Discover and read the best of Twitter Threads about #icu

Most recents (10)

#Thread
Our new #OpenAccess work @AnnalsATS examines how ICU doctors talk to families when they don’t expect a patient to survive. Congratulations to @SVasherMD, Sandra Zaeh of the @JHUPCCMFellows, and @mneakin
#ICU #PalliativeCare @creativecommons

atsjournals.org/doi/abs/10.151…
63 intensivists in the intervention arm of the SCIP trial (NCT02721810) answered the question “Do you expect this patient to survive to hospital discharge?”

50 of the 63 in the intervention arm answered that they did NOT expect the patient to survive.
These intensivists then participated in a recorded simulated family meeting.

During the meeting, 25 intensivists told the actor playing the daughter that her dad might not live. The actor responded verbatim:

“What do you think is most likely to happen?”
Read 8 tweets
UTI-Club #3: lesión pulmonar inducida por la ventilación mecánica: VILI #tweetorial

interconsulta.online/uti-club-3-les…

#TuitMédico #MedTwitter #FOAMed #FOAMcc #MedEd #UTI #ICU #MechanicalVentilation #VIL

1/
👩‍🦱 55a
⌨️POP hemicolectomía (CA Colon). 3 hs de cirugía, sin complicaciones
2/
Ingresa a UTI extubada, sin requerimientos de vasopresores.

Al poco tiempo desarrolla hipoxemia e infiltrados pulmonares 🖥️

EAB: (con máscara de O2 al 50%): 7,42/50,4/36,5/-1/23/85,9% 💉

Ecocardiograma normal ❤️

AngioTC negativa para TEP ❎
3/
Requiere intubación orotraqueal y conexión a asistencia respiratoria mecánica.

Cuando se procede a setear al respirador, llama la atención que la paciente tiene baja estatura (1,55 m) y sobrepeso (en la historia clínica de ingreso figura peso previo a la cirugía de 68 kg) ⚖️
Read 16 tweets
Citation counts come from OTHER RESEARCHERS. They are important, yes.

But, sharing #science on #SoMe=broad & instantaneous dissemination to those who focus their time AT THE BEDSIDE. Which may surprise some- but is MOST OF MEDICINE especially....#anesthesiology.(Thread) #AUA2019
A metric like the “Kardashian Index” *MAY* be relevant in genome biology where the proportion of basic/translational science is significantly higher and no immediate bedside application for a general practitioner is there. (and I’m making an assumption here) #medtwitter #aua2019
When your #research is relevant primarily to other #scientists who are also writing research papers then citation counts do more wholly reflect the paper’s impact. But in clinical research, it’s different. Bedside clinicians are looking to the literature for guidance & new ideas.
Read 13 tweets
1/ Why is lactate elevated in sepsis or septic shock?

@dolan_russell & I explore this common #ICU pimp question via #tweetorial.

We're taught that ↓O2 revs up anaerobic metabolism causing ↑ lactate. But wait, there's more...

#medtwitter #FOAMed #meded #FOAMcc #criticalcare
2/ In homeostasis, lactate is continually produced and metabolized; serum concentration is at steady state.

Which of the following organs is responsible for the majority lactate consumption and metabolism?
3/ The liver is responsible for ~70% of lactate metabolism.

Patients with hepatic dysfunction can have ↑ lactate 2/2 ↓ clearance or ↑ production. Also, cirrhotics are more prone to hyperlactatemia in setting of sepsis.

Diving deeper, how does the liver metabolize lactate?
Read 13 tweets
THREAD
Recently in our #MICU, I took pics of the oxygen sats of patients on oxygen supplementation.

What is the optimal oxygen supplementation strategy for a clinically stable patient in the ICU?

Follow me down this #tweetorial rabbit hole. #medtwitter #pulmcc #AIMW19
1/
Given that population health improvements often come from small benefits in large populations, and the fact that #oxygen is one of the most commonly prescribed interventions in the #ICU, there is potential for benefit if we can correctly titrate our oxygen titration.
2/
I’m going to refer to hypoxia and hyperoxia in this #medthread, and I’d like to (somewhat arbitrarily) define these terms. I’ll call hypoxia anything below 90% and hyperoxia anything above 96%. This is based upon some of the literature I will discuss.
3/
Read 23 tweets
Solución Salina Hipertónica
¿Cómo preparar diferentes concentraciones?

Abro🧵iniciamos👩‍💻y abierto los comentarios

#PedsICU #FOAMed
Los métodos mostrados usarán Cloruro de Sodio al 17.7% (también conocida como Concentrado de Sodio al 17.7%), al ser la presentación común en países de #LatinAmerica donde usualmente no se cuenta con presentaciones al 3%, 5%, etc (con el método avanzado, podemos crear estas)
En otros países del mundo, cuentan con presentación también al 20% (España, p. ej.)
Read 23 tweets
Monitoreo de CO2 Exhalado

Abro hilo, iniciamos 👨‍💻y abierto los comentarios

#FOAMed #PedsICU #Urgencias #Pediatrics #SoMe #FOAMped #Pediatria

@sgdambrauskas @CantillMauricio @AMEEMCTI2018 @OlgaPena @diegovinci @ESACMex @SaidDLCR @Javier_Prego @erikablasco ¡Ayuda a compartir!
Un caso clínico no ayudará a entrar al tema, veremos conceptos básicos de #EtCO2, y algunas de sus aplicaciones clínicas en Urgencias y #UCI
Caso clínico
Read 42 tweets
Cetoacidosis Diabética #DKA #CAD #AMTIP

Bases de la Enfermedad y análisis del Diagráma de Flujo @NICEcomms Diciembre 2018

Abro hilo, iniciamos👨‍💻y abierto comentadios

@MarianaPediatra @FOAMexico @CantillMauricio @Javier_Prego @erikablasco @pediatraweb10 @RobustosMD @carsolbal
Para ti #urgenciologos, #pediatras e #intensivistas

Daremos un repaso discreto de CAD y analizaremos el texto de la NICE Pathway

Comentaremos con relación a las guías @ispad_org, una de las más utilizadas a nivel mundial

En pocas palabras, el diagrama con relevante información
#CAD puede presentarse en #T1D y #T2Diabetes. Debido a obesidad, han aumentado los casos en esta última, presentándose también como debút.

#T1D es resultado de destrucción autoinmune progresiva de células beta. Ocurre a una tasa de 6-8%/año en aquellos con Dx establecido.
Read 39 tweets
#twitterjournalclub
The ANDROMEDA- SHOCK Randomised Clinical Trial
Thoughts by @z_cepillo
jamanetwork.com/journals/jama/…
Multicentre (28) open label RCT to determine if peripheral perfusion targeted resuscitation during early septic shock in adults is more effective than a lactate-targeted resuscitation for reducing mortality.
Inclusion criteria: adult patients with septic shock (infection, lactate >2, vasopressors to maintain MAP >65mmHg after IV fluid of 20ml/kg over 60 mins.
Read 26 tweets
#BigData #ICU #sepsis research I wish some1 would do

Optimal Duration of Time-Limited Trials in Critically Ill Patients

"If they are going to respond to this, we should see a response by ..."

What are median + 95th percentile for responses to common life-saving therapies?
I feel like we "know" this for lots of small things
- Lasix should make 'em pee within 20 minutes
- PEEP improves oxygenation in 20 minutes
- uroseptic shock should break within 24 hour
There are some scattered superb research projects:
- optimal durations of SBTs
- optimal time to neuroprognostication s/p anoxic injury
- Blood cultures will turn positive for MRSA w/i 48 hours if they are going to
Read 6 tweets

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