After a week of working in the #ICU here in #Seattle caring for patients with #COVID19 (and other illnesses), here are some thoughts. #medtwitter (1/10)
We try to have a high index of suspicion for #SARSCoV2 and test critically-ill patients broadly. However, this means that many patients we test are actually negative. This presents a challenge for clinical reasoning. (2/10)
It takes more energy than usual to avoid anchoring too early and to keep a broad differential.
This is complicated further by the limits of rigorous #Isolation and attempts to preserve #PPE. (3/10)
This is complicated further by the limits of rigorous #Isolation and attempts to preserve #PPE. (3/10)
With the time and resources needed to go into the room of a patient getting ruled out for #COVID19, we try to think carefully and plan ahead before entering the room because we can’t go back and forth so easily. (4/10)
If we forget to ask something or do an exam, we try to wait until there are additional things we need to do in the room, or we ask another medical team member to help us do that while they are going to be in the room. #Teamwork and #Communication are key. (5/10)
Another complicating factor is that while a patient is awaiting #SARSCoV2 results, there are delays in obtaining other non-emergent diagnostics because any equipment has to be fully cleaned after contact with the patient. This takes it out of circulation longer than usual. (6/10)
If a scan/cath/scope or other procedure is truly needed, it can be done, but sometimes we will treat presumptively first.
This can be stressful for those of us used to getting studies done stat for ICU patients. (7/10)
This can be stressful for those of us used to getting studies done stat for ICU patients. (7/10)
The unsung heroes of all our work have been the environmental services and supply chain workers in our hospital. They keep us all healthy and are working overtime. Rooms are getting amazingly detailed cleaning. I have been so impressed by the rigor and professionalism. (8/10)
Lastly, a huge thanks to the logistics folks. When we were low on #PPE, they found additional suppliers. I don’t see these people in my clinical role but benefit immensely from their work. (9/10)
For up to date copies of the #COVID19 protocols we are using @UWMedicine, they are available free to use at covid-19.uwmedicine.org/Pages/default.… #InfectionControl (10/10)
