My Authors
Read all threads
Lots of talk about the expected surge in ICU and hosp beds with #COVID. I’ve been hearing about reducing elective case burden (great thread from @ajaykirtane about that). We should also be rethinking our hospital approach to conditions that will continue in the covid era 1/n
Most obvious is with #STEMI care. If your hospital doesn’t have an ED bypass protocol for stemis - probably a good time to develop one. Ours at @VHC_Hospital has 1 min pitstop in ed w ems txp to cath lab - less pt exposure time to ED and less burden on ED resources 2/n
Also with #STEMI care - No icu for stable pts w normal EF should be standard. For most of these pts ICU is not necc and creates unneeded exposure for pt and occupies much needed ICU beds. (I think @agtruesdell had a great thread on this a while back) 3/n
For NSTEMIs we’ve had a practice standard of doing weekend nstemis for a while but this requires coordination with cath lab staff...if this is part of your surge planning, good to have that discussion now to make sure you are adequately staffed. 4/n
Also consider early post PCI d/c in NSTEMi. as @SVRaoMD often says complications post PCI are very rare after 6 hours and the risks of keeping a pt in hospital longer than needed are potentially dire...even more so these days 5/n
Other conditions to consider are tougher, like rapid AF-where default is admit. Shifting to only admit w sig sx and using #telehealth to manage all others at home (even with HR to 150s..) may make some uncomfortable, but will be critical to reduce exposure risk in these patients
Similar changes in thinking will be needed with chest pain rule outs. As @DavidLBrownMD has shown, most pts who come to ED w trop neg chest pain don’t benefit from additional testing. Clinical pathways to rapidly eval, reassure, and dc these pts should be built before the surge.
Our protocol uses a real time “mini stress” by having them walk up and down the hallway but whatever works to rapidly offer reassurance may save them from #COVID 8/n
If u have a system that can leverage medical monitoring at home (like ours @MdAtlPermanente), this is the time to deploy home based acute care for pts whose conditions (eg CHF exacerbations) would typically result in admit but also put them at highest risk for covid morbidity 9/n
Everyone will need to work together to get us through #COVID (and I know we will get through). My take is those who care for acute pts but aren’t ID/ED or ICU can help now by carefully rethinking our whos and whys of our common admissions in the context of covid (10/10)
Missing some Tweet in this thread? You can try to force a refresh.

Enjoying this thread?

Keep Current with Ameya Kulkarni, MD

Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

Twitter may remove this content at anytime, convert it as a PDF, save and print for later use!

Try unrolling a thread yourself!

how to unroll video

1) Follow Thread Reader App on Twitter so you can easily mention us!

2) Go to a Twitter thread (series of Tweets by the same owner) and mention us with a keyword "unroll" @threadreaderapp unroll

You can practice here first or read more on our help page!

Follow Us on Twitter!

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just three indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3.00/month or $30.00/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!