Thread by @JessicaLuc1

This is happening now! @ISMICS webinar on #COVID19 "Lessons and Perspectives from Italy and New York!

Moderated by Dr. @drbypass
Featuring Drs. Gino Gerosa, Mattia Glauber, Eric Lehr, and Nirav Patel

Link -> zoom.us/j/406456900

Ping @STS_CTsurgery @AATSHQ @ctsnetorg

https://twitter.com/ISMICS/status/1247235389242425345

/1 #Tweetorial to follow on the #COVID19 "Lessons and Perspectives from Italy and New York" from the @ISMICS webinar 👇

/2 Dr. Gino Gerosa from Italy:
- protect your healthcare workers with adequate PPE, otherwise, many will fall ill and be taken out of patient care
- isolate those infected -> ideally dedicate areas or hospitals to #COVID19 patients to not contaminate
- test pts and your ppl

/3 Dr. Mattia Glauber from Italy: #COVID19 @ISMICS webinar
- death rate can be very high -> 32% of all infected
- death rate varies by location
- the importance of social distancing cannot be overstated

/4 Dr. Mattia Glauber from Italy: #COVID19 @ISMICS webinar
- protect your healthcare workers -> otherwise many will die
- need to expand your ICU capacity while maintaining ability to deal with emergency non-COVID cases such as acute coronary syndrome

/5 Dr. Mattia Glauber from Italy: #COVID19 @ISMICS webinar

- The importance of standardizing your definitions cannot be overstated
- Maintain excellent communication
- Set guidelines and criteria to bring everyone on the same page
- Share healthcare personnel and resources

/6 Dr. Mattia Glauber from Italy: #COVID19 @ISMICS webinar

/7 Dr. Mattia Glauber from Italy: #COVID19 @ISMICS webinar

Phase 1
- beware of cardiac surgery patients who initially test negative for #COVID19 -> they may in fact still be positive and manifest symptoms postoperatively
- high rates of vascular complications

/8 Dr. Mattia Glauber from Italy: #COVID19 @ISMICS webinar

Phase 2
- prepare for the building of temporary ICU modules to host critical patients

/8 Dr. Eric Lehr from Seattle: #COVID19 @ISMICS webinar

Status update of capacity at hospitals in Washington
- 30% of vented pts had #COVID19
- 30% of pts with #COVID19 admitted to ICU died
- majority of pts had no comorbidites
- #COVID19 does not discriminate by age

/9 Dr. Eric Lehr from Seattle: #COVID19 @ISMICS webinar

- cardiovascular surgery cancellations due to #COVID19 in Seattle

/10 Dr. Eric Lehr from Seattle: #COVID19 @ISMICS webinar

Interesting that many patients with massive pulmonary embolism, perhaps due to higher rates of CT scans?

/11 Dr. Eric Lehr from Seattle: #COVID19 @ISMICS webinar

Lessons learned:
- limit exposure of your team and healthcare personnel
- organize hospital to limit spread
- utilize telemedicine
- risk stratify and triage pts
- conserve healthcare personnel and resources

/12 Dr. Eric Lehr from Seattle: #COVID19 @ISMICS webinar

- #COVID19 cases are not learning cases for your residents or medical students
- treat every airway as a potential #COVID19 patient
- ideally utilize negative pressure rooms

/13 Dr. Nirav Patel from New York: #COVID19 @ISMICS webinar

Trends and status in New York

/14 Dr. Nirav Patel from New York: #COVID19 @ISMICS

What New York did in preparation for #COVID19
- suspend nonCOVID research enrollment
- be selective in surgeries one does
- ideally every pt should be tested before surgery
- beware of robotic surgery -> CO2 aerosolization

/15 Dr. Nirav Patel from New York: #COVID19 @ISMICS webinar

How to organize your team:
- intubation team
- procedure team
- proning team
- pyramidal critical care team

/16 Dr. Nirav Patel from New York: #COVID19 @ISMICS webinar

ICU pearls in management:
- be liberal with proning and extubation

/17 Dr. Nirav Patel from New York: #COVID19 @ISMICS webinar

- low supply chain
- streamline your order sets
- decrease your traffic throughout hospitals and units
- have a central command center
- be liberal in the transition of pts to postacute care
- pts can rapidly crump

Thank you to @ISMICS and Dr. @drbypass and all panelists on the fantastic webinar on #COVID19

Very helpful and insightful.

May we all stay safe and well.

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