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Lakshman Swamy
@laxswamy
, 10 tweets, 8 min read Read on Twitter
Physical signs of chronic stress /burnout that Howard hears from his patients.

Pulmonologist in the room immediately adds breathlessness!

#ERSCongress #ERS2019
And now emotional signs - important to recognize in yourself but also in colleagues who may react differently than you do. #ERSCongress #ERS2019
Behavioral signs of burnout:
Howard re clinicians who treat substance abuse (as we all do) - "it won't ever happen to me" - - but it does. Awareness is, again, critical.
Recs @jratey book Spark about relationship between exercise and mental health. #ERSCongress #ERS2019
Compassion: a place in your heart in which you feel empathy with another & want to ease their pain.

Compassion fatigue: secondary trauma to a helping professional who experiences emotional/mental/physical exhaustion while helping another. You must keep going on.
#ERSCongress
Some drivers of compassion fatigue - external as well as internal #ERSCongress2019
Howard shared this video from @ChildrensColo about compassion fatigue. You should watch it... incredibly powerful. #medtwitter #NurseTwitter #ERSCongress
Elements of self compassion #ERSCongress
Howard emphasizes recognizing fatigue in our colleagues. Avoid gossiping or talking to others-- it leads to further social isolation. Approach the person directly. Find support. Recognize suffering and act on it. #ERSCongress #ERS2019
Howard has a wealth of experience- he really is incredible. Check out more of his work here: linkedin.com/in/howard-baum… #ERSCongress #ERS2019
Thank you @EuroRespSoc for an amazing conference experience! #ERSCongress #ERS2019 #ERSCongress2019
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More from @laxswamy see all

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Lakshman Swamy
@laxswamy
My approach to family meetings in the ICU & some #TipsForNewDocs I've learned along the way. Here is my approach - - my favorite part is the mandatory interpreter!
<THREAD>
Set the stage: invite the right people (HCP, RN), consider ambiance & setup, have a plan w objectives but manage your own expectations! It's work to you, but life & death to the family.

Sometimes the patient's room itself is the best location, esp if they can participate!
✨The Jargonese Interpreter ✨
Empower someone to interrupt you & ask for clarifications before the meeting. "Can you explain what you mean by ventilation?"

We use way more jargon than we think, and the family may not ask for nearly as much translation as is needed.
Read 16 tweets
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Lakshman Swamy
@laxswamy
It was a quiet day in the ICU, for me.

The morning started with an elderly man admitted with respiratory failure. He did not tolerate BiPAP. He was clearly uncomfortable and suffering.
The family agreed: no more suffering. It is the end. Goals of care changed to prioritize comfort. He died naturally and comfortably surrounded by loving family.
Later, an extubation. I always go to the room for this, one of our most important decisions/procedures. It went smoothly, and the first words out of the patient's mouth: "thank you." and then, more importantly, a great cough!
Read 7 tweets
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Lakshman Swamy
@laxswamy
[THREAD] Our tips on small bore chest tube placement for pleural effusion! Performed by a resident @BostonCityEM supervised by fellows @BUPulmonary. We'd love your input! Not a comprehensive guide. Made with written patient authorization. #meded #FOAMcc #pulmcc
For new large unilateral effusions such as this, we place a chest tube if fluid pH <7.2, glucose <60. Without fluid studies, we place a tube empirically if effusion is large, loculated, infected, or likely to reaccumulate- except CHF/fluid overload.
First step: ultrasound. We position the probe with marker to the head, as lateral as possible. Intercostals tend to sag as you move towards the midline, so you could hit them when going above the rib. Lateral access is safest.
Read 24 tweets

Related threads

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Xinqi Su
@XinqiSu
#NOW in Tsim Sha Tsui , people are forming human chain that is set to extend along Nathan Road towards Jordan
Hold hands with @pepe , the spirit animal of #HongKongProtests , is the theme of tonight's human chain from Tsim Sha Tsui to Prince Edward Station.
Pepe in human chain : one with a broken but still illuminating heart, black bloc pepe, big pepe, hand drawn pepe.
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Doreen Rabi, M.D.
@doreen_rabi
Dear friends & colleagues- the support you have shown in a vulnerable moment has been overwhelming. I will try to highlight some of the advice and reflections I have received on #burnout that were helpful & thought provoking:
1) Celebrate your numerator. We focus to much on the denominator (those things not yet done), but the wins we have delivered get forgotten too quickly.
2) Life is a marathon run on an oval track. There are often things/issues that come around again. Don’t beat yourself up, you have not failed- this is life. Learn a bit more about yourself with each experience.
Read 11 tweets
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Bernadette Keefe MD
@nxtstop1
Physical Activity and Exercise –––– Their massive role in our health and wellness, at ALL ages/ stages of life.

A #curatedthread with tips and resources ––

Tags: #PhysicalActivity #Exercise #PhysicalMobility #SixthVitalSign #HealthyAging #health #wellness
More –– #PhysicalActivity #Exercise #PhysicalMobility
Tips on Getting Started
m.gulfnews.com/news/europe/uk…
- Craft your 'why'/purpose
- Start slowly
- U may 'love' exercising OR Not
- Be kind to U
- Use 'why'& habit, Not willpower
- Plan,Prioritize
- Be flexible
-+Resistance, +Balance
More ––––#PhysicalActivity #Exercise #PhysicalMobility #SixthVitalSign

"Common Sense Guide To Exercise and Moving More!" ––– by @CorKinetic

20 Great Tips! 👇
Read 52 tweets
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Colin West
@ColinWestMDPhD
1/ Several provocative papers were published on #burnout last week in @JAMA_current. I have some thoughts on both the papers and the field. I hope these might stimulate further informed discussion. I will take part in that to the extent time permits, but I do have a day job. 😀
2/ First up, the systematic review by @LisaRotenstein @srijan_sen_lab @DouglasMataMD and others. Hearty congratulations for such a visible publication based on an immense amount of work! #burnout @JAMA_current jamanetwork.com/journals/jama/…
3/ Key findings include: “marked variation in burnout definitions, assessment methods, and study quality” which “preclude definitive conclusions about the prevalence of burnout”.
Read 34 tweets
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Leena📎🧝🏼‍♀️ Alv
@LeenaJohansson
Är du oroad över att demokrati och de mänskliga rättigheterna är i fara? Utveckling i världen och här hemma tyder på det. Du som vill göra något för att lyfta fram det viktiga med samtal om demokrati kan nu att agera. Läs tråden
röstamermänskligt.se
#röstamermänskligt
Alla goda röster behövs för att komma bort från den enkelspåriga retoriken där gruppers gälla mot varann.
#röstemermänskligt är en partipolitiskt och religiöst obunden grupp från skilda bakgrunder med en gemensam nämnare: ett mänskligt samhälle
Valkampanjen är öppen för alla. Du behöver inte vara expert. Det du kan göra är att sprida kunskap, informera och samtala om mänskliga rättigheter under #röstamermänskligt eller irl, på gator och torg, med dina bekanta och familjer.
Read 8 tweets
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Elijah J. Magnier
@ejmalrai
#Important:
Yesterday late afternoon #Russia/n forces took 3 positions in Qusseyr and Juseh and established checkpoints. #Hezbollah, not informed of the Russian presence, came close to these forces and asked their immediate pull out+
Following the direct intervention of President Bashar al-Assad, the Russian force pulled out this morning and avoided any clash with #Hezbollah in the area.

hezbollah maantin and kept all positions. The #Russia/n move was not coordinated.+

#Hezbollah did not...I repeat, did not pull out one single element from the area.

I spoke to people on the ground: The Russian decision was unclear and considered unwelcome by the forces on the ground. Still, many elements of this move are unclear.

Read 6 tweets

Trending hashtags

#evergreen #human #PlotsOfData #ObrasDeEmergencia #walking #hurricanes #sarcopenia #WeekendWarrior #Daraa #Cognition #THINK #Palestine #evidence #ríoTajo #MarMenor #Indyref2NOW #Trasvase #LOL #exode #youth #PozosDeSequía #Quneitra #PreventFalls #HappyMothersDay #patients
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