Takeaways from COVID patient care—->by no means this is meant to replace your practice. I am sharing thoughts and experiences from floor and ICU care of #COVIDー19 patients
@drdangayach @AlexReynoldsMD @katereillymd @ChrisCarrollMD @virenkaul @sfaiz212 @navithadev @FOAMecmo
@drdangayach @AlexReynoldsMD @katereillymd @ChrisCarrollMD @virenkaul @sfaiz212 @navithadev @FOAMecmo
1. Be a physician, be critical in thinking, no two patients are the same. Weigh Risk vs Benefits & reevaluate regularly
2. No definitive data on therapies for #COVID-19
3. Precision medicine tailored to patient care in collaboration with your teams ( ID, Rhem, Immunology etc)
2. No definitive data on therapies for #COVID-19
3. Precision medicine tailored to patient care in collaboration with your teams ( ID, Rhem, Immunology etc)
4. Early prone is key to improving PF ratio, do it even in non-intubated patients
5. Early steroids in my short humble experience seem to show improvement in oxygenation (study out of China 26 on steroid vs 20 not on steroids had less O2 requirement and less vent days)
5. Early steroids in my short humble experience seem to show improvement in oxygenation (study out of China 26 on steroid vs 20 not on steroids had less O2 requirement and less vent days)
6. Hydroxychloroquine does not seem to work in those on Vent support and no hard data to support, could consider early in course on supplemental oxygen in confirmed COVID cases: Risks vs Benifits
7. Patients appear to be dry and kidneys bounce back with fluids but be careful, have room on FiO2 to allow for worsening P/F ratio.
8. PEEP titrate to patients need: different PEEP for 120 lb female vs 300 lb male is needed!
9. IL-6 consider in collaboration with your institutional experts but give early
9. IL-6 consider in collaboration with your institutional experts but give early
10. Late steroids seem to have increase superinfection with bacteria in vented patients
11. Not all COVID is the same
12. Extubate aggressively and Post-extubation care is key to survival outside ICU
13. Need to have a plan for follow up (telehealth?)
11. Not all COVID is the same
12. Extubate aggressively and Post-extubation care is key to survival outside ICU
13. Need to have a plan for follow up (telehealth?)
14. Thank you to all those that are working hard to save lives
15. We are in this together, I am thankful and inspired by those around me to be able to contribute in these times in a meaningful manner. 16. Be kind to yourself and others around you.
15. We are in this together, I am thankful and inspired by those around me to be able to contribute in these times in a meaningful manner. 16. Be kind to yourself and others around you.
Please do not intubate otherwise asymptomatic patients with a sat of 88%! Positive pressure can exacerbate inflammation and has its complications. #COVIDー19 intubation has to be a planned clinical decision. When possible discussion with patient and family key. Prone while awake!
