Discover and read the best of Twitter Threads about #ecmo

Most recents (15)

During #China’s fight against #Covid-19, the Chinese government adopted TWO FIRSTS approach: people first, the life and health first. China's national TV @CCTV 7 o’clock news on April 29 carried a few exceptional examples, miracles indeed:
1.The general cure rate in #Wuhan, the epicentre of the outbreak was 94%, while almost 90% of those in critical condition were able to return to normal life.
2. A 50-year-old Mr. Cheng suffered multiple organ failure and was the first patient to use #ECMO in his hospital. After 10-day #ICU care and was saved from near death He spent 80 days in the hospital and quarantine. He and doctors were tearful when he woke up.
Read 10 tweets
🏥 MEDICAL UPDATE: While we all have been barraged by media reports about hospitals needing more ventilators, we have not heard the same about the need for #ECMO circuits.

ECMO could make a difference of life / death in SARS-CoV-2
ECMO works by doing the blood/gas exchange that the aveolar tissue in the lungs normally does.

Ventilators merely push air in. Vents do the mechanical work. Vents can NOT do the gas exchange work.

We are seeing GAS EXCHANGE failures with COVID; not mechanical failure.
To put this in simple terms:

You have car that is out of gas. Three of your friends decide to push the car, and the car moves.

Those three friends are the VENT; they are doing the mechanical work. But once they stop pushing, the car still won’t work.

You still need gas.
Read 6 tweets
1/N thread on Nat’l #COVID19 Clinical Rounds Apr 7 relevant images at END of thread
2/N Mark Cardi Emory U:Outcome vary on patient mix, location and resources
3/N Rapid moving, but plateaus with rapid transition
Tachypnea early warning
90%of ICU require intubation
5-10% of ICU mortality
Read 24 tweets
Starting a series on clinical Pearls I am gathering in #COVID19 patients based on experiences of many experts

Will add as we go along

Feel free to add your own observations/experiences

#covidclinicalpearls /1
Anosmia is likely the most specific #COVID19 related symptom
30% of patients have anosmia as their 1st symptom
#covidclinicalpearls /2
Around 90% of patients have fever.
50% maybe afebrile at the time of presentation
Fever tends to be very resistant to routine measures in hospitalized patients
There is no consensus that NSAIDs are to be avoided in #COVID2019 patients

#covidclinicalpearls /3
Read 66 tweets
THREAD: I was sad, but now I am angry. As clinicians, we have the enormous privilege of attending to people when they are at their worst. Death, loss, disease, events that alter the trajectory of people’s lives, and keep working, because there is always work to be done. 1/
We ease the suffering of #humanity. That is what we have been called to do. And I feel like part of that is that we often censor ourselves to protect non-medical people. But how about we start to share a tiny glimpse of our reality? (Medical terminology is in quotes) 2/
While we know that 80% of cases are mild, do you know how people die after being infected with “Severe Acute Respiratory Syndrome #Coronavirus 2” (#SARS_COV_2)?

Rather, do you know how the majority of people who are deceased as a result of the new Coronavirus, perished? 3/
Read 19 tweets
1/39 2nd podcast & tweetorial for Pediatrica Intensiva, the art & science of pediatric intensive care. Here, an update on the realities of battling a tsunami of #COVID19 with intensivists Giovanna Colombo & Lorenzo Grazioli from Bergamo, Italy

#ICU #pedsICU
Here's the link to the recording

podcasts.apple.com/au/podcast/ped…
2/39 But first, a story about 2 real life heroes in the midst of #COVID19. #ICU & #pedsICU docs Giovanna Colombo & Lorenzo Grazioli are working in the epicentre of the outbreak. They’ve seen countless deaths & know that to save many they can’t save all
Read 22 tweets
For an entire ER shift, I saw a total of one non #COVID19 patient (TIA, prior strokes, 95yr). Only able to discharge 2 #COVID19 home, rest too sick to convalesce at home. There is a Tsunami coming. The public needs to understand:
- there is no cure,no quick fix, 2 wk of suffering
- sick contact & travel history matters little now
- a LOT of household transmission. This is a BIG problem
- all "flu"s should be treated as #COVID19| isolate, quarantine
- even sick should stay home.Only if short of breath need to be seen.Still may be sent home.
Spread the word
Almost forgot: the data from US could prove very different from Wuhan experience. Young patients become severely ill relatively fast. Multiple patients in their 20-30 in severe #ARDS and two on #ECMO
Read 3 tweets
1/31 1st podcast & tweetorial for Pediatrica Intensiva, the art & science of pediatric intensive care.

Incredible real experience of battling 100s of #COVID19 cases with intensivists Giovanna Colombo & Lorenzo Grazioli from Bergamo, Italy

#ICU #pedsICU
apple.co/39QmpIV
2/31 “The problem is seeing the outbreak in the other part of the world…is very different when you face it. Now the outbreak is here. We are the epicentre of the earthquake”

#COVID19 #ICU #PedsICU
apple.co/39QmpIV
3/31 “Lombardy is one of the richest regions in Europe, & its healthcare is one of the best in Europe. If we are in this situation with #COVID19, you can imagine the rest of Europe”

#ICU #pedsICU
apple.co/39QmpIV
Read 32 tweets
The moment we have been waiting for!! @jerjohzimm #sepsis @PedCritCareMed @ESICM #ccc49 (thread)

#sepsis #PedsICU

bit.ly/3bJIr1k
.@PierreTissieres is up first introducing the process & rationale #CCC49 #PedsICU #Sepsis
@TexKissoon tells us “Why Now”? #ccc49 #PedsICU #sepsis

Burden is highest on #children, and deaths occur early in the course
Read 21 tweets
What is CORONAVIRUS? How might it affect ICU? Let's go back to basics and look at the emerging evidence bases, protocols and risks. #FOAMed #FOAMcc #WuhanCoronavirus #CoronavirusWho
Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). #FOAMcc #FOAMed
A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans.... which is what the virus that is widely reported on the media, and via the WHO and CDC etc are talking about. #FOAMed #FOAMcc
Read 52 tweets
Tweetorial of @AparnaHoskote ‘s fantastic talk on #ecmo pearls for #singleventricle #chd in the #PedsCICU #PedsICU at #jpccim2019. Single ventricle pts have 43% ecmo survival. Several tweets to follow with pearls for how to optimize! @PICS_Conference @PCICS2 @PICSociety
1/10
Pearl 1: Timing is important; go on #ecmo electively
#jpccim2019 2/10
Pearl 2: hypoxemia is a better indication with better prognosis than hypotension (I.e. shunt issues are better than cardiac dysfunction) #jpccim2019 3/10
Read 10 tweets
With the help of @PICJournalWatch @harrykchris we though we could put together a collaborative thread with useful #PedsICU resources like apps, websites, blogs and accounts. This thread is open so please don’t hesitate to add yours. Here are mine 👇🏻
Apps:
- I-Perfuse: great tool for anything cardiovascular including #ECMO cannula sizes, equations, a calculator... very useful for #PedsCICU
- Heartpedia: awesome 3D models of heart anatomy. Also great for teaching at the #PedsCICU. And it was created by the great @pccm_doc
Apps continued:
- The Sanford Guide: it costs 25€/year. I’d pay 250€ since I use it everyday in the #PedsICU. Basically everything you need to now about antibiotics and bugs #PedsID.
Read 14 tweets
I listen to ~90 #Podcasts on a (semi) regular basis. Let me give you a rundown of ALL of them and why you should listen to some amazing #FOAMed, especially for all the new #EmergencyMedicine interns. #FOAMed #MedEd #medtwitter
First of all, you need a good podcast app. I absolutely love Downcast. Great app, gives you more control over playback, downloading, and allows you to categorize your podcasts into playlists (picture 2). This is where you get to customize your #FOAMed experience! #medtwitter
In no particular order,

- Anesthesia and Critical Care Reviews and Commentary (ACCRAC). Great insight into Crit Care from an anesthesia perspective. Coming from EM, this is great to listen to- much different from my day-to-day! #FOAMed #FOAMcc #CriticalCare
Read 88 tweets
Choque Séptico en #Pediatria

Porque #PedsICU facilita la información

Abro hilo, veamos definición, bloques, monitoreó y reanimación hídrica y medidas de soporte. Enfoque a "low income countries"

¡@Sepsis_Mx @FOAMexico @CantillMauricio @DrBlood5 @XiumaraCher ayudame a difundir!
El diagnóstico es muy práctico. Y solo necesitas dos puntos a considerar:
Ahora, vamos a facilitar recordar los criterios con las tres ventanas de perfusión:

(Irritable, somnoliento, estuporoso, puedes ocupar AVDI o Glasgow; cianótico, pálido, reticulado, rubicundo; uresis disminuida)
Read 22 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

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