WesElyMD Profile picture
Sep 8, 2020 8 tweets 10 min read
1/ Women in Critical Care:

👍 Just recorded #ISICEM roundtable w @frubulotta @ElisabethWaele @FlaviaSepsis & Dr. Juffermans. 🎥 🍿 on Sept 16th.

Let’s eliminate prejudice based on gender, sexual pref & color. Here is a Baker’s Dozen of Women ICU Leaders!

#heforshe #medtwitter Image
2/ The first woman leader in Critical Care I discussed was Dr. Christina Jones from UK. She is a Biochemist, Nurse, Masters Social Work, PhD in Psychotherapy.

👊Mother of ICU Support Groups & ICU Diaries. As an expert, she shaped our field!

#sccm #esicm #pulmcc #ICUrehap Image
3/ 2nd world leader in Crit Care presented was Dr. Deborah Cook, from McMaster Univ in Canada. Seminal trials in Ulcer Proph, Bioethics, CCCTG trials, and now edifying us about how to provide healing in the dying process through her 3-Wishes Project.
#endoflife #palliativecare Image
4/ We get no where in the ICU without great #NURSES & #PhysicalTherapy. Powerful leadership in Crit Care from Polly Bailey + Vicki Spuhler (1st mobility CCM paper) & Chris Perme + @HeidiEngel4 PT gurus!

#A2Fbundle #icurehab ImageImage
5/ I wanted to focus also on #PharmD leadership. Two great examples are Dr. Judi Jacobi (past SCCM president) & Dr. Stollings @JoannaCCPharmD (two NEJM papers in 1 year – MIND-USA & SMART trial). Walking encyclopedias of knowledge & so vital to safety & great care.

#pharmicu Image
6/ And let’s not forget Social Workers, who save the day time & time again for our ICU pts & families. Kelly McCutcheon Adams is an icon - she led IHI’s sedation & early mobility collaboratives for thousands of ICU teams over 6 years all across the US. Game changer!

#socialwork Image
7/ #Mentoring women in Critical Care is such a gift. See my CIBS Center gifted mentees

(clockwise top left 1st)
Dr. @doctorShawniqua - CC Neurology & EEG
Dr. @JoEllenWilson- CC Psychiatry Delirium & Catatonia
Dr. @DrMariu – CC Geriatrics
Amy Kiehl – Psych Outcomes
#togetherwecan Image
8/fin - Women in Critical Care:

👀 Our #ISICEM roundtable also discussed removing #bias from #medicine by deliberate inclusion of women & POC at all levels - authorship, academic leadership, pay, balance in home roles, & safety for front line women! ⚡️

#heforshe #medtwitter

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More from @WesElyMD

Sep 13
1/🧵 Land Mines in Long COVID - @BostonGlobe

Alex was training for 2024 Olympic Trials 🥇

That dream exploded 💣
 
New #LongCOVID science
📌Viral reservoirs at 1 year
📌Cardiac edema at 1 year
📌Dementia at 2 years
📌Hijacked mitochondria

ScreenShot👇
bit.ly/3U77u4r
2/ It’s one thing to concede that Long COVID exists as a societal problem for those w vulnerabilities like advanced age, pre-existing health conditions, or nearly dying in ICU.

What about nationally ranked D-1 long-distance runners⁉️

Paywall so read 🧵
bit.ly/3U77u4r
3/ Alex Schell is 21 & based his life decisions on making the 2024 Olympic trials.
 
“Not only can I not run due to #LongCOVID, I’ve also lost everything I hoped for. Who I envisioned myself to be is a past idea. It’s a monumental loss.” (story w perm)
 
What causes LongCOVID?
Read 22 tweets
Sep 12
1/🧵🎥 How do “Dominoes of life” fall in critical illness⁉️

A pt arrives awake & talking but vomiting. In just 8 hrs he nearly dies of sepsis 🤯

Lung & kidney failure, heart attack, coma.

How can this happen & can we save him?

This🧵can help us understand the “arc of illness”
2/ His disease is Ascending Cholangitis

A gall stone lands in his common bile duct

📍Pain & vomiting
📍He’s admitted to the ICU
📍GI performs an ERCP to place a stent, bypass the stone, drain pus & control the source of sepsis
📍Add fluids & antibiotics
📍But he gets worse
Why?
3/ We bypassed the septic source (stone) & drain the pus, but dominoes were already falling.

Bacteria had gotten into his blood.

Too much inflammation & capillary blood clotting occurred, just like in COVID.

What happens when “cellular” dominoes start to fall uncontrollably?
Read 11 tweets
Sep 6
1/🧵 Beauty in the Now…

While normally Greg doesn’t #worry, in this case, he succumbed to fear of change.

He was screaming and Crying in Fear - see tweet below.

How did he get through it?
What did he teach me?

#NothingDownAboutIt #DownRightPerfect #UpSyndrome #Tribe321
2/ Greg held his head in his hands and trembled with worry.

We were disrupting his usual Saturday of watching “I Love Lucy.”

Think Rain Man type of dependence on routine &
that’s Greg.

So when Kim and I took him to the mountains, it totally messed him up.

What happened?

#T21
3/ At first Greg got angry with us for taking him on this trip.

I mean, REALLY angry.

And we know that #ANGER is just one letter away from #DANGER.

He was heading in a dangerous path of rejecting something that could be healing & good in his life.

#TheLuckyFew #FindYourTribe
Read 7 tweets
Aug 30
1/🧵 Paxlovid in Omicron⁉️
 
🔸Large study of 4k treated pts vs. 105k not on Pax
🔸Robust 80% ⬇️ in death prevention in elderly
🔸Hospitalization 70% lower if >65 y/o
🔸No help in young?

Why will I keep using in young & old patients?

Read next tweet…
 
bit.ly/3PRbbId
2/ This retrospective observational cohort in @NEJM only showed statistical benefit in patients 65 & older.

Does that mean Paxlovid does not work in the young during #omicron times?

I don’t think so.

Here are reasons why I will keep using the drug in young patients as well…
3/ Subgroup analysis of studies are mainly meant for hypothesis generation.

Usually in clinical trials there are not qualitative differences in how a medication works by age cut off.

There can be, but it’s unusual.

Original Paxlovid data showed efficacy across age.
Read 5 tweets
Aug 25
1/🧵 The Haunting Brain Science of Long COVID 🧠

@washingtonpost Aug 25

📍Brain shrinking
📍Corona ghosts
📍Autoimmunity
📍Clinical clusters

“The good news is that in some pts #LongCovid #BrainFog may not be permanent.”

Link👇 but paywall so see 🧵

wapo.st/3wvPBlF
2/ Mild Covid is biologically dangerous long after initial viral infection.

81 mild COVID pts:

Study revealed:
✔️Astrocytes (🧠 support cells for neurons) get infected
✔️Neurotransmitters are altered
✔️Neurons die indirectly
✔️Then we lose brain power

bit.ly/3pcqbFV
3/ Epidemiology💥

Long COVID is tightening its grip on society.
 
We’re still losing >600 people a day to death from COVID in US alone

Over 100,000 new infections per day (Johns Hopkins data).
 
This is an epic global 🌍#PublicHealth catastrophe.

wb.md/3SKjGrh
Read 28 tweets
Aug 22
1/🧵Mild Traumatic Brain Injury (TBI) isn’t “Mild” 🧠
 
Our daughter fell off a high diving board headfirst to cement years ago. Though she had 2 cracks through her foramen magnum, her GCS was 15 & CT had no bleeding.
 
“She’s OK,” they said.
 
Wrong answer 😔

#TrackTBI Data…
2/ Mild TBI isn’t mild at all. Lives & entire families are uprooted.
 
Over half of these N=991 patients with GCS of 15 & negative head CT scan reported incomplete recovery at 6 months.
 
90% w incomplete recovery were unable to return to preinjury life.
 
bit.ly/3pxd4ze
3/ Medicine & Trauma are only now waking up to the realities of this “invisible” yet devastating injury.
 
I’d been trained in all modern #CriticalCare & you’d think I would know better.

But I didn’t.
 
bit.ly/3R0enCt
Read 4 tweets

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