Discover and read the best of Twitter Threads about #chestcritcare

Most recents (12)

What does a TEG do? A 🧵
Several blood tests are used to assess clinical diagnosis of coagulopathies: PT, INR, APTT, platelet count, activated clotting time, bleeding time. Specific clotting factors can also be measured: Factor V, protein C and S, anti-thrombin III, anticardiolipin antibodies.
These tests are all very specific and useful in certain clinical scenarios (anticoagulation monitoring, investigation of unprovoked PE, for example), but they usually have a long turnaround time and rarely measure platelet function and the activity of the clotting cascade.
Read 16 tweets
Get your popcorn ready because this is going to be quite the learning contest. #CHEST2020

The webinar is LIVE in T - 5mins, speakers are checking their 🎤🎤

We are only a tiny bit biased towards our co-chair @GallodeMoraesMD!
Dr. Mathews: Starts with sharing what drives ventilation-induced lung injury. This is "leak" is likely more pronounced in #COVID19

Dr. Mathews: ARMA supported LTVV in ARDS with significantly improved mortality. LTVV has been since found to be beneficial in non ARDS situations. #CHEST2020
Read 26 tweets
Join us now to learn about Sepsis Antibiotics and Fluids!

Moderated by our co-chair @virenkaul

Up first is Dr. Angel Coz

Decrease in expected mortality with introduction of sepsis protocol.

Why broad spectrum antibiotics?? This means:

- not the same for every patient
- based on patient history and source
- based on institutional resistances

Read 30 tweets
Coagulopathy on COVID-19 is about to start! @accpchest #CHEST2020 #CHESTCritCare
Comparison of VTE in other diseases in the ICU #CHEST2020 #CHESTCritCare
And comparison of COVID-19 VTE and historical ICU co-horts. Thrombosis in COVID higher in well matched ARDS patients and also higher than in patients with flu. @accpchest #CHEST2020 #CHESTCritCare
Read 11 tweets
@GallodeMoraesMD will be live tweeting the #PICS talk @accp #CHESTCritCare
@crit_caring_MD @GioraNetzer @itsradu @ICU_Recovery are talking about #PICS now!
At 12 months only 44% of ICU survivors are PICS-free, being cognitive a significative part of the post-ICU impairment. With more ICU survivors, we will likely be seeing more PICS. #CHEST2020 #CHESTCritCare
The lack of visitors in the COVID-19 era, will likely contribute to higher number of survivors with PICS #CHEST2020 #CHESTCritCare
Read 11 tweets
Starting soon, Sepsis: Most Recent Advances

#CHESTCritCare is going to be Tweeting hightlights live by @crit_caring_MD

Up first, Dr. Matthew Churpek discussing machine learning and big data.

Trade off between high sensitivity and high specificity depending on if you use SIRS vs. qSOFA.

NEWS and MEWS much more acute tools for predicting mortality.

Read 21 tweets
First up: Props to #CHEST2020 learning partners for that amazing wait music. Ne'er been a fan of wait music. But this is ... well .. peppy. Am in the mood to learn about #AirwayManagement!

Speakers: @Chaeface @J_Mendelson_MD @KDoerschug

Coverage: @virenkaul

.@J_Mendelson_MD: HFNC and proning in severe hypoxic resp failure:

- Can reduce dead space ventilation, assist with WOB, improved resp mechanics
- Pre-COVID data: Can be successful in potentially preventing invasive ventilation vs NIV and low flow O2

#CHEST2020 #CHESTCritCare Image
.@Chaeface: Pre-oxygenation modifications to reduce aerosolization

Use V-E technique vs C-E technique for rescue BMV. Improved efficacy for ventilation and better seal. (Lower picture):

#CHEST2020 #COVID19 Image
Read 9 tweets
Vitamins in Critical Illness starting now!

Discussing: Vitamin C, Vitamin B12, Vitamin D

#CHEST2020 Image
Vitamin B12 up first by Dr. Jayshil Patel.
#CHEST2020 Image
There are elevated hydrogen sulfide (H2S) in early sepsis.
Read 22 tweets
Amazing discussion going on at the #CHEST2020 opening session by @sqsimp @CHESTPrez @RMavesMd @mnarasimhan Image
@mnarasimhan highlights that as we know more about the natural course of COVID-19 we have seen that #PPE works! Also, that we should try non-invasive ventilation in COVID-19 patients as long as we have appropriate PPE #CHEST2020 #CHESTCritCare
@RMavesMd highlighted that several countries in the South Hemisphere didn't have as much flu this season as in previous years, and hopefully we will see the same phenomenon in the US now that flu season is coming #CHEST2020 #CHESTCritCare
Read 4 tweets
We' ll continue our vasoactive medication review with our old frined dobutamine! #chestcritcare
It is primarily a Beta-1 agonist, but it acts on Beta2 and alpha as well, making it a great inotrope, and also an ok vasodilator (in high doses alha agonism kicks in, and some vasoconstriction may occur…
Dobutamine is used in the treatment of cardiogenic shock, it improves symptoms, but it has been associated with increased in-hospital mortality and future HF readmissions. It is also associated with arrhythmias and it has been rarely associated with eosinophilic myocarditis.
Read 7 tweets
Continuing the vasoactive meds week, we will talk about dopamine. It is a precursor of norepinephrine, inducing its release. There are dopamine receptors in the renal, splanchnic, coronary and cerebral vascular beds; stimulation of these receptors cause vasodilation. #critcare
Again, since our historical "nerdiness" was so well received, this is one of the first papers that talked about dopamin in shock:…
And this is their conclusion:"Because dopamine increases myocardial contractility, selectively redistributes perfusion to essential viscera and allows a pharmacologic titration of effect, it is a logical first-choice catecholamine for treatment of shock and refractory HF."
Read 7 tweets
1/12 Hey #medtwitter, let’s look at what we know thus far about use of steroids in #COVID19 ARDS.

2/12 Let’s start with current use of steroids in pre-COVID-19 ARDS, what is the data to support our practices?

3/12 A recent meta-analysis evaluating prolonged methylprednisolone therapy for ARDS showed a reduction in mortality, with an increase in ventilator-free days.

Read 12 tweets

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