we deviated from our evidence-based
Why should YOU care?
Ā
bit.ly/3QIp2Tl
Ā
šN=1,846 pneumonia patients w versus w/out COVID
šCOVID didnāt āinventā a new lung disease
šWe freaked out saying vents needed to be so different
šDocs erred as we deviated from our evidence-based
Why should YOU care?
Ā
bit.ly/3QIp2Tl
2/ COVID is a very long pneumonia process, but we exacerbated itā¦
This graph shows that Death occurs similarly, but COVID #death takes longer (10 vs. 7 days).
Time to discharge alive is twice as long (10 vs. 5 days) in COVID vs non-COVID pneumonia.
We caused a lot of this š
This graph shows that Death occurs similarly, but COVID #death takes longer (10 vs. 7 days).
Time to discharge alive is twice as long (10 vs. 5 days) in COVID vs non-COVID pneumonia.
We caused a lot of this š
3/ Letās breaks outcomes down by O2 levelsā¦
Ā
At 90 days, death rates were same in COVID & non-COVID pneumonia for patients w moderate & severe low O2 levels
COVID was NOT a predictor of more death or liberation from the vent or hospital (after matching & multivariable models)
Ā
At 90 days, death rates were same in COVID & non-COVID pneumonia for patients w moderate & severe low O2 levels
COVID was NOT a predictor of more death or liberation from the vent or hospital (after matching & multivariable models)
1/š§µ Imagine Deliriumā¦#COVID or notā¦
āHer mind tottered & slithered again, broke from its foundation & spun like a cast wheel in a ditchā¦She sank through deeps & deeps of darknessā¦
Katherine A. Porter, āPale Horse, Pale Riderā on her delirium in 1918 Spanish flu pandemic
āHer mind tottered & slithered again, broke from its foundation & spun like a cast wheel in a ditchā¦She sank through deeps & deeps of darknessā¦
Katherine A. Porter, āPale Horse, Pale Riderā on her delirium in 1918 Spanish flu pandemic
2/ Until she lay like a stone at the bottom of lifeā¦a stench of corruption filled her nostrilsā¦she opened
her eyes & saw pale light through a coarse cloth
over her face, knew the smell of death was in her
body & struggled to lift her hand.ā
Spare your patient. How?
#A2Fbundle
her eyes & saw pale light through a coarse cloth
over her face, knew the smell of death was in her
body & struggled to lift her hand.ā
Spare your patient. How?
#A2Fbundle
3/fin
This investigation of 13 studies found that earlier mobilization of ICU patients reduced the risk of #delirium by 47% and by nearly 2 days in total duration.
To do this we must stop sedation & have patients safely able to participate in walking.
bit.ly/3gTYvVk
This investigation of 13 studies found that earlier mobilization of ICU patients reduced the risk of #delirium by 47% and by nearly 2 days in total duration.
To do this we must stop sedation & have patients safely able to participate in walking.
bit.ly/3gTYvVk
1/š§µWhat do ICU survivors tell me about PICSā¦(post intensive care syndrome)āļø
Former ICU patient: āIām angry. Iām furious because the doctors who injured me arenāt willing to help me recover.ā
Is this fair?
I think so.
Why?
Read onā¦(perm to share)
Former ICU patient: āIām angry. Iām furious because the doctors who injured me arenāt willing to help me recover.ā
Is this fair?
I think so.
Why?
Read onā¦(perm to share)
2/ I just got off the phone w a patient who has had PICS for 12 years since nearly dying in the ICU. His story is included in #EDDBā¦he granted permission to share some thoughts today that I think are eye openingā¦in terms of how poorly weāre doing w Chronic Disease management
3/ people who never had PTSD before critical illness, leave with inexplicable experiences of road rage, rejecting their spouse, acting in ways that are so foreign to them that they donāt recognize themselves.
They also have tremendous problems with lack of self worth becauseā¦
They also have tremendous problems with lack of self worth becauseā¦
1/š§µš„ How do āDominoes of lifeā fall in critical illnessāļø
A pt arrives awake & talking but vomiting. In just 8 hrs he nearly dies of sepsis š¤Æ
Lung & kidney failure, heart attack, coma.
How can this happen & can we save him?
Thisš§µcan help us understand the āarc of illnessā
A pt arrives awake & talking but vomiting. In just 8 hrs he nearly dies of sepsis š¤Æ
Lung & kidney failure, heart attack, coma.
How can this happen & can we save him?
Thisš§µcan help us understand the āarc of illnessā
2/ His disease is Ascending Cholangitis
A gall stone lands in his common bile duct
šPain & vomiting
šHeās admitted to the ICU
šGI performs an ERCP to place a stent, bypass the stone, drain pus & control the source of sepsis
šAdd fluids & antibiotics
šBut he gets worse
Why?
A gall stone lands in his common bile duct
šPain & vomiting
šHeās admitted to the ICU
šGI performs an ERCP to place a stent, bypass the stone, drain pus & control the source of sepsis
šAdd fluids & antibiotics
šBut he gets worse
Why?
3/ We bypassed the septic source (stone) & drain the pus, but dominoes were already falling.
Bacteria had gotten into his blood.
Too much inflammation & capillary blood clotting occurred, just like in COVID.
What happens when ācellularā dominoes start to fall uncontrollably?
Bacteria had gotten into his blood.
Too much inflammation & capillary blood clotting occurred, just like in COVID.
What happens when ācellularā dominoes start to fall uncontrollably?
So the problem of MD shortages is so very real. ā¤ļø the timely article, agree with so much of it, but only partial solutions discussed here. A thread for some more color to this š§µ 1/8
time.com/6199666/physicā¦
time.com/6199666/physicā¦
As the MD numbers donāt add up from supply-demand curves, we started a āfellowship/residencyā for NP/PAs in critical care & then pulmonary @RKleinpell is a pioneer in this space.
ncbi.nlm.nih.gov/pmc/articles/Pā¦
ncbi.nlm.nih.gov/pmc/articles/Pā¦
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/10.108ā¦
liebertpub.com/doi/pdf/10.108ā¦
1/š§µ You have a COVID ICU patient on benzos who doesnāt respond to needle injection of local anesthetic do to sedatives.
Ā
What depth of sedation do you consider this? (it was a CME question just now)
Ā
What depth of sedation do you consider this? (it was a CME question just now)
2/ The answer is GENERAL ANESTHESIA, which of course makes sense.
If a person is so deep that he/she doesnāt respond to getting stuck by a needle and the pain of lidocaine injection, that is general!
Why am I writing about this?
If a person is so deep that he/she doesnāt respond to getting stuck by a needle and the pain of lidocaine injection, that is general!
Why am I writing about this?
1/š§µ Why is COVID hospitalization like 2X sticks of dynamite š§Ø?
Ā
A thread on the ICU portionā¦ #PICS + #LongCOVID.
Ā
Prevent this w 3 steps:
šAvoid #COVID by Vax & Mask
šAvoid severe COVID by Paxlovid & Monoclonal Ab
šš read here about PICS & how to reduce injury in the ICU
Ā
A thread on the ICU portionā¦ #PICS + #LongCOVID.
Ā
Prevent this w 3 steps:
šAvoid #COVID by Vax & Mask
šAvoid severe COVID by Paxlovid & Monoclonal Ab
šš read here about PICS & how to reduce injury in the ICU
2/ Hereās what you must know if you get too sick & land in an ICU.
History Lesson š
In the past, too many decisions in #CriticalCare were guided by fear. We oversedated patients for too long out of worry they might self-extubate & pull off restraints.
Thatās happening again š¤®
History Lesson š
In the past, too many decisions in #CriticalCare were guided by fear. We oversedated patients for too long out of worry they might self-extubate & pull off restraints.
Thatās happening again š¤®
3/ We kept patients immobilized due to an overly conservative approach to fall prevention that precluded us from attempting to walk them early. We kept families away from patients, treating loved ones as visitors rather than members of the healing plan.
Thatās happening again.
Thatās happening again.
1/š§µš„ A young mom suffering #COVID. Her husband is scared.
We need to prevent serious long-term complications. Her new normal will likely include PTSD, Dementia, Depression & severe physical disability. (shown w Perm)
Not so āmildā ā”ļø Do you want this?
#vaccinate
#LongCOVID
We need to prevent serious long-term complications. Her new normal will likely include PTSD, Dementia, Depression & severe physical disability. (shown w Perm)
Not so āmildā ā”ļø Do you want this?
#vaccinate
#LongCOVID
2/ what you need to know about ICUs, #PICS and #LongCOVID prevention:
I wrote this @thedailybeast pieceš to help empower you as patients & families. Itāll tell you what you need to know & ask your team for amid the chaos and confusion.
Thereās moreā¦
bit.ly/3DhC6Xe
I wrote this @thedailybeast pieceš to help empower you as patients & families. Itāll tell you what you need to know & ask your team for amid the chaos and confusion.
Thereās moreā¦
bit.ly/3DhC6Xe
3/ This patient on 100% O2 and high-dose propofol & fentanyl did not need both agents. When able, we try to avoid prop & benzos. We stopped Prop, continued Fentanyl & added dexmedetomidine because itās shorter acting & wonāt build up so much in her brain.
This is the #A2Fbundle.
This is the #A2Fbundle.
1/š§µROADMAP: What should you know before someone you ā¤ļø lands in the ICU? @TheDailyBeast
Ā
I whittle down IMPORTANT PEARLS & pro-tips about how to approach acute #COVID19 and non-COVID care to avoid life-changing disabilities later.
š
bit.ly/3oRVZRt
Ā
I whittle down IMPORTANT PEARLS & pro-tips about how to approach acute #COVID19 and non-COVID care to avoid life-changing disabilities later.
š
bit.ly/3oRVZRt
2/ #COVID pts return home after cutting-edge medical care but many survivors are now living with massive & likely life-long disabilities that include dementia, PTSD, depression & major weakness from muscle and nerve disease. #PICS #LongCOVID
3/ These two entities, #LongCOVID and #PICS, have many overlapping forms of suffering that must be acknowledged by healthcare professionals and loved one for survivors to feel validated & heard. People throughout society in all our communities will benefit.
1/š§µ People ask me, āWhatās the main purpose of treating #COVID ICU pts with the #A2Fbundle? (a daily safety checklist of ā¬ļø sedation & ā¬ļø mobilization). Itās to prevent #PICS related dementia, PTSD, depression & reduce suffering in #LongCOVID.
HOW? What is the philosophy?
HOW? What is the philosophy?
2/ For patients itās about magnifying their #dignity and self-worth by liberating them sooner from us (our treatments that put them through a depersonalization chamber). For HCWs, itās about purity of service, avoiding hypocrisy, and better self-sacrifice for our patients.
1/š§µš„ Hard-Won #Wisdom from the wife of a #LongCovid patient >140 days into hospitalization.
You need to hear her 2 messages:
1. āWhat I can tell you is Iāve never given up #hope. To make it to tomorrow, we have to make it through today first.ā
HUMILITY ā¤ļøāš©¹ IS HER MEDICINE
You need to hear her 2 messages:
1. āWhat I can tell you is Iāve never given up #hope. To make it to tomorrow, we have to make it through today first.ā
HUMILITY ā¤ļøāš©¹ IS HER MEDICINE
2/ When things are acute, like in this video of her husband when he was 1st in the ICU, we tend to think our task list is all technological. Iām guilty of this. And Iāve caused ā¬ļø suffering because of my tunnel vision.
3/š„ Point #2 from my pts wife:
āHeās not gonna get better next week or next month. #COVID takes a LONG time. Our lives are forever changed. Expect setbacks & be your loved oneās advocate!ā
NOW she & he are convinced of the importance of #Vaccination & masking. Learn from them!
āHeās not gonna get better next week or next month. #COVID takes a LONG time. Our lives are forever changed. Expect setbacks & be your loved oneās advocate!ā
NOW she & he are convinced of the importance of #Vaccination & masking. Learn from them!
1/š§µWhat is Testimonial Injustice in medicine? Itās Silencing ptsā¦
@crageshri tells her story & itās brave & important. In #COVID, I have silenced pts by giving too much sedation to ventilated pts. I was wrong.
At every opportunity, I must amplify my ptsā voices!
#A2Fbundle
@crageshri tells her story & itās brave & important. In #COVID, I have silenced pts by giving too much sedation to ventilated pts. I was wrong.
At every opportunity, I must amplify my ptsā voices!
#A2Fbundle
2/ Dr. Rageshri writes:
Testimonial injustice can occur when a personās voice or knowledge is discounted or dismissed due to bias from the listener about their social identityā¦
Testimonial injustice can occur when a personās voice or knowledge is discounted or dismissed due to bias from the listener about their social identityā¦
3/ Itās a type of silencing called ātestimonial smotheringā. This is a form of self-censoring, where silence or withholding testimony is preferable to the psychological trauma of being dismissed and disbelieved.
1/š§µ Iād like to think as a medical community that we have changed & no longer discharge people w/out appropriate follow-up, but just last week I met a #COVID19 survivor who was discharged from the ICU simply to follow up w his primary care physician.
#LongCOVID #PICS #A2FBundle
#LongCOVID #PICS #A2FBundle
2/ He couldnāt return to his job, was fired & had no income for his family. That resulted in him not having enough money for medications, gas, or bills. He missed his doctorās appointment, his electricity was turned off, so he is unable to apply online for disability. š¤
3/ The cycle continues. I usually see these pts when they get septic again & end up back in my ICU on life support.
1/ š§µWisdom in Medicine
Ā
Whatās going on here? And why itās key in #COVID19
Ā
Itās quite simple: we finally had the #wisdom to ask Mr. D the right question! He and his wife encouraged us to use this picture to teach what we learned.
Ā
#PalliativeCare #MedTwitter #NurseTwitter
Ā
Whatās going on here? And why itās key in #COVID19
Ā
Itās quite simple: we finally had the #wisdom to ask Mr. D the right question! He and his wife encouraged us to use this picture to teach what we learned.
Ā
#PalliativeCare #MedTwitter #NurseTwitter
2/ What we learned was to switch the preposition!
Ā
Mr. D was a pre-#COVID patient. On this day, he was taken off the vent after a MONTH. The incessant mantra had been, āWhatās the matter WITH Mr. D?ā He was surprised when we asked, āWhat matters TO you, Mr. D?ā
Ā
Mr. D was a pre-#COVID patient. On this day, he was taken off the vent after a MONTH. The incessant mantra had been, āWhatās the matter WITH Mr. D?ā He was surprised when we asked, āWhat matters TO you, Mr. D?ā
3/ He has a tracheostomy, as you can see. We insert this airway through the neck to improve #comfort when someone is on a vent well beyond 10 days. Heās more comfortable because he no longer has a tube in his mouth. We used a program called the #A2Fbundle to reduce his #delirium.
1/š§µ#COVID19 Compassion
Our patient wants to live 3 days to see his grandson graduate. He has #COVID19 pneumonia & is extremely short of breath. Heās chosen NOT to go on a ventilator & is on 100% O2 HiFlow Canula. Heās afraid of tight-fitting a bipap mask.
#PalliativeCare
Our patient wants to live 3 days to see his grandson graduate. He has #COVID19 pneumonia & is extremely short of breath. Heās chosen NOT to go on a ventilator & is on 100% O2 HiFlow Canula. Heās afraid of tight-fitting a bipap mask.
#PalliativeCare
2/ The intern said, āI never saw a patient whose respiratory rate was twice his oxygen saturation!ā Yep, last night his O2 sats dropped to 30% and he was breathing 60 times a minute! By morning he was 85% sat and RR was 28. Better but tenuous.
#TipsForNewDocs #MedStudentTwitter
#TipsForNewDocs #MedStudentTwitter
3/ All of this raises some complicated ethical + treatment questions that Iād like to cover. We addressed this on rounds several times this week & at times it got a bit heated. His #nurse said she noticed herself flushed, mad, and heart rate >130ā¦why?
1/š§µThis figure from CHEST on early tracheostomy in #COVID19 pts is helpful for 2 reasons: it points out different ways of care. Read the BLUE circles clockwise & then switch to OUTER RED ARROWS clockwise again. Clear and True.
bit.ly/3w3DXfc
#medtwitter #nursetwitter
bit.ly/3w3DXfc
#medtwitter #nursetwitter
2/ The #COVID pt with ARDS + Sepsis on a ventilator is TOO often subjected to TONS of sedation, which adds brain injury, immobilization & development of physical disability. NEW DISEASES added to the original problem. We call this Post-Intensive Care Syndrome #PICS.
3/ Early tracheostomy around day 10 can help (not always!) as outlined in the RED ARROWS. The goal is to lessen the added injury by waking people up, getting them out of bed and early mobilization plus talking with family. This is done via the #A2Fbundle. @SCCM
1/ Do data support pt trial off sedation for āSATā when pt is comfortable on current dose? Yes
Ā
Shared w permission:
āDr. Ely, yesterday our ICU #nurses went over #A2Fbundle in Epic for implementation. Do you recommend SAT at RASS Goal of RASS -1 to +1?
#medtwitter #criticalcare
Ā
Shared w permission:
āDr. Ely, yesterday our ICU #nurses went over #A2Fbundle in Epic for implementation. Do you recommend SAT at RASS Goal of RASS -1 to +1?
#medtwitter #criticalcare
2/ Excellent #Nurse added:
āWe are currently not doing SAT (Spontaneous Awakening Trial) but keeping ptās RASS -1 to +1.Ā Just want to make sure we are interpreting #A2Fbundle correctly.ā
Ā
#TipsForNewDocs
#medstudenttwitter #COVID19 #pandemic
āWe are currently not doing SAT (Spontaneous Awakening Trial) but keeping ptās RASS -1 to +1.Ā Just want to make sure we are interpreting #A2Fbundle correctly.ā
Ā
#TipsForNewDocs
#medstudenttwitter #COVID19 #pandemic
3/ my Answers:
Great questions. I donāt think +1 (anxiety) is ever a good goal but 0 to -1 is a š default target RASS if we acknowledge there are times when sedation target should acceptably be set as deep as -3/-4 in bad #ARDS or -5 transiently when pt requires paralytics.
Great questions. I donāt think +1 (anxiety) is ever a good goal but 0 to -1 is a š default target RASS if we acknowledge there are times when sedation target should acceptably be set as deep as -3/-4 in bad #ARDS or -5 transiently when pt requires paralytics.
1/ Scientific Discovery: time & patience
Ā
Be patient in science. 25 yrs ago, I & others felt we were harming ICU patients by deep sedation & immobility. Our goal: PROVE IT & change culture in #criticalcare.
Ā
How did we start?
#medtwitter #A2Fbundle #nursetwitter
Ā
Be patient in science. 25 yrs ago, I & others felt we were harming ICU patients by deep sedation & immobility. Our goal: PROVE IT & change culture in #criticalcare.
Ā
How did we start?
#medtwitter #A2Fbundle #nursetwitter
2/ Scientific Discovery: takes time
There werenāt tools š¤Reluctantly, I had to go ābackwardsā to validate CAM-ICU & RASS (@JAMA_current X3). A DECADE later we produced studies lightening sedation (MENDS/ABC trials JAMA/@TheLancet). Be patient!
#academictwitter #ScienceTwitter
There werenāt tools š¤Reluctantly, I had to go ābackwardsā to validate CAM-ICU & RASS (@JAMA_current X3). A DECADE later we produced studies lightening sedation (MENDS/ABC trials JAMA/@TheLancet). Be patient!
#academictwitter #ScienceTwitter
3/ Scientific Discovery: patience
Ā
Give yourself space to be creative! Science takes time & Data must lead you. All our 1st grants & papers were rejected for 5 YEARS. NIH said: #Delirium in ICU is not a viable topic or a āthing.ā Go away. Persistence paid off for patient safety.
Ā
Give yourself space to be creative! Science takes time & Data must lead you. All our 1st grants & papers were rejected for 5 YEARS. NIH said: #Delirium in ICU is not a viable topic or a āthing.ā Go away. Persistence paid off for patient safety.
Green Urine: #NEJM
Ā
....will be seen in #COVID ā Why? Massive use of Propofol. While Green Urine is Benign, effects of prolonged over-sedation & immobilization ++ #DELIRIUM are not š¤ Wake them up & get out of bed. Start w/SATā¦#A2Fbundle & #PICS
#medtwitter #nursetwitter
Ā
....will be seen in #COVID ā Why? Massive use of Propofol. While Green Urine is Benign, effects of prolonged over-sedation & immobilization ++ #DELIRIUM are not š¤ Wake them up & get out of bed. Start w/SATā¦#A2Fbundle & #PICS
#medtwitter #nursetwitter
1/ re: SATs to avoid over-sedation in #COVID19 pts, Thx @phanton_icu for Protocol Blindness caution & @Nitkjain reminder āEasier said than done.ā Iāve been pondering your comments all day & think them ripe for further conversation on #A2Fbundle
#medtwitter #pulmcc #nursetwitter
#medtwitter #pulmcc #nursetwitter
2/ Remember, protocols like #A2Fbundle are guides & not ā1-shoe-fits-all pts.ā Correct, we must deviate when needed. However, these 6 principles (ABCDEF) are derived from 35 NEJM, JAMA, Lancet papers +400 others & now >25,000 pts of data. Not chump change.
bit.ly/2JwVA4E
bit.ly/2JwVA4E
1/ ICU #diaries for Good #Death:
Ā
Especially at EOL, ICU #Diary is part of #A2Fbundle. My pt w/ home-hospice told me details recorded in #ICU by #nurse allowed her to decipher cryptic #delirium memories she was struggling with.
bit.ly/36DOtk3
#medtwitter #meded
Ā
Especially at EOL, ICU #Diary is part of #A2Fbundle. My pt w/ home-hospice told me details recorded in #ICU by #nurse allowed her to decipher cryptic #delirium memories she was struggling with.
bit.ly/36DOtk3
#medtwitter #meded
2/ Then she told me of hours spent reading big-hearted comments others had written in her ICU diary, making her realize how much her life meant to others. It was a priceless gift to her at a critical juncture in what had a time of deep poverty in her life. #PalliativeCare
3/ ICU Diaries give family members at bedside a practical way of helping w/ loved oneās care & can help channel their worries in a focused way.
#criticalcare #pulmcc
#criticalcare #pulmcc
1/ When I play the #criticalcare movie š„ of me as an intern or resident back in my head, I see myself as much too robotic š¤ with my patients, as if plugging in kitchen appliances.
#medtwitter #meded #tipsfornewdocs #medstudenttwitter #nurse #pulmcc #COVID19
#medtwitter #meded #tipsfornewdocs #medstudenttwitter #nurse #pulmcc #COVID19
2/ The nurse would slip a Foley catheter up his urethra into his bladder. Iād go to the stockroom to get all the materials to slide a plastic endotracheal tube down his trachea to become command-central for his breathing on the ventilator.
3/ Next, Iād methodically place a Swan-Ganz catheter by serial insertion of a needle first, then a wire through the needle, next a dilator over the wire, and finally the catheter itself down into his great vessels and heart. And start the āpressors.
1/ In #COVID19, we must learn from #BRAIN masters Engel & Romano, who described #DELIRIUM to #DEMENTIA relationship in the 1950s! Here are my TOP 10 CLASSIC quotes from their famous 1959 article:
bit.ly/2SePA1a
Ā
#medtwitter #meded #tipsfornewdocs #neurology #geriatrics
bit.ly/2SePA1a
Ā
#medtwitter #meded #tipsfornewdocs #neurology #geriatrics
2/ The problem of delirium is far from an academic one. Not only does the presence of #delirium often complicate and render more difficult the treatment of a serious illness, but also it carries the serious possibility of permanent irreversible brain damage.
Ā
#dementia #COVID
Ā
#dementia #COVID
3/ The deficiencies in the education of many physicians ill equip them to recognize any but the most flagrant examples of delirium.
Ā
#A2Fbundle #tipsforolddocs
Ā
#A2Fbundle #tipsforolddocs
1/ Women in Critical Care:
š Just recorded #ISICEM roundtable w @frubulotta @ElisabethWaele @FlaviaSepsis & Dr. Juffermans. š„ šæ on Sept 16th.
Letās eliminate prejudice based on gender, sexual pref & color. Here is a Bakerās Dozen of Women ICU Leaders!
#heforshe #medtwitter
š Just recorded #ISICEM roundtable w @frubulotta @ElisabethWaele @FlaviaSepsis & Dr. Juffermans. š„ šæ on Sept 16th.
Letās eliminate prejudice based on gender, sexual pref & color. Here is a Bakerās Dozen of Women ICU Leaders!
#heforshe #medtwitter
2/ The first woman leader in Critical Care I discussed was Dr. Christina Jones from UK. She is a Biochemist, Nurse, Masters Social Work, PhD in Psychotherapy.
šMother of ICU Support Groups & ICU Diaries. As an expert, she shaped our field!
#sccm #esicm #pulmcc #ICUrehap
šMother of ICU Support Groups & ICU Diaries. As an expert, she shaped our field!
#sccm #esicm #pulmcc #ICUrehap
3/ 2nd world leader in Crit Care presented was Dr. Deborah Cook, from McMaster Univ in Canada. Seminal trials in Ulcer Proph, Bioethics, CCCTG trials, and now edifying us about how to provide healing in the dying process through her 3-Wishes Project.
#endoflife #palliativecare
#endoflife #palliativecare
