Discover and read the best of Twitter Threads about #pedsicu

Most recents (24)

A #Tweetorial on Blood Gas Analysis (adapted from my WKRP in Cincinnati style method of teaching blood gases).
Blood gas interpretation is something that is initially very confusing, is usually poorly taught, comes up hourly in the #pedsICU and #ICU and will be on every exam for the rest of your life.
But it doesn't have to be that complicated and this method will get you through 99.99% of blood gas interpretation and serves as a good foundation to learn those exceptions. (So don't @ me!)
Read 27 tweets
New Research—First Europe-wide study of 582 children & adolescents confirms #COVID19 predominately causes mild disease and fatalities are very rare (4 deaths, <1%).

thelancet.com/journals/lanch…
This #ptbnet study primarily captured data from children & adolescents who were seen or managed within the hospital setting, and so the study population is likely to primarily represent individuals at the more severe end of the disease spectrum of #COVID19
In this cohort of n=582, 48 (8%) required #pedsICU admission, 25 (4%) mechanical ventilation (median duration 7 days, IQR 2–11), 19 (3%) inotropic support, and one (<1%) #ECMO.
Read 4 tweets
Does the time taken by the transport team to reach the bedside of a critically ill child impact on their outcome? A thread of key findings from our newly published @DEPICT_Study research investigating the transports of >9,000 children #PedsICU [1/7]
If a child is critically ill & in a hospital without a paediatric intensive care unit, a transport team is sent to collect them. Teams aim to arrive with the child within three hours, a standard set by @PICSociety & decided by expert consensus [2/7]
But, is the three hour target appropriate? Well, currently ~87% of the time the target is met, so we can’t say much about those children who have to wait longer. But there seems to be no evidence that arriving faster is better for the child in terms of survival [3/7]
Read 7 tweets
1/A short recollection about compassion and moral distress in a #pedsicu that turned into an adult ICU for #COVID19 patients. This is my personal experience and there are no patient identifiers.
Thread.
2/I’m asked, almost daily now, how it felt to look after Adult ICU patients in full PPE when you I’ve been looking after children for the last 15-ish years. Intensive care is a funny old beast. We are accustomed to death and the possibility of death on a daily basis.
3/We look him in the eye, we play chess with him and in #pedsicu roughly 9 times out of 10 we win (based on last PICANET data here cutt.ly/0yMvV3t).

That is our comfort zone.
Read 38 tweets
A short thread on using #online #education following my own experience in moving to this for #PedsICU teams @UHSFT @SotonChildHosp & our #medical #students @UoS_Medicine @unisouthampton

Hope this helps.... #MedEd
TIP 1:
Be kind to yourself

This is knew. It feels different. Recognise this will take time for you to adapt. Learners realise this and have been delighted people have taken the effort to teach and be innovative
TIP 2:
Learn your platform

Practice with the resource you are using before the session. Discover:
- chat room
- interactive whiteboard
- screen share
- raise hand/question function
- break out small group function
- mute & camera functions
Read 12 tweets
If you care for #PedsCICU patients or #CHD patients in the #PedsICU & aren't engaged with PC4, the outstanding recap of the #CardiacArrestPrevention project results by @bubblesdadee is one great example of how you can change your practice & outcomes as a @pc4quality center! 1/3
Significant reduction in #cardiacarrest by this #CollaborativeQI project lead to many lives saved! It's possible to #PreventCardiacArrest! Over 110 of our PC4 family participated in today's call to review the results, which were previously presented at #AHA19 @AHAMeetings!
2/3
Thanks to @TheCHF for their generous support of PC4 & @CardiacUnited for helping us collaborate to change the paradigm in #CHD research! 3/3
Read 3 tweets
1/Which fluid is more appropriate in patients with hyperkalaemia 0.9% saline or Hartmann’s?
A #pedsicu thread:
How much K+ does Hartmann’s solution and 0.9% Saline solution contain respectively ?
2/ Hartmann’s solution has 4mmo/L of K+
0.9% saline has no K+ content.
So with that in mind, which one do you think is safer to use in a patient with hyperkalaemia (lets assume that's someone with a K+ more ore equal to 5.5mmol/L)
3/
There is a very common misconception that Hartmann’s solution(aka) Ringer’s lactate is contraindicated in patients with hyperkalaemia. We are challenged on this almost weekly when we get pedicu referrals @NWTStransport
Read 26 tweets
Short thread on vent mode preference differences between #PedsICU and adult ICU land because I’ve seen some references to each that aren’t exactly right. Namely SIMV vs Assist Control. #covid19
First misunderstanding: SIMV can’t trigger the vent without PS. That was true with IMV. Set rate, every 60/R seconds a breath was delivered. The S part, for synchronized, introduced a window where patient can trigger, if no trigger, then breath is delivered #COVID19 #PedsICU
It’s not the same as assist control, where every trigger delivers a breath, but it approximates it. #PedsICU #covid19
Read 8 tweets
Thanks to @cdc we’re now calling it MIS-C. #MISC (can’t have hyphens in hashtags).
MIS-C Tweetorial: Here’s recent alert from CDC regarding this multisystem inflammatory syndrome in children (MIS-C, or #PIMSTS on #medtwitter). emergency.cdc.gov/han/2020/han00…. This Kawasaki-like syndrome was noted about 4 weeks after #COVID peak in Italy #PedsICU
CDC named it MIS-C, diagnosed by:
✅T>38 for 24hrs
✅⬆️CRP, ESR, ferritin, procal, or IL-6, etc
✅>=2 organ system dysfxn
✅no other infxn/reason for sxs
✅recent #COVID19 or just exposure (many are PCR-, variable serology)
Read 14 tweets
The "mysterious pediatric coronavirus illness" resembling Kawasaki Disease (KD) and toxic shock syndrome (TSS) has been in the news recently. From a current pediatrics resident and soon-to-be #PedsICU fellow, let's talk a little bit about it. (Thread).

nytimes.com/2020/05/09/hea…
First, what's KD? It's an inflammatory disease that can cause problems with the coronary arteries, which supply the heart muscle. Its cause is unknown, but a viral trigger is one idea. It's also more common than you'd think - every pediatrician has seen it more than once.
Second, what's TSS? It's the effect of an infection (classically staph on the skin) producing a toxin that can make patients really sick and sometimes need an ICU to help keep their blood pressure up. Again, somewhat rare but more common than you'd think.
Read 13 tweets
Ok a few things have been moving in the world of paediatric #COVIDー19 literature

Time for an updated #tweetorial on SARS-CoV-2 infection in children!

#FOAMped #FOAMed #PedsICU #PedsID #IDtwitter

1/12
So there are fewer cases in children. How much fewer?

Children consistently make up <2% of confirmed COVID-19 cases. These are usually ascertained by testing sick people in hospital

US: dx.doi.org/10.15585/mmwr.…
Italy: jamanetwork.com/journals/jama/…
Madrid: jamanetwork.com/journals/jamap…

2/12
COVID-19 is less severe in children, but often is it severe?

From a Chinese cohort 0.6% needed PICU but lots of community testing involved
pediatrics.aappublications.org/content/early/…

US CDC data has 2% of admissions in PICU (limited data)
dx.doi.org/10.15585/mmwr.…

3/12
Read 12 tweets
A #PedsICU story about bronchiolitis that may be helpful to my adult colleagues who are struggling with who and when to intubate for #COVID19.
A caveat to this. I know that COVID isn’t bronchiolitis, but there are lessons from this story that might be helpful.
Bronchiolitis is ubiquitous in the winter and is one of the most common causes of admission to a #PedsICU. Most infections are minor and just seem like a “cold”, especially in adults, older children, and toddlers.
Read 13 tweets
OK, time for a tweet summary of what we know from the paediatric literature about #COVID19 in kids SO FAR

Given the disease has only existed for 3 months, it's quite a lot...

#FOAMPed #PedsICU #IDTwitter

1/7
Kids get MUCH less severe disease than adults. Mortality AND critical illness v. low (close to 0%), confirmed from both China and Italian data

pediatrics.aappublications.org/content/pediat…

jamanetwork.com/journals/jama/…
2/7
Kids PROBABLY acquire the disease less often than adults. Low rates seen in symptomatic cohorts, and in S Korea which had higher rates of population screening.

statista.com/statistics/110…

Japanese contact tracing found lower attack rates in children

medrxiv.org/content/10.110…

3/7
Read 8 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
I spent the afternoon with many @HopkinsMedicine colleagues making #ppe for the staff. I am sharing (with permission) the steps and materials for making faceshields of your own. We are all in this together. ❤️💪🏼 #PPEshortage #ppeisnotoptional #PedsICU #covid19 #ICU #healthcare
@AOC @BarackObama @HillaryClinton @SenSchumer @SenateDems @JoeBiden @3M we need your help! The #PPEshortage is real and many of us are helping make #ppe to keep our colleagues in #healthcare safe. #GetMePPE #ppeisnotoptional #WeNeedPPE
Read 3 tweets
All "Mechanical ventilation for dummies" videos in one thread so we can have a bit of discussion around each topic. All questions encouraged, will try to answer to the best of my knowledge! @lberto_Medina #SoMe4MV #PedsICU
I will dedicate each video to a friend and ask them to help me with the discussion (no pressure). We are learning together, and we are a team!
1. Lung simulator. Here we learn how to build a low cost simulation device to help with our teaching. And who will be better to discuss simulation than my colleague @davidgrantsim!
Read 9 tweets
#medtwitter- now not time to dress up at work. Do it like staff in operating room. #COVID19 #ICU #pulmcc #PedsICU

1. Wear “Commute clothes” from home. Old stuff/shoes you don’t care about.

2. Remove commute clothes before any pt/team contact in office/locker room.

1/
3. Wear Surgical scrubs from machine if possible- if you don’t have access see if you can get it. Otherwise keep several clean pairs of scrubs in locker/office

4. Deposit scrubs end of day or if not from machine,keep in closed bag.

#covid19 #medtwitter #icu #PedsICU #pulmcc
2/
4. Wear Commute clothes home, straight into wash.

5. Repeat.

Trust me this is important- do not wear your clothes home. #SocialDistancing #covid19 #medtwitter
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
T1. Each March for the last decade, I have given a visiting lecture at @GWpublichealth "Mathematical Modeling of Infectious Disease Epidemiology", which combines my love of math w/ work relevant to my life in the #PedsICU (disclaimer: I am not an ID doc)
T2. This year unfortunately, we weren't able to find a date that worked but given the emergence of #COVID19, I thought it might be worthwhile providing a little context to some of the terms being thrown around the interwebs.
T3. "I simply wish that, in a matter which so closely concerns the wellbeing of the human race, no decision should be made without all knowledge which a little analysis and calculation can provide" Daniel Bernoulli (yes, the 0,1 guy) 1760 onlinelibrary.wiley.com/doi/abs/10.100…
Read 13 tweets
Ahmeneh Ghavam from U of Chicago: first speaker in ethics of rationing in #PedsICU #CCC49
Ghavam : objectives and overview #CCC49 #PedsICU
Ghavam: how did we get here? #CCC49 #PedsICU by 2030 we’ll spend more than 20% of GDP on healthcare in the US
Read 38 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
Si escribo coronavirus probablemente encienda en tu cabeza varias alarmas.
Si lees que, como todo virus, no suele requerir de tratamiento específico quizá esa alarma suene extraña.
Si añades distancia e incertidumbre tienes un cóctel revuelto y agitado.
Hablemos del cóctel pues.
Este #HiloYTal tendrá los siguientes apartados:
1️⃣ La COPIA RARA
2️⃣ El PERO
3️⃣ La CURA
4️⃣ La ALERTA
5️⃣ ¿Conclusión?
1️⃣ La COPIA RARA
El coronavirus depende de aquel a quien infecta para replicarse. Tipo con instrucciones pero sin material ni herramientas.
Llega al individuo, alcanza las células que tapizan su vía aérea y entra en su interior para amueblarse la casa.
Read 34 tweets
Prevención de #Quemaduras🧯🚒

Enfoque Pediátrico. Por nuestros niños.

Abro hilo, iniciamos y abierto los comentarios 👨‍⚕️👩‍⚕️

#tweetorial #MedEd #PedsICU
Los esfuerzos para reducir la incidencia de quemaduras han tenido resultados variables.
El asesoramiento familiar en las visitas al pediatra en el control de niño sano puede ser lo más efectivo.
Existen programas educativos y en lugares públicos que buscan prevenir este tipo de accidentes, siendo estos diferentes en cada país.
Read 27 tweets
🚨Junto a @Dr_Hari_Krishna hicimos selección 🇬🇧🇪🇸de mejores artículos 📑 2⃣0⃣1⃣9⃣ en #PedsICU para @PICJournalWatch

Comparte y comenta!
#Tweetorial acompañante

Lista PDF👉docs.google.com/viewer?a=v&pid…
Infográfico clickeable👉docs.google.com/viewer?a=v&pid…
Pubmed👉ncbi.nlm.nih.gov/sites/myncbi/h…
@Dr_Hari_Krishna @PICJournalWatch @Nopanaden @curso_vm @miguelrdgzrubio @LA_Rednetwork @WFPICCS @SapnaKmd @jramonfernandez @PedCritCareMed @ChrisCarrollMD @pccm_doc 3/ La colección es incompleta. Muchos buenos estudios han sido publicados durante 2019. Ayúdanos a completarla y comparte tus ideas!

Surely this colection is incomplete. Many good studies have been published during the past 2019. Feel free to share with us!

#PedsICU #BestOf2019
Read 30 tweets

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