Thread by @ogi_gajic

1/#Ogitorial No21 Real Patient with Consent. 42M, previously healthy collapses upon entering ED
A ok
B clear, bag/maskFiO2
♥️ BP 60/, HR80 Epi drip
D avPu
E punctate skin marks, diaphoresis, ashen skin, L eyelid swell
U - dark ages
L Hb10, WBC6,K 2, Na146, HCO3 12, Lact 2.4-4.5

You place (just in case) DC pads, replace K/Mg. ED volunteer says: prior to collapsing, the patient mumbled “bees”. You speed up fluid (5LNS/1h), add steroid & H1/H2 blocker with ⬆️BP but severe rigors, anxiety & delirium. The risk of future PTSD is best ⬇️ by:
#FOAMed #FOAMcc

3/ #Ogitorial No21 answer
Psychological sequelae of critical illness are common & important
ncbi.nlm.nih.gov/pubmed/25449881
Dex is not safe in patients on Epi drip & no evidence it can help.
Diaries ncbi.nlm.nih.gov/pubmed/30431494 &
Post-ICU clinics ncbi.nlm.nih.gov/pubmed/25731633
are of limited help

4/ Nurse-led cognitive-behavioral (CBT) intervention offered to ICU patients at risk was ineffective as well: jamanetwork.com/journals/jama/…
The window until traumatic memories are permanent is narrow suggesting that an early #goldenhour approach is warranted
ncbi.nlm.nih.gov/m/pubmed/26820…

5/ Moribund patients may not see but do hear and feel!!!
pubmed.ncbi.nlm.nih.gov/28807140
Also amazing description of shock & ICU experience by @RanaAwdish amazon.com/Shock-Journey-…
New approaches for early goal directed psychological support are funded by @nih_nhlbi
clinicaltrials.gov/ct2/show/NCT03…

6/ #Ogitorial No 21 patient’s experience and outcome are detailed here:
atsjournals.org/doi/full/10.11…
He is infinitely grateful to @MayoClinicEM @AnnieSadostyMD
for being able to tweet and more years after the event..
🙏🙏🙏
Dignity & human touch matter in #goldenhour