Anna Boniface Profile picture
May 7, 2020 10 tweets 2 min read Read on X
#COVID reflections from ICU (THREAD) my experience & own views
💙 I have been blown away by the incredible human beings I’m working alongside - their compassion, ability to stay upbeat & calm doing tasks outside their comfort zone
⚙️MDT teamwork - everyone is an important cog working together. This is crucial & it’s been exceptional
🚩 Obesity, HTN & T2DM seems to be the a common trend of co-morbidities (I’m calling it the triple threat)
🌬Patients have ⬆️FiO2 requirements which fluctuate regularly
🎈Derecruitment often with repositioning = big ⬇️ SpO2 - preoxygenate & have dr nearby for vent recruitment is helpful. Once repositioned often need time to settle again (can be a 15 min nervous wait!)
🛌 Proning really works! but it’s an art. Lots of careful prep & communication is 🔑- nail the Cornish Pasty technique 🥟 with the sheets
🦠 Sputum - not a lot in the early stages but > later with traches
🚶🏼Early mobilisation is essential & needs to happen ASAP
👩🏻‍🦽ITUAW requires a long rehab journey - specialised services for BOTH #covid & non covid ICU pt’s needs to be established & appropriate follow up long are they are discharged from the acute setting
😷 Many issues will include breathlessness, exercise ⬇️ sats, BPD, atrophy, fatigue, loss of ROM, anxiety, PTSD, cognitive impairments, shoulder subluxation, ⬇️ ex tol, anxiety etc,etc,etc! These are complex issues & can result in long term disability & ⬇️ QoL
👍🏼 it’s exciting to see lots of ideas/discussion on looking after this cohort of pt’s, but I hope ALL critical care patients will be considered in this
🌈 patients are rehabbing, weaning off vents & being discharged with their #rehablegend badges 💙 there is lots of positivity!
👌🏼 Staff are being well looked after - peer support, wellbeing locations, generous donations & psychological help is all available (Thank You!)
*appropriate follow up long term after they are discharged from the acute setting #whycantyouedittweets

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More from @AnnaBoniface

Oct 3, 2020
COVID Reflections/moving forwards @TheACPRC course
My learning points 🤓
THREAD (long)⤵️
Huge thank you to all the speakers and for putting on a great webinar 🙏🏼
Looking forward to putting into practice with @RBH_ICU_Physio & @GoPerformUK
Intubation & Ventilation 🖥
- Different phenotypes = different results
- Tracheostomy in 14 days decreased ICU stay
- Physio important in ICU Mx - sputum/trache’s 💦
- 2nd wave showing reduced I&V patients 🌊
NHF
- reduces WOB, bronchospasm, helps AWC 💦
- Flow is key 🔑 10L/min = 1cm PEEP
- Prescribe FiO2 & Flow ranges 📈
- Start at 40% : 40L/ min
- Combo with proning
- AGP issues ? face mask 😷 with NHF but tolerance issues
- 5% wean at a time
Read 31 tweets
Jun 29, 2020
Following #therapylive with my webinar on RED-S & based on some follow up questions, I would like to sign post these resources for those who would like to learn more 🤓(THREAD) ⤵️
@nickyKfitness blog
⭐️What’s so good about menstrual cycles, inc info on contraceptive pill nickykeayfitness.com/2019/02/03/wha…
⭐️Masters Athletes x 3 blogs nickykeayfitness.com/category/athle…
⭐️ The Young Athlete & RED-S nickykeayfitness.com/2017/01/13/opt…
⭐️ General RED-S posts nickykeayfitness.com/category/sport…
@BJSM_BMJ IOC concsensus statement: beyond the female triad - relative energy deficiency in sport 2014 bjsm.bmj.com/content/48/7/4…

2018 update bjsm.bmj.com/content/52/11/…
Read 8 tweets
Apr 13, 2020
This week, I’ll be going back to ICU
The info on treating #COVID19 involves regularly & the amount of info out there can be overwhelming. I’ve found the following most helpful
🦠@BTSrespiratory guidelines on ARDS
🦠@atscommunity breathe easy podcast covering physio guidelines Image
😷Respiratory Physiotherapy in pt's with COVID-19 in the Acute Setting: Position Paper from the Association of Italian Physiotherapists
😷Critical Care Global Grand Rounds podcast on ARDS
😷 Respiratory Physiotherapy in pt's with COVID- 19: Clinical Practice Guidelines
Read 8 tweets
Dec 11, 2019
THREAD: Demonising food & promoting exercise as punishment, the message here is all wrong.
This will not help the obesity crisis
This promotes unhealthy relationships with food & exercise, triggering those vulnerable or going through eating disorders
bbc.com/news/health-50…
The model is oversimplified
Everyone’s age, gender, body composition, physical activity levels, health status will impact their energy expenditure
200 calories of one food will have very difference nutritional density to another “worth” 200 calories
Instead of wasting money in worthless labelling of food but instead invest money in education on healthy relationships with food & exercise
Read 5 tweets
Nov 2, 2019
Strength work for endurance athletes
🏃🏽‍♂️Improved running economy
📈Improved lactate threshold
😴Delay/reduced fatigue
🏋🏽‍♂️Increase peak power output ⚡️Increased anaerobic capacity
💨Improved maximal speed
🔥Improved peak force (Ronnestad & Mujika, 2014)
*Learning cleans 😳
I always find compound lifts are best when it comes down to “bang for your buck” by hitting multiple muscles at once (movement > muscles)
Add some resistance doing 3-5RM for 3-5 sets, you can get some decent strength training done in a relatively short session
2-3 x a week is plenty
Many endurance athletes struggle to fit this in, therefore getting their buy in to drop some junk miles for the gym is essential
Read 7 tweets
Oct 9, 2019
Brilliant listen on #asthma, #breathingpatterndisorders & #EILO in running from @DrJohnDickinson & @tinamuir
Key messages (see thread)
🏃🏽‍♂️Athletes have ⬆️ airway irritation due to mechanical shift to mouth breathing during exercise ⬇️ air humidification & filtration.... (cont)
🦠 Plus, they’re often exposed to environments which are more irritable to the airway, e.g running in cold weather, dry air, pollution, pollen etc
🔄 Airways can react by constricting, making it difficult to breath out, resulting in symptoms such as breathless, wheeze or cough
🗣 Asthma should not be diagnosed purely on subjective symptoms. An objective test e.g. spirometry needs to be completed
💊If well controlled, asthma symptoms should be well managed. Taking your preventive inhaler is essential for this (Inhaled corticosteroid)
Read 8 tweets

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