Discover and read the best of Twitter Threads about #icu

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1/3- 🙋‍♂️12 KEY TRIALS I teach on #ICU Rounds each week residents & fellows must know!

BACK by request for July!

Do you agree?
Any you would add?

1. ARDSNET @NEJM-PMID 10793162

2. LEUVEN Glucose 1 @NEJM-PMID 11794168

3. SAFE Trial @NEJM-PMID 15163774
#FOAMcc #medtwitter #MedEd
2/3🙋‍♂️12 Key ICU TRIALS I teach each week continued…

4. TRICC Trial @NEJM PMID: 9971864

5. SOAP Vasopressor trial @NEJM PMID: 20200382

6. NICE-SUGAR @NEJM PMID 19318384

7. Rivers EGDT @NEJM PMID 11794169

8. VAAST Trial @NEJM PMID 18305265

9. SMART Fluids @NEJM PMID 29485925
🙋‍♂️ 3/3 12 KEY ICU TRIALS I teach each week continued…

10. APROCCHSS @NEJM PMID 29490185

11. Schweickert Early Mobility @Lancet PMID19446324

12. ABC Trial @TheLancet PMID 18191684

What others would you add?

#FOAMcc #FOAMed #SCCMSoMe #medtwitter #MedEd #MedStudentTwitter
Read 3 tweets
1) Finally, seems IMF progm being shortly revived, wth more taxes.
GDP growth to slow down-may be 3%- more increase in petrol prices & utilities- significantly higher inflation may be 15%. In this 🧵 I cover 2 strategic options country has to choose n/1
dawn.com/news/1696100/l…
2) With #IMF revival, default averted in near term, but economy to remain in #ICU . How will the govt address fiscal & currnt acnt deficits, ensure servicing of huge stock of external debt, improve forex reserves, enhance exports & restore investor confidence? n/2
3) How will the energy crisis, its mounting debt, SOE crisis be addressed? How will we improve our human development indicators?
Above 3 questions require major change in mindset wth regard to governance & public financial management . n/3.
Read 5 tweets
Professor John Edwards, epidemiologist on Radio4Today talking about #Covid waves. Says, vaccines would still work (without adaptation to new variants presumably) says problem going forward is immunosuppressed patients. Why does Gov need to test #Evusheld when this is the answer?
It is time the @BBCFergusWalsh @BBCHughPym investigated why the a government refuse to procure @evusheld4theuk when the only people unable to live with #Covid are the clinically extremely vulnerable who don’t respond or can’t have the standard Covid vaccination.
The standard vaccines aren’t withdrawn, tested and adapted each time a new variant appears AND YET, the excuse for not rolling out #Evusheld is that it was approved before Omicron and more data is required. The real reason appears to be the Gov won’t pay for it.
Read 5 tweets
Les #canicules sont mortelles, et s'il y a le plus de morts en ville, et c'est dû à un phénomène physique qu'on appelle "îlot de chaleur urbain" (#ICU).
En France, Paris est la plus vulnérable de toutes avec proportionnellement le + de victimes.

Explications & Thread
👇 Image
1/
En 2003, la surmortalité observée à Paris est de 1067 décès en excès, c'est le record national. L'IDF représente 1/3 des victimes en France à elle seule.
Voici, en août 2003, ce qui s'est passé jour après jour. Image
2/
Pourtant, Paris est située au nord du pays. Sauf que les #ICU contribuent à rajouter parfois jusqu'à +15°C à la température ressentie, et surtout, ils font que les nuits ne sont jamais fraîches, ne permettent pas au corps de se reposer, ce qui est mortel... 💀🥵💀 Image
Read 11 tweets
1) Welcome to a #tweetorial on what every #ICU #nurse should know about #hypertensive crisis, or #hypertensive #emergency as it is now more properly termed. I’m Bryan Boling @bryanboling, ICU #NP, & co-host of the @icuscenarios podcast. Follow this 🧵for 🆓CE/#CME credit!
2) This accredited educational activity is intended for healthcare providers & is supported by grants from AstraZeneca, Bayer, & Chiesi. Faculty disclosures cardiometabolic-ce.com/disclosures/. Like ❤️this topic? More CE/#CME on #hypertension mgt at cardiometabolic-ce.com/category/hyper….
3) So let's start with a case: 65yo ♂️, presents to the #ED with #headache, lethargy & confusion. PMH: #HTN, #hyperlipidemia, #DM2, COPD. Initial VS: HR 85, BP 205/120, T 37.2 RR 12, SpO2 92% on RA. Family reports that he has been more lethargic over the past 2 days.
Read 37 tweets
Ich gehe heute weinend nach Hause. Mal wieder.
Bilanz des heutigen Dienstes:
-3 Aufnahmen gleichzeitig
-2 Intubationen
-1 Verstorbener
Und das waren nur meine Pat.

Ein Mensch ist alleine gestorben, weil wir währenddessen um das Leben des Nachbarpat. gekämpft haben.
Dieser Mensch
Mensch ist unter unwürdigen Bedingungen gestorben.
Alleine, obwohl so viele Menschen im Zimmer waren.
Ich hatte nicht mal die Zeit, ihn danach zu versorgen u. das macht mich fertig.
Ich habe diesem Menschen bis zu seinem Tod die Angst u. die Schmerzen genommen, so gut ich konnte.
Es tat mir in der Seele weh, ihn so da liegen zu lassen, aber es war einfach nicht möglich mir 10 Min. dafür zu nehmen.

Es ist der 6. Dienst in Folge.
Der 5., in dem ich keine Pause hatte.
6 Überstunden in 6 Diensten.
Ich war nicht mal auf Toilette.
Das 1. Mal was gegessen habe
Read 5 tweets
I’ve never shared these pics, I was mad they were taken at first. I am sharing now to try and wake some ppl up. It’s easy to see the # of people on ventilators and gloss over it. Seeing a loved one on a #ventilator torture. This is my dad. A 🧵1/ Image
This is why it looks like for the first 7 to 14 days. It violently shakes them, you can’t help but imagine how much it hurts them even though your brain tells you they are sedated. You hold their hand but its like they aren’t there. You have no idea if they will make it. 2/
They are so weak you don’t know which outcome to hope for. After the 1st fewdays the dr says if they leave the vent in their throat it will permanently damage them, so they cut their neck to to a tracheotomy. You think the first day you saw them was the worst. You are wrong 3/ Image
Read 8 tweets
Today marks 20 yrs of #remission from #Crohns. For some #IBD patients, remission feels like an elusive thing. I get it, I’ve had my share of time in the #ICU. I’m extremely fortunate that #Remicade has worked this long. Many people must switch meds to find a lasting solution. 1/n
The last 20 yrs haven’t come w/o complications. A sustained high quality of life was worth the trade offs that come with #biologics. I lived with recurrent infections and a #cancer diagnosis. Was it challenging? Yes. Was it better than living with flares? Absolutely. 2/n
There isn’t a day that I don’t think of those that weren’t as lucky. Alex Davidson, Ty Redler, Lacey Conners and Lindsey D’Ercole were younger than me and have since passed from IBD complications. In spite of some survivor’s guilt, I do my best to keep their memory alive.💜 3/n
Read 8 tweets
I don’t know if anyone has seen the pernicious claim flying round social media in the last few days that only “17,000 people in the UK have died from #covid

I’ve yet to see anyone debunk it so I thought I’d do a 🧵

1/
Recently, I saw a number of people making the same, obviously false claim along the lines of “only 10% of covid deaths are actually covid deaths”

I asked for sources repeatedly and eventually got sent a link to an @ONS Freedom of Information request…

2/
ons.gov.uk/aboutus/transp…

The ONS were asked for the numbers of people who had died from covid, but had no other underlying conditions.

The answer came back as ~17,000.

So does that mean the other 150,000 didn’t die of covid??

No - of course it doesn’t.

3/
Read 27 tweets
Utterly shocked by the performance of Anaesthesia Consultant Steve James & his assertion that staff don’t need vaccination following recovery from COVID
He is wrong on the facts - vaccines have proven beneficial boosting “natural immunity”
Anti-vac are eating it up
#anaesthesia
Read 45 tweets
#antivaxx efforts now even use #deepfake

to target #refugee, Black, religious minority communities

like measles outbreak in Minnesota in 2019: Wakefield was flown in TO spread #misinformation & #disinformation

Now: online fake accounts/fake identities vs #VaccinesWork
What has #healthcare been doing meanwhile?

#Medbikini: Teach (male Asian) med students to make fake accounts to cyberstalk trainees’ personal Facebook for: bikini
or “being political” or “religious” (#BLM)

➡️“model minority” pipeline for “shadow faculty” vs Blck @ayshakhoury
#Medbikini #research got flak for men vs women

BUT was ALSO fake acct #surveillance vs #BLM like drove out @ayshakhoury @uche_blackstock @nhannahjones

While academia has ignored #vaccineequity
➡️ongoing #pandemic & deaths in marginalized targeted by #antivaxx

@womanistpsych
Read 23 tweets
This 👇🏽👇🏿👇🏻 This is why #BLM exists & why “implicit bias” is not only real but it kills

Why, when you see it, say something, do something
The system changes not by sharing tweets & hashtags but actions & consequences & removal of toxicity from the system

Follow #BlackTwitter
Above #MedEd #TikTok improvement: #citeblackwomen who lead this work (not only utilized the savior mindset of Black & brown as victims) #Blackexcellence @citeblackwomen center Black women
Send #SoMe traffic to Black creators & activists. #healthcare twitter.com/i/lists/122380…
Take #sharethemic initiative. It allowed #Blackexcellence to speak thru #influencer accounts to large followings for a day. I looked at before/after numbers, it did NOT drive any additional traffic to the actual accounts of those voices. Resurfacing this:

https://t.co/VZ26WWNxRP
Read 45 tweets
‘Im just a nurse’

A nurse working in #PedsICU >19 years had nowhere to park for her shift on Tues morning
Leaves hospital at 8.15pm, 13 hrs after arriving, car has been towed by clampers
Phone charge runs out, walks 3km in pouring rain to Garda station
Garda locate her car 5km away
She walks back to hospital, charges phone, pays release fee, walks to the car, soaked and freezing

Gets home to her worried family at 11pm
My colleague recounted this to me today, how she cried with cold and fatigue while waiting for phone to charge

But mostly she spoke about how small, insignificant and undervalued it made her feel
‘Just a nurse’
#ICU #icunurse
Read 6 tweets
Do we need maintenance fluids at all? What is your preferred maintenance fluid solution?
#IFAD2021 #FOAMed #FOAMcc

REPOSITORY (access 100+ lectures): whova.com/portal/webapp/…

@avkwong - @Manu_Malbrain - @azJanPalfijn - @FOAMecmo - @Wilkinsonjonny - @strachanjamie - @iceman_ex
When do you use (hypotonic) albumin 4% solutions?

#IFAD2021 #FOAMed #FOAMcc
REPOSITORY (access 100+ lectures): whova.com/portal/webapp/…
@avkwong - @Manu_Malbrain - @azJanPalfijn - @FOAMecmo - @Wilkinsonjonny - @strachanjamie - @iceman_ex - @icmteaching - @Gas_Craic
Read 30 tweets
Today we cremated my father, who died this past weekend after suffering effects of #LongCovid accelerating his dementia & other health problems. He went from an adventurer to a cripple in a matter of months. A 🧵 1/
He got COVID spring of ‘21 before being fully immunized. Initially seemed like he recovered, but clearly more trouble with memory, weakness, motivation. thelancet.com/journals/lanps…
And then this sudden lack of desire to move became harder to overcome his weakness. @HeidiEngel4 @IcuPerme @ellenhillegass would have loved to have had PT prioritized for him. We knew he needed but he lacked motivation & resources

blog.rehabselect.net/life-after-cov…
Read 16 tweets
The latest United States COVID-19 wave is taking its toll on some states’ intensive-care units, with several parts of the country seeing outbreaks that are as bad as ever. #ICU #COVID19 #DeltaVariant #DeltaSurge bloomberg.com/news/articles/…
“Many of our physicians are at a breaking point,” IHME's @AliHMokdad told @business.

“It’s not easy to be day in and day out in an emergency room, in an ICU, looking at someone who is dying because he or she is not vaccinated.” #COVID19 #VaccinesSaveLives #DeltaVariant
In 15 states, patients with confirmed or suspected #COVID19 are taking up more ICU beds than a year earlier, according to @NIH_NIAMS data. These are top states with highest %s of ICU beds occupied by COVID-19 patients:

▪️ Colorado – 41%
▪️ Minnesota – 37%
▪️ Michigan – 34% Image
Read 5 tweets
Was gibt's Neues aus #Oberoesterreich und #Salzburg? Wie viele Impfstraßen sind offen? Testcenter? Haben alle Spar-Filialen und Apotheken ausreichend PCR-Tests?
Ich freue mich über Hinweise.
#covid19at #covid
So wars gestern. 1 Impfstraße offen und ansonsten... ooe.orf.at/stories/312917…
Info aus anderem Kanal: Im Bezirk #Perg haben sich zwei Ärzte für diese Woche für Popup-Impfungen gemeldet. Einer in #Waldhausen und einer in #Schwertberg
Read 9 tweets
📮 Letter from an intensive care physician. #ICU

German translation below. Deutsche Übersetzung unten.
📮 Brief einer Intensivmedizinerin. #Intensivstationen

via @andrewbostom
Read 8 tweets
#Florida has finally been seeing dramatic improvements in its #COVID19 numbers.

It's been a while since I've done this, but it's warranted, so here goes a Florida update 🧵

Viz using covid19florida.mystrikingly.com

1/ Image
New daily infections (cases) have been decreasing in September as rapidly as they increased during this #delta surge.

We're where we were in mid-July, with numbers also similar to where we were in early February.

Under 7,700 cases per day over the last 7 days.

2/ Image
The chart below highlighting the past 8 weeks tells the story. After plateauing for 2 weeks towards the end of August, it's been 4 straight weeks of considerable decreases in cases.

We don't want to be at 7,000+ cases per day, but moving in the right direction...fast.

3/ Image
Read 33 tweets
@NdsLandesReg hat neue #CoronaVO veröffentlicht.
(niedersachsen.de/Coronavirus/vo…)
#Schule größtenteils super👍
ABER die Höhe der #Warnstufen - das kann doch nicht Ernst sein?!
Häfte der #Notfallreserve mit eingepreist?
Warnstufe 2 erst bei mehr als #covidspezifisch-e Betten?➡️
2/
Ich hatte das ja schon bei den Entwürfen analysiert (⬇️ und vorherige).
Aber da war ich noch so dumm, davon auszugehen, dass @NdsLandesReg bei "Prozent Belegung Intensivbetten" nur die
__betreibbaren__
meint.
3/
Das ist aber offensichtlich nicht so.
In §2, Abs. 5 heißt es in Satz 2
"Die Intensivbettenkapazität beträgt 2 424 Betten"
(Vgl. unten rechts)
Findet man die irgendwo im @DIVI_eV Register?
Joa, bei "Aktuell betreibbbar + 47% Notfallreserve".
__NOTFALL__🔥__RESERVE__
Read 14 tweets
Today, @WHOWPRO held a press conference on #COVID19 across the Western Pacific.
WHO colleagues Drs Tamano Matsui, Socorro Escalante & I discussed sharp rises in cases, future scenarios, the people who give us hope and this critical moment.

My speech: bit.ly/3y9YeQY
More than 19 months into the pandemic, 6 million people in the Western Pacific have been infected and more than 83,000 have lost their lives.
Until a few weeks ago, our region had fared comparatively well, with around 2% of global cases and deaths.
But…
Now several countries in the Western Pacific are experiencing surges, in part driven by the Delta variant. Our share of global cases and deaths is rising sharply.

In the first 3 weeks of August, we reported over 10% of new global cases and more than 8% of new global deaths.
Read 15 tweets
#InzidenzAbschaffen und stattdessen #Hospitalisierungen betrachten?
Macht keinen Unterschied, zeigt auch der Bundesländer-Vergleich #NDS #NRW #HH
Doppelte, dreifache Inzidenz und Positivitätsrate führen zu doppelter, dreifacher #Hospitalisierung & #ITSBelastung.
Länger↔️ 5fach.
2/
Übrigens sind es seitdem Datenstand von Donnerstag auch schon wieder mehr Patienten geworden:
#NRW steht jetzt bei 1,42/100k auf #ITS statt 1,05 und
#HH bei 2,32 statt 1,95.
Beide grob +40% in 5 Tagen - und nur die Erwachsenen betrachtet. In #NRW kommen noch 2Kinder dazu
3/
Oft werde ich gefragt: Wieviele #KinderITS Betten haben wir denn?
Im Bundesschnitt 2,3 covidspez. Betten pro 100.000 Kinder, mit Schwankungen in den Bundesländern, 0 in #SH bis 4 in #HH (wenn die SH mitversorgen aber nur noch 1,7) bzw. 3,7 in #TH
Read 22 tweets
Ergänzend zum gestrigen #OktoberImAugust Thread heute noch ein paar weitere Einblicke in #Hospitalisierungen #Kinderdurchseuchung
TLR: #KeineEntkopplung:
Steigt Inzidenz, steigt #Belastung der Krankenhäuser - und der niedergelassenen sowieso.
Ausführlicher im Thread:➡️
1/x
2/
Betrachtet man die #Hospitalisierungsinzidenz-en für alle Altersgruppen über den Gesamtzeitraum, sieht erstmal alles #Tutti aus, weniger als KW44/20 bis 23/21.
Aber zu den Werten gehörten auch 90.000 Tote, das wollen wir ja auch nicht wiederholen.
Wie ist der Trend?
➡️
3/
Betrachtet man letzte 2 Monate, steigt nicht nur #Hospitalisierung bei #Kinderdurchseuchung, sondern auch bei 80+ sehr deutlich,
ebenfalls 60-79Jahre steigend, ähnliche Höhe wie #Hospitalisierungsinzidenz der 0-4Jährigen.
War das zu erwarten?➡️
Read 48 tweets

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