Discover and read the best of Twitter Threads about #sepsis
Most recents (24)
🧵1/Most people don’t know that everyday cuts & infections can lead to life threatening sepsis, amputation or death
New, rapid diagnostic tests are available to get the right treatment early, but docs need to start using them
insider.com/rick-bright-wa… @thisisinsider @Hilarx #AMR
New, rapid diagnostic tests are available to get the right treatment early, but docs need to start using them
insider.com/rick-bright-wa… @thisisinsider @Hilarx #AMR
2/ Failure to accurately diagnose bacteria / fungi early, often leads to delayed / wrong treatment. Every minute of delay increases severity of the infection; it’s spreading in your body
Wrong meds can make the problem worse for you & for the world, increasing drug resistance
Wrong meds can make the problem worse for you & for the world, increasing drug resistance
3/ We are losing the battle against drug resistant bacteria & fungi. Fewer drugs work on every day infections. More people are dying of sepsis. R&D funds for new drugs is shrinking.
It’s truly a silent pandemic that is closing around us.
It’s truly a silent pandemic that is closing around us.
“Ten tips to optimize #vasopressors use in the critically ill patient with #hypotension.” #IntensiveCare #MedTwitter #CardioTwitter #sepsis #FOAMed #FOAMcc #CriticalCare #EmergencyMedicine #PedsICU #ICU #EMCCM
📚 Intensive Care Med (2022) 48:736–739 rdcu.be/c57Se
📚 Intensive Care Med (2022) 48:736–739 rdcu.be/c57Se
1. Set goals of mean or diastolic blood pressures.
2. Individualize the arterial pressure targets goals.
3. Vasopressors induce an endogenous fluid recruitment and may limit positive fluid balance.
4. Reassess fluid status and cardiac output after initiation of vasopressors
2. Individualize the arterial pressure targets goals.
3. Vasopressors induce an endogenous fluid recruitment and may limit positive fluid balance.
4. Reassess fluid status and cardiac output after initiation of vasopressors
5. Consider agents with a different mechanism of action as a second line agent.
6. Consider adding hydrocortisone in patients on high doses of vasopressors.
7. Vasopressin is an option in patients with right ventricular failure.
8. There is no maximal dose of vasopressors.
6. Consider adding hydrocortisone in patients on high doses of vasopressors.
7. Vasopressin is an option in patients with right ventricular failure.
8. There is no maximal dose of vasopressors.
1/5 "In healthy individuals, normal #body #temperature is variable and has decreased consistently since the 1860s."
atsjournals.org/doi/10.1164/rc…
atsjournals.org/doi/10.1164/rc…
2/5 "The #gut #microbiome is a key modulator of body temperature variation both in #health and critical illness, and is thus a major, understudied target for modulating #physiologic #heterogeneity in #sepsis."
3/5 The Carrington Event was the most intense geomagnetic storm in recorded history, peaking from September 1 to September 2, 1859 during solar cycle 10.
1/ *Re-consult 📞*
You: What did the last consult note say?
Them: I don't know how to interpret it...
*reading the ✍️ yourself*
#Sepsis
- send tick serologies
- start broad-spectrum antibiotics
- we will follow up OSH data
You: 🤦 I feel you... We'll see the patient again.
You: What did the last consult note say?
Them: I don't know how to interpret it...
*reading the ✍️ yourself*
#Sepsis
- send tick serologies
- start broad-spectrum antibiotics
- we will follow up OSH data
You: 🤦 I feel you... We'll see the patient again.
2/ You wonder...
💭 What tick serologies were we referring to?
💭 What antibiotics were we wanting to start?
💭 And which OSH has prior records?
And you're not the only one wondering...
How can we ✍️ more effective notes?
💭 What tick serologies were we referring to?
💭 What antibiotics were we wanting to start?
💭 And which OSH has prior records?
And you're not the only one wondering...
How can we ✍️ more effective notes?
I work in a private nursing healthcare facility,since the elderly had their FIFTH jab 6-8 weeks ago,we have lost 8-10 residents,more having to go into hospital.All supposedly ending with #sepsis - very strange. Keep your ears peeled @FatEmperor @JohnBoweActor
Just to say,no this isn’t a lie,obviously I can’t 100% the cause,but we usually have a more frequent rate of residents passing away Dec/Jan,not Oct/Nov,many ‘found’ dead, not expected.following Jab,frequent chest infections,inc staff.I am only one not jabbed
I also on the day the jabs were administered had an argument with the nurses administering them,as I told every resident it was their choice wether to have it. They said I was fearmongering, I told them exactly what I thought.Made the head nurse think.
NEXT: Who's "high risk" in ICU? Nicolas Bennett - Zurich, Switzerland.
reminds me of NELA score development in UK.
Declaration : he now works for industry (known side effect for medics doing data science )
@ESICM #criticalcare #ai #datascience #LIVES2022
reminds me of NELA score development in UK.
Declaration : he now works for industry (known side effect for medics doing data science )
@ESICM #criticalcare #ai #datascience #LIVES2022
@ESICM Interesting : eventually end up writing R package. cran.r-project.org/web/packages/r…
#sepsis classification using MIMIC-3 - time series data. Time-series classficiation.
#sepsis classification using MIMIC-3 - time series data. Time-series classficiation.
It is World Sepsis Day.
Guess what❓ #Sepsis kills 11 million people each year, many of which are young children & other vulnerable populations in low-income countries.
Learn more 👉bit.ly/3bIsUiE
Guess what❓ #Sepsis kills 11 million people each year, many of which are young children & other vulnerable populations in low-income countries.
Learn more 👉bit.ly/3bIsUiE
Anyone with an infection can develop #sepsis. But some people are more at risk. These are:
🔸Pregnant women
🔸Newborns
🔸The elderly
🔸The immunosuppressed People with chronic diseases
🔸Hospitalized patients
🔸Pregnant women
🔸Newborns
🔸The elderly
🔸The immunosuppressed People with chronic diseases
🔸Hospitalized patients
The symptoms of #sepsis include:
🔸Fever or shivering
🔸Confusion
🔸Shortness of breath
🔸Rash that does not fade when pressed
🔸Extreme discomfort
🔸Sweaty skin
Seek medical care as soon as possible when an infection is not getting better.
🔸Fever or shivering
🔸Confusion
🔸Shortness of breath
🔸Rash that does not fade when pressed
🔸Extreme discomfort
🔸Sweaty skin
Seek medical care as soon as possible when an infection is not getting better.
Racial bias in temporal (forehead) thermometers🌡
Out @JAMA_current @JAMANetwork
ja.ma/3cLF53j
23% relative reduction in fevers detected in Black patients w/ temporal compared to oral thermometers
Another medical device that could be failing our patients
(1)
Out @JAMA_current @JAMANetwork
ja.ma/3cLF53j
23% relative reduction in fevers detected in Black patients w/ temporal compared to oral thermometers
Another medical device that could be failing our patients
(1)
Cohort: All patients w/suspected infection🦠from 4 hospitals
Paired oral & temporal temperatures within 1 hour of each other🌡️
Eval of association between fever (>38°C) & route of measurement adjusting for age hospital & comorbidities in Black patients & White patients
(2)
Paired oral & temporal temperatures within 1 hour of each other🌡️
Eval of association between fever (>38°C) & route of measurement adjusting for age hospital & comorbidities in Black patients & White patients
(2)
Figure shows odds of fever w/ temporal thermometers (oral = reference) in Black & White patients
Horizontal line at 1.0 = no difference in fevers w/ temporal vs oral
@ varying fever cutoffs Black patients had⬇️odds of having fever detected w/ temporal thermometers
(3)
Horizontal line at 1.0 = no difference in fevers w/ temporal vs oral
@ varying fever cutoffs Black patients had⬇️odds of having fever detected w/ temporal thermometers
(3)
New WHO-@UNICEF report reveals 50% of healthcare facilities around the world 🌏🌍🌎 lack basic hygiene services with water & soap or alcohol-based hand rub.
Read more 👉bit.ly/3CJoLL2
Read more 👉bit.ly/3CJoLL2
Without access to basic hygiene services, more than 3.8 billion people face greater risk of infection while using these facilities.
Read more 👉bit.ly/3CJoLL2
Read more 👉bit.ly/3CJoLL2
Hygiene in healthcare facilities is key to pandemic recovery, prevention and readiness. The basics include:
🚰 safe water
🚽 clean toilets
🚮 safely managed waste
Read more 👉bit.ly/3CJoLL2
🚰 safe water
🚽 clean toilets
🚮 safely managed waste
Read more 👉bit.ly/3CJoLL2
#Sepsis tötet - und wir schauen zu.
Ein Thread mit anschaulichem Beispiel.
Eine der gefährlichsten #Diagnosen in der (#Notfall-)Medizin ist die "Verschlechterung des Allgemeinzustandes" (AZ-Verschlechterung). Und das aus 2 Gründen:
Ein Thread mit anschaulichem Beispiel.
Eine der gefährlichsten #Diagnosen in der (#Notfall-)Medizin ist die "Verschlechterung des Allgemeinzustandes" (AZ-Verschlechterung). Und das aus 2 Gründen:
1. es scheint keine konkrete Ursache für den aktuell schlechten Gesundheitszustand benannt werden zu können & es kann "alles" dahinterstecken.
2. Durch die Bezeichnung AZ-Verschlechterung werden teilweise lebensbedrohliche Erkrankungsbilder im Alltag verharmlost.
2. Durch die Bezeichnung AZ-Verschlechterung werden teilweise lebensbedrohliche Erkrankungsbilder im Alltag verharmlost.
This work was done in partnership with Dr. Vinnie Liu of @KPDOR, with funding from @AHRQNews, support from @vahsrd, and led by our awesome teams @VA_CCMR & @KPDOR. I can't say thank you enough for the support and to the awesome teams behind this work.
#Sepsis Guidelines, QI programs, and performance evaluation all recommend and/or incentivize prompt antimicrobial treatment for sepsis because earlier time-to-treatment is associated with improved outcomes.
Und da ist es mir passiert: Ein Patient mit Unterarmphlegmone, bestehendem Drogenabusus und ungepflegtem Zustand steht zur OP im Dienst an. Eine kurze Fallbeschreibung als Reminder💡
Er kam fahrig, unruhig und tachykard in den OP.
🧵(1/4)
Er kam fahrig, unruhig und tachykard in den OP.
🧵(1/4)
Schublade: entzügiger Drogi, na toll 🙄
Narkose gut überstanden, im AWR weiter tachykard und unruhig, RR nach Volumenstubstitution normwertig aber weiter tachykard und kaltschweissig. Na toll: Entzug geht richtig los. Methadon von Station besorgt und…
(2/4)
Narkose gut überstanden, im AWR weiter tachykard und unruhig, RR nach Volumenstubstitution normwertig aber weiter tachykard und kaltschweissig. Na toll: Entzug geht richtig los. Methadon von Station besorgt und…
(2/4)
Clonidin - Patient jetzt etwas entspannter: ab auf Station, ist ja jetzt auch schon spät. 🥱🕐
Stunde später Anruf von der Dienstärztin von Station: Patient weiter tachykard, jetzt hypoton und BZ schlecht ➡️ Übernahme auf ICU. Labor mit akutem Nierenversagen, PCT hoch, …
(3/4)
Stunde später Anruf von der Dienstärztin von Station: Patient weiter tachykard, jetzt hypoton und BZ schlecht ➡️ Übernahme auf ICU. Labor mit akutem Nierenversagen, PCT hoch, …
(3/4)
Al parecer Emmanuel Rivers tenía conflicto de interés en su estudio de EGDT, en 1997 había mandado a la oficina de patentes de 🇺🇸 un dispositivo para medir SvO2 continua (🧵 1/4) #FOAM #FOAMcc #sepsis #Emergency
Sus metas tempranas como sabemos consistían entre otras en mantener una SvO2>70 (con monitoreo continuo🧐) ya sea con líquidos inotrópicos o hemoderivados, excluyeron 27 pac 13 del grupo EGDT y 14 del grupo control porque “no completaron 6 hrs” (2/4)
Sus resultados fueron biológicamente improbables, el perfil hemodinámico de SvO2⬇️ con TAM⬆️ en sus datos basales es atípico para sepsis, casi todos los sépticos tienen SvO2 ⬆️ (3/4)
#Sepsis hat keine Lobby. Ist das ein Problem? Klar!
#Sepsis tötet! Und das gar nicht selten. Die Sepsis gehört zu den häufigsten Todesursachen in D.
Die gute Nachricht: d. Verlauf einer Sepsis kann durch frühes Erkennen & rasches Behandeln positiv beeinflusst werden.
Thread 1/23
#Sepsis tötet! Und das gar nicht selten. Die Sepsis gehört zu den häufigsten Todesursachen in D.
Die gute Nachricht: d. Verlauf einer Sepsis kann durch frühes Erkennen & rasches Behandeln positiv beeinflusst werden.
Thread 1/23
Deshalb ist es wichtig, dass alle mal was davon gehört haben und zumindest grob wissen, worum es hierbei geht.
Also gibt es jetzt und hier für Laien und medizinisch Interessierte diesen kleinen Thread zum Thema #Sepsis. #einfachMedizin
2/x
Also gibt es jetzt und hier für Laien und medizinisch Interessierte diesen kleinen Thread zum Thema #Sepsis. #einfachMedizin
2/x
#Sepsis wird auch als Blutvergiftung bezeichnet. Sie kann durch jede Infektion ausgelöst werden; also z.B. Lungenentzündung, Entzündungen im Bauch, den Harnwegen od. auch Infektionen, die entstanden sind, weil man sich verletzt hat & Erreger in d. Körper eingedrungen sind.
3/x
3/x
#Pneumonia is the #1 infectious killer of kids – killing > 40,000 in #Somalia, #Guinea, #SouthSudan & #Chad in 2019
Introducing #PCV 💉would dramatically save lives - 92,000 by 2030!
What must be done: bit.ly/3ggUA1g
#EveryBreathCounts #VaccinesWork #AUSummit
🧵 1/
Introducing #PCV 💉would dramatically save lives - 92,000 by 2030!
What must be done: bit.ly/3ggUA1g
#EveryBreathCounts #VaccinesWork #AUSummit
🧵 1/
More than half of child #pneumonia deaths are in countries with < 60% #PCV coverage. These kids are paying with their lives!
These govts👇must introduce & protect >90% children with #PCV by 2025
More 👉 bit.ly/3ggUA1g
#EveryBreathCounts #VaccinesWork #AUSummit
2/
These govts👇must introduce & protect >90% children with #PCV by 2025
More 👉 bit.ly/3ggUA1g
#EveryBreathCounts #VaccinesWork #AUSummit
2/
Introducing the #PCV 💉in #Somalia could avert 32,600 child deaths from #pneumonia, #meningitis & #sepsis
Prevention is key where just 23% of kids with pneumonia symptoms are taken for care. bit.ly/3ggUA1g
#EveryBreathCounts #VaccinesWork #AUSummit @MoH_Somalia
3/
Prevention is key where just 23% of kids with pneumonia symptoms are taken for care. bit.ly/3ggUA1g
#EveryBreathCounts #VaccinesWork #AUSummit @MoH_Somalia
3/
Do you know all of these nuances of #pleuraldisease? Why is an #empyema distinct from a complicated #parapneumoniceffusion? What is #contarinisyndrome #explosivepleuritis #chyliform #pseudochylous? Are all #chylothorax milky? #pccm #pulmcrit #pulmonary
#pleuraldisease is fascinating and nuanced. First step is #lightscriteria which give favor to finding #exudates which tend to be more urgent. You only need one criterion, which maximizes #sensitivity. Meaningless statement: "It's an exudate only by protein." One criterion=exudate
(Like on Tinder, the more criteria you require, the more you narrow your pool, compromising sensitivity for specificity.) Transudates I will skip over. Most common #exudate is #parapneumoniceffusion #PPE. If there is or is likely to be #pneumonia, it's PPE. Next task is to...
Review the Executive Summary to see how the updated guidelines were developed and how they differ from the 2016 guidelines: bit.ly/3wuDOmw
#SurvivingSepsis
#SurvivingSepsis
As #MedTwitter regulars, you may have already heard that the #SurvivingSepsis Campaign has released the updated 2021 version of the International #Guidelines for Management of #Sepsis and #SepticShock!
But have you gone thru the updates yet?
A #Tweetorial (1/x):
But have you gone thru the updates yet?
A #Tweetorial (1/x):
There are 93 #recommendations made in the new publication. I don’t have time to write (or read) that kind of #Tweetorial and neither do you. That’s what the publication is for -> journals.lww.com/ccmjournal/Cit… !
But let’s hit the ✨highlights✨ starring Table 1: (2/x)
But let’s hit the ✨highlights✨ starring Table 1: (2/x)
Why we care (and we care so much!): Sepsis and septic shock affect millions of people globally each year, and kills somewhere between 1/6 and 1/3 of those diagnosed with the #syndrome. 1/3!!! 😳😢 (3/x)
(Knopfzelle 1/6) Leider kommt es immer wieder zum Verschlucken von Knopfzellen durch Kleinkinder. Eine Knopfzelle ist eine kleine runde Batterie. Relativ große Knopfzellen haben einen Durchmesser von über 2 cm und sind besonders gefährlich #Batterie #Kinder #sepsis #vergiftung
(Knopfzelle 2/6) Oftmals bleibt die Knopfzelle in der Speiseröhre stecken. Knopfzellen haben meist eine Spannung von 3 Volt. Durch das feuchte Gewebe in der Speiseröhre kommt es zu dauerhaften Stromfluss.
Knopfzelle (3/6) Folgen sind meist Verbrennungen und Verätzungen. Das Gewebe in der Speiseröhre kann so sehr verletzt werden, dass die Speiseröhre undicht wird. Bakterien können den Blutkreislauf sowie Herz und Lunge erreichen.
Die vor 20 Jahren publizierte "Rivers"Studie hat die #Sepsis Therapie grundlegend verändert. Sie definierte Therapieziele, die innerhalb von 6h erreicht werden sollten. Sie zeigte eine Mortalitätssenkung von 46,5 auf 30,5% (1/4)
nejm.org/doi/10.1056/NE…
nejm.org/doi/10.1056/NE…
In den letzten Jahren wurden die Parameter angepasst, der zentrale Venendruck spielt z.B. keine große Rolle mehr, ebenso wird die großzügige Flüssigkeitsgabe zunehmend kritisch gesehen. Die Indikation zur schnellen Bluttransfusion wurde ebenfalls revidiert. (2/4)
Warum also bahnbrechend? Die Studie hat die #Sepsis als einen zeitkritischen medizinischen Notfall behandelt. So schwer nachvollziehbar das heute ist, davor war das nicht immer der Fall. Die #SurvivingSepsisCampaign wurde gegründet, mit dem Ziel, die Mortalität zu senken. (3/4)
Today is #WorldSepsisDay
Q: What is #sepsis?
A: Sepsis is a life-threatening medical emergency. It occurs when a person has an infection, and the body’s response causes injury to its own tissues and organs.
Sepsis affects millions of patients 🌍
bit.ly/2X12EN2
Q: What is #sepsis?
A: Sepsis is a life-threatening medical emergency. It occurs when a person has an infection, and the body’s response causes injury to its own tissues and organs.
Sepsis affects millions of patients 🌍
bit.ly/2X12EN2
#Sepsis is estimated to kill 1⃣1⃣ million people each year, including almost 3⃣ million young children. It disables millions more.
who.int/news-room/fact…
who.int/news-room/fact…
Anyone with an infection can develop #sepsis, but some people are more at risk than others:
🔸Pregnant women
🔸Newborns
🔸The elderly
🔸People with chronic diseases or immunosuppression
🔸Hospitalized patients
bit.ly/2X12EN2
🔸Pregnant women
🔸Newborns
🔸The elderly
🔸People with chronic diseases or immunosuppression
🔸Hospitalized patients
bit.ly/2X12EN2
Our #systematicreview and #metaanalysis on the association of #sepsis with long-term #CVD is out now in @yourICM ! Surviving sepsis was associated with ⬆️#cvMI, #heartfailure, and #stroke over 5+ years. Take-home points below. tinyurl.com/p5n634jy
1. Many studies have examined the risk of #CVD after #sepsis, but variable population and outcome selection has complicated generalizability. We estimated the risk of #cvMI, #heartfailure, #stroke, and composite #CVD after sepsis relative to hospital and population controls.
2. 12,649 citations identified, 27 (25 cohort, 2 case-crossover) studies included. Median of 4,289 (IQR 502–68,125) sepsis survivors and 18,399 (IQR 4,028–83,506) controls per study. We assessed cumulative incidence and relative risk of #CVD from 30 days to longest follow-up.
1/🧵Fluids in sepsis: When a patient’s blood pressure is too low and they are in shock, as happens all the time with #COVID19 viral #sepsis, we give fluids. This @bmj_latest figure👇makes a bit of sense of where the fluid goes. Let me unpack a bit more…
bit.ly/3lvrL50
bit.ly/3lvrL50
2/ 👇 @bmj_latest
We talk about 2 categories of fluids: Crystalloids & Colloids. For crystalloids think “thin fluid like salt water with sugar.” For colloid think “thick fluid with lots of protein like albumin.” The figure shows that crystalloids leak out of the blood vessels…
We talk about 2 categories of fluids: Crystalloids & Colloids. For crystalloids think “thin fluid like salt water with sugar.” For colloid think “thick fluid with lots of protein like albumin.” The figure shows that crystalloids leak out of the blood vessels…
3/ while colloid stays in the blood vessels. But there are several other important teaching points beyond what the figure shows.
✅ If a person has a lot of edema, as we see in heart, kidney & liver failure, colloids pull fluid into our vessels & ⬆️ blood volume to end shock…
✅ If a person has a lot of edema, as we see in heart, kidney & liver failure, colloids pull fluid into our vessels & ⬆️ blood volume to end shock…
1/🧵 The Road to #LongCOVID:
In her @ScienceMag piece, @Dr2NisreenAlwan teaches that @Twitter & FB served a purpose but can’t remain our authority in defining devastating disability suffered by millions after #COVID19. We must have more science!
bit.ly/2Wv8Lcf
In her @ScienceMag piece, @Dr2NisreenAlwan teaches that @Twitter & FB served a purpose but can’t remain our authority in defining devastating disability suffered by millions after #COVID19. We must have more science!
bit.ly/2Wv8Lcf
2/ In 2020 the main support for pts with prolonged symptoms came from online testimonials and absent community testing sites, people were left to guess as to whether or not their crazy symptom profile was due to COVID.
3/ “A common theme emerged: lack of recognition by the medical profession. Patients, including doctors, w #LongCovid consulted healthcare providers & their symptoms were commonly minimized, dismissed, or labeled as anxiety.”
#Stigma #Discrimination #MECFS
#Stigma #Discrimination #MECFS
