Discover and read the best of Twitter Threads about #delirium

Most recents (14)

1/ Today I was asked by #ATS forum: “Are antipsychotics ever indicated for #delirium in ICU patients?”

My reply: “YES, to control hyperactive delirium symptoms to avoid respiratory suppression...👀 example...

#MedTwitter #MedEd #MedStudentTwitter #pulmcc #TipsForNewDocs
2/ HYPERACTIVE DELIRIUM & antipsychotics

Answer cont: For example, in a patient with CHF or COPD who needs BIPAP to avoid intubation but has marginal BP and HR so perhaps can’t tolerate an alpha-2 agonist. In such patients, antipsychotics might be just the right medication...
3/ HYPERACTIVE DELIRIUM & antipsychotics

Answer cont...to help patient get over claustrophobia of CPAP mask. This approach is fine as long AS LONG AS we know we are NOT reducing delirium, rather converting positive sympt of anxiety/delirium into calm toleration of resp support.
Read 5 tweets
Encephalopathy vs Delirium 🧠: 1/11

#COVID19 has profoundly amped this malady for millions...

ICU Doc asked: “Wes, what’s the difference between delirium & encephalopathy?” I chuckled, “Got an hour?” & distilled it down in 2 min.

#medtwitter #pulmcc #meded #tipsfornewdocs
Encephalopathy vs Delirium: 2/

20 years ago we started publishing our ICU Delirium papers. The biggy was in JAMA after being rejected by NEJM’s main Neurologist Reviewer because “we used the term delirium & not encephalopathy.”

So this confusion is STILL going on…
Encephalopathy vs Delirium: 3/

To help with this nomenclature problem, Arjen Slooter led us & we published this 2020 delphi study and paper endorsed by 10 med societies.

Intens Care Med:
bit.ly/3eLODWJ

#medtwitter #medstudenttwitter #pulmcc #tipsfornewdocs
Read 12 tweets
In this thread, I'm live-tweeting @sgdambrauskas awesome talk for @AKUGlobal series on #COVID19 in #PedsICU

Critically important topic #Zentensivist #ICURehab #BacktoBasics #DoNoHarm
Defining iatrogenic via @sgdambrauskas #PedsICU
Critical Illness is an iatrogenic disorder- @sgdambrauskas highlights an important perspective by John Marshall in @CritCareMed #PedsICU
Read 16 tweets
@KingsIoPPN @TheLancetPsych @NeuroCov @Tim_R_Nicholson @tompollak @rcpsych 1/

Trying to understand the case definition section here.

"altered mental status (defined as an acute alteration in
personality, behaviour, cognition, or consciousness) ... "

altered mental status then divided into:
@KingsIoPPN @TheLancetPsych @NeuroCov @Tim_R_Nicholson @tompollak @rcpsych 2/

(a) (encephalopathy, encephalitis—
defined as encephalopathy with evidence of inflammation
in the CNS [CSF white cell count >5 cells per µL, protein
>0·45 g/dL, or MRI consistent with inflammation],
seizures [clinical or electroencephalographic evidence],

and ...
@KingsIoPPN @TheLancetPsych @NeuroCov @Tim_R_Nicholson @tompollak @rcpsych 3/

(b) neuropsychiatric syndromes notified through psychiatrists or neuropsychiatrists [psychosis, neurocognitive dementia-like syndrome, personality change, catatonia, mania, anxiety or depression, chronic fatigue syndrome, and post-traumatic stress disorder]);
Read 21 tweets
#CelebremosLasVictorias
#celebratethevictories #DefeatTheVirus
🔆Crónica de una victoria “atípica”

Ella es mi nonna, se las presento. La mujer más increíble que conozco.
Le dieron su alta médica después de derrotar a este terrible virus.
Tiene 99 años y está historia #Covid
Todo empezó con una visita al médico para tratar un tumor de piel en la nariz.
Fue un miércoles, fuimos con todas las precauciones posibles.Esto fue por allá del 18 de marzo
4 días después de la nada,fiebre ligera y tos.Pensamos que podía ser una infección urinaria ¿pero la tos?
⛔️Al día siguiente, el lunes 23 mucha tos y mucha fiebre. La llevamos con mucha angustia a consulta con un excelente Dr. Neumologo
Los rayos x mostraban una neumonía complicada, con infiltraciones bien definidas.
TODOS los síntomas clínicos coinciden con #SARSCoV2 #Covid19
Read 25 tweets
Some more thoughts after another 4 long days if I may

1. The majority of people are getting better and going home, which is positive. This can get missed, especially when we in the West Mids are getting hammered 1/n
2. There is loads of #delirium, and this from someone who is always looking - so much so that other specialists are now asking about it. Like all things COVID it is similar, but like nothing seen before. Severe attention deficits, as if they are the only person in the room.. 2/n
...and very agitated - unable to sit still, pacing around room, not keeping O2 on. Lots of 'wool picking'. It is extremely difficult to manage and responds poorly to drugs. Seems an early hypoactive/mixed phenotype, and a late hyperactive phenotype @midlandsneuro
Read 9 tweets
I know everyone is doing this, but here are my reflections after 2 wks in #ICU w/ #COVID19. Also includes lessons from our outstanding collaboration w/ #RapidResponseTeam

(1/12)
Much discussion on clinical phenotypes, but like any disease, #COVID19 is a spectrum. Here are 3 big phenotypes I saw

(2/2)
I’m more worried about running out of #intensivist, #RespiratoryTherapists, etc than running out of #ventilators. Given wide spectrum of disease, true expertise in mech ventilation needed. No 1-size-fits-all approach here

#COVID19 #VentilatorShortage

(3/12)
Read 13 tweets
This week, I taught the @UCSF IM residents about tools for cognitive assessment in hospitalized patients. For my very first #tweetorial – I’m sharing my pearls with #medtwitter! #FOAM #geriatrics #MedEd 1/
@UCSF Throughout my training, I was taught to use the MoCA (Montreal Cognitive Assessment). But after a few months seeing patients at @VABostonHC, I noticed that most of my patients were getting a score of 21-23. Everyone especially seemed to think this was a hippo. 2/
@UCSF @VABostonHC I wanted to know why! So I looked into the development and validation of the MoCA a bit. Turns out, a cognitive test developed in a mostly white, highly educated, bilingual population (aka the people of Montreal) hasn’t really panned out for use among other groups. 3/
Read 16 tweets
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?
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%
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!
Read 17 tweets
Mnemotecnias Médicas👩‍⚕️👨‍⚕️🌏🌍🌎

Abro 🧵iniciamos👨‍💻y abierto los comentarios

#FOAMed #FOAMped #medtwitter #Urgenciologa #Urgencias #MedStudentTwitter #Pediatrics #Pediatria #FOAMex #UCIP #UTIP #PedsICU #ENARM2019 #MIR2019 #FACMED
Son tres los objetivos, donde el principal, es compartir y fomentar el conocimiento útil en la práctica médica
Saber que puede usarse tanto nemotecnia como mnemotecnia según @RAEInforma
Read 38 tweets
🗣️And it is finally out!

👉Amazing shared forum from @OPENPediatrics about #PedsICU rehab and patient (family)-centered care

👉Please share/RT this paradigm shift lecture

#thrive #ICUrehab @McMasterU

@karen_choong from 🇨🇦
openpediatrics.org/assets/video/e…
🗣️Al final llegó!

👉Increíble foro compartido desde @OPENPediatrics sobre rehabilitación en #PedsICU y cuidados centrados en el niño y su familia

👉Comparte/RT esta charla sobre cambio paradigmas

#thrive #ICUrehab @McMasterU

@karen_choong from 🇨🇦
openpediatrics.org/assets/video/e…
Thread/Hilo (🇬🇧🇪🇸)

3/
Epidemiology has changed. New children population: SURVIVORS
La epidemiología cambió en #PedsICU : nuevos niños: SOBREVIVIENTES

MORTALITY Shift
Cambio el patrón de MORTALIDAD
👇
Read 16 tweets
🗣️Hilo

Los mejores artículos #PedsICU (UCIP) del 2018 📖
La suma de lo más relevante publicado y un #Tweetorial acompañante

Selección colaborativa con entre @PICJournalWatch & @sgdambrauskas
Publicado en simultáneo Inglés/Español

Favor comparte. ¡Nos vemos en 2019!
1/
Estudio PARIS en @nejm
Gran estudio que gatilló discusión en el ámbito del #CNAF. Incluso diferentes interpretaciones de resultados de sus coautores

¿Cambió mi práctica? NO
¿Mi investigación? SI

ncbi.nlm.nih.gov/pubmed/29562151

Lean correspondencia:
nejm.org/doi/full/10.10…
2/
ECA en @PedCritCareMed
@pus27 y cols encontraron que #CPAP precoz en niños inmunocomprometidos admitidos en #PedsICU no es mejor (incluso peor) que O2 estándar en 🇬🇧
¿Cambió mi práctica? Quizás
¿Mi investigación? NO

ncbi.nlm.nih.gov/pubmed/30095746
Read 21 tweets
Thread de apreciação dos perpétuos de Sandman, escrito por Neil Gaiman. Texto tirado do arco Estação das brumas: Um prelúdio.
#Sandman #Perpetuos #NeilGaiman #Theendless #Dream #Death #Destiny #Despair #Delirium #Destruction #Desire
Desejo tem estatura mediana. É improvável que algum dia se produza um retrato que lhe faça justiça, porque vê-la (ou vê-lo) é amá-la (ou amá-lo) de forma apaixonada e dolorosa, acima de todas as coisas.
Desejo exala um perfume quase subliminar de pêssegos maduros e projeta duas sombras: uma negra, de contornos nítidos, e a outra translúcida e indistinta como a névoa sobre o asfalto fervente.
Desejo sorri em lampejos breves, como a luz do sol resplandecendo no gume de um faca.
Read 25 tweets

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