Discover and read the best of Twitter Threads about #covid4MDs

Most recents (11)

1/ Good morning, #medtwitter, and welcome to another round of #readingroom #covid4MDs edition!

You should have a system for reading CXRs, and you need to approach each image systematically. Apply that system now and tell us: what do you see? Could this be #covid19?
2/ In short, yes, this could be COVID-19, and in this case it was. But it could’ve been something else. Or it could’ve been a normal CXR and they still might’ve had COVID-19.

Moving on, do you know what the current ACR recommendations are for imaging in suspected COVID cases?
3/ Each patient who goes to CT is followed up by a thorough scrubbing of the scanning room - a process that takes up valuable time and delays necessary scans. Only COVID patients with strong indications for CT should be sent to the scanner.
Read 7 tweets
Don’t take responsibility for decisions you didn’t make.

Escaping this pandemic psychologically whole and spiritually well is going to be a monumental task. It will require you to assign responsibility correctly.

First, you didn’t make this virus. It wasn’t your idea.

Nature did that. She does things like this from time to time. She is powerful and does things like this from time to time.
More than likely, you did not initiate the response of you country, state, city, or hospital. If you had, you might have done it differently, but you were not assigned that authority.
Read 16 tweets
Some thoughts on the spike of new cases in the US
Some of this is due to increased testing. We must do our part in continued mitigation, social distancing, etc. We won't know fully until later but for now, caution is warranted.
#COVID19 #covid4MDs
The # of known cases is highly correlated to how many tests you do - as you scale up testing the # of cases spikes. The data is linearly correlated!
Remember this is PCR testing - you need to detect virus in symptomatic cases. It does not tell you about past exposure.
We now have more "new cases per day" than Italy. This is likely a combination of exposure in the last 2 weeks but also due to increased testing! We cannot determine what percent each contributes. But increased testing contributes.(Our population is 5x that of Italy)
Read 15 tweets
We've been in full #COVID19 mode in my hospital in Alcorcón (Madrid), Spain for the past 2 weeks.

This crisis has forced us to adapt like we never thought possible. Here's how we're doing that on our units, in hope that it'll help others across the globe do the same #FOAMcovid
We've divided the hospital in COVID + or COVID - units. At the time of writing, almost all of our hospital is comprised of COVID + units, with the few remaining COVID - patients in the:

1) Day medical hospital (in-patients)
2) Day surgical unit (converted to a non-COVID ICU)
We've abandoned traditional rounding in favor of teams with multiple members with one coordinator (usually from ID or IM).

These teams consist of 6-8 doctors and include residents and attendings from different specialties.

Each team is in charge of a +/- 32 person COVID ward.
Read 21 tweets
#covid4MDs #math

Stay cool. ❄️❄️❄️
Read to the end.

According to the @JohnsHopkins map, the current COVID infection rates are:

🇮🇹: 1/1,900

🇺🇸: 1/51,000

~ Do not start screaming ~
The US numbers are useless because of our national testing failure.

The Italy numbers are probably more accurate.

Now you will day my math is wrong. You’ve seen the headlines and read the first hand accounts. I must be wrong.
I’ll say my math is good. The data might be bad but my math is good.

So why the discord between numbers and news?
Read 24 tweets
Oh shit. I finally read this. We are not ready for any of this. I’m not sure if we have the capacity to do this at this level. See the screenshots of the slides below. #covid4MDs
Read 8 tweets
Saddened as had been anticipating this along with many. Cancelling the conference during this unprecedented time is the right thing to do.

Through it all, I couldn't have asked for a better leadership team & the larger @SocietyHospMed community for their support! 1/

As stated with the evolving circumstances out of our control with COVID-19 there were risks to our community as it would have gathered, communities we connect with on our travels, and our home communities and hospitals – cancelling was the best way to mitigate these risks. 2/
It has been difficult to process especially with the original trends just over a week ago that showed this conference to have record attendance which is a testament to the engaged community, innovative ideas, amazing core content that was diverse & inclusive. 3/
Read 8 tweets
The #covid2019 Disposition Challenge.

I’ll start with the conclusion. Defend your walls. For the next few months, getting someone out of the hospital is going to be a lot harder than getting them in.

Patients are going to come from places where they may not be able to return after a positive test. Even if they aren’t that sick.
Nursing home patients who test positive might not be able to go back there.
Read 13 tweets
I have put together a @WhatsApp text thread with ER, IM hospitalist and plum/Crit care MDs from:
- Seattle
- LA
- DC
- Florida

Still looking for
- New York City
- Houston
- Chicago

Between us we have seen PUI and ~10 cases. We are also reviewing clinical experience from others which often comes in the forms of hastily hammered out tweets, emails and (yes) Facebook posts from busy tired front-line providers.
These testimonies are circulating. They are not peer-reviewed or vetted but as a practicing physician they ring clear and true and they re all we have.
Read 9 tweets
People don’t understand the single greatest risk of #COVIDー19.

It is The Pinch.

Come along with me while I explain.

#COVID19US #CoronavirusUSA #coronavirus #SARSCoV2 #COVID19seattle #Coviditalia #covid4MDs #thepinch
This will potentially affect you, your kids, you parents. They don’t even have to get sick. It all has to do with TOO MANY PATIENTS TOO SICK AT ONE TIME.
Here’s what we know. One person in a community gets sick and they infect others. Most people don’t get too sick and they get better.

They are not “safe” though. Read to the end.
Read 20 tweets
@medicalaxioms #covid4MDs I have been following the information on the cytokine storm related to #COVID19. This is similar to MAS that occurs in SJIA and SLE patients or HLH that occurs in malignancy and other infections. This was documented in MERS a few years ago.
@medicalaxioms #covid4MDs The difference in HLH related to malignancy is the HLH protocol with etoposide, decadron etc is meant for those who may get bone marrow transplants. Rheumatologists treat this differently. Unfortunately many hospitals do not have inpatient rheumatology!
@medicalaxioms #covid4MDs Pediatric rheumatologists are the ones who are experts in dealing with MAS and there are even less of them! If this virus goes viral hospitalists and intensivists will be dealing with the cytokine storm. China approved an IL6 agent (tocilizumab) to treat #COVID19
Read 5 tweets

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