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1/ Today I was asked by #ATS forum: “Are antipsychotics ever indicated for #delirium in ICU patients?”

My reply: “YES, to control hyperactive delirium symptoms to avoid respiratory suppression...👀 example...

#MedTwitter #MedEd #MedStudentTwitter #pulmcc #TipsForNewDocs
2/ HYPERACTIVE DELIRIUM & antipsychotics

Answer cont: For example, in a patient with CHF or COPD who needs BIPAP to avoid intubation but has marginal BP and HR so perhaps can’t tolerate an alpha-2 agonist. In such patients, antipsychotics might be just the right medication...
3/ HYPERACTIVE DELIRIUM & antipsychotics

Answer cont...to help patient get over claustrophobia of CPAP mask. This approach is fine as long AS LONG AS we know we are NOT reducing delirium, rather converting positive sympt of anxiety/delirium into calm toleration of resp support.
4/fin HYPERACTIVE DELIRIUM & antipsychotics

For data see our NEJM MIND-USA trial: bit.ly/2AWg1TJ

Also read letter: bit.ly/3gJzGX4 where we answer this specifically to @MarkOldhamMD
Here are hyperactive & hypoactive #delirium subgroup figures from NEJM MIND-USA trial since others were asking. At the bottom is my conclusion slide including examples of when I still use antipsychotics in clinical practice and why.

#MedTwitter #TipsForNewDocs #pulmcc
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WesElyMD
@WesElyMD
@drdangayach 1/ ANSWERS: How to create your best ACADEMIC MEDICAL READING program? @drdangayach

Here’s what I have done >30 years…there are three types of reading: daily reading, journal reading, & book reading…stay tuned

#tipsfornewdocs #medtwitter #medicalstudenttwitter #pulmcc #meded
@drdangayach 2/ Why care to read scientific literature more effectively & thoroughly? Applied knowledge at the bedside is how you “speak” for your patient – maximizing her dignity & respect. Reducing suffering through knowledge is mercy. The eyes are your lamp, use them to read and shine!
@drdangayach 3/ I got depressed as a young MD when I saw docs’ journals piling up in plastic wrappers, unread. I vowed never to let that happen because my patients deserve better. So bought into Osler’s mantra to “set reading habits early & you’ll be set for life.”
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WesElyMD
@WesElyMD
Encephalopathy vs Delirium 🧠: 1/11

#COVID19 has profoundly amped this malady for millions...

ICU Doc asked: “Wes, what’s the difference between delirium & encephalopathy?” I chuckled, “Got an hour?” & distilled it down in 2 min.

#medtwitter #pulmcc #meded #tipsfornewdocs
Encephalopathy vs Delirium: 2/

20 years ago we started publishing our ICU Delirium papers. The biggy was in JAMA after being rejected by NEJM’s main Neurologist Reviewer because “we used the term delirium & not encephalopathy.”

So this confusion is STILL going on…
Encephalopathy vs Delirium: 3/

To help with this nomenclature problem, Arjen Slooter led us & we published this 2020 delphi study and paper endorsed by 10 med societies.

Intens Care Med:
bit.ly/3eLODWJ

#medtwitter #medstudenttwitter #pulmcc #tipsfornewdocs
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WesElyMD
@WesElyMD
The ERROR: @stevenspohn TY immensely for exposing #COVID19 Michael Hickson interaction. Hospital released letters, internet blew up 💣 & ethicists commented. Read👂learn. I wasn’t there but audio reveals cardinal error: DOCTOR ASSUMED HE KNEW QOL. I’m guilty too #medtwitter 1/
The ERROR: Hickson’s medical details are not known to me, but we can ALL RECEIVE CALIBRATION:

Projecting our desired QOL onto another is a grave mistake. We have to ASK & LISTEN to know if pts “QOL-gap” is narrow or wide. 2/

#Palliativecare 101: bit.ly/38t5aNY
The grave ERROR Michael Hickson’s Doctor made was not understanding the QOL-GAP. Data from 1984 Oncology literature first revealed it: bit.ly/3iygpJu. NARROW GAP = good. Adaptable.

I am guilty & wrote 📝 about it in Pulse Voices true story: bit.ly/3f3AFAG

3/
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