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

21 Jun
1/🧵How do we overcome #vaccination hesitancy?
 
#COVID19 ICU pts & #LongCOVID survivors tell me they wanted to get #Vaccinated but had immense pressure from family/friends NOT to…All but 1 said, “I should have protected myself & stayed safe.”

What’s our best approach? Read👇
2/ A significant portion of Skilled Nursing Facility (SNF) Staff remain #unvaccinated. Early data: bit.ly/3gOdSLi. Reasons include mistrust of govt & big pharma, potential side effects, and racism. Staff’s close contact w pts makes it essential to study their reasoning.
3/ N=193 staff from 63 Skilled Nursing Facilities (SNFs) were studied. The best way to overcome misinformation on #Vaccination from social media is to model specific scenarios & prepare positive approaches, NOT guilt or shaming. Let’s look at specifics…

bit.ly/2UmoOYX
Read 9 tweets
21 Jun
1/ Imatinib for #COVID19: @TheLancet

This study of N=385 ICU pts tested a Tyrosine-Kinase Inhibitor vs. Plac for 9 days. It’s important because it did NOT decrease ventilator or oxygen needs BUT reduced death at 28 days. What does this mean?

bit.ly/3gFJELG

#MedTwitter
2/ This study is technically “negative” because it didn’t hit the primary endpoint scientists “guessed” ahead of time as best choice to see if the drug works in #COVID: time to stopping ventilation & O2. Importantly, we sometimes GUESS WRONG! Next let’s look at other endpoints!
3/ This drug stops lung & blood vessel membranes from going haywire. It did not have safety problems & decreased DEATHS by ~50%, TIME on VENT by 5 days, length of ICU stay a WEEK, #delirium by 5%. These are huge improvements that I would want if I had #COVID. ( Fig 2, Tab 2/3)
Read 6 tweets
16 Jun
1/ 🎥🧵 How do we test someone for #delirium in #COVID19 or any ICU? When someone won’t engage it can be a huge red-flag for “quiet” delirium, which predicts 3X ⬆️ #DEATH by 6 mo & acquired #dementia. Watch this movie of me testing pt #1 for delirium.

#MedTwitter #NurseTwitter
2/ What does this mean? He starts out OK but then can’t follow my command to squeeze only on the letter A. Instead, he squeezes when I say the word “squeeze” & doesn’t relax his grip or vary it on different letters. This is inattention & a cardinal feature of #Delirium.
3/ 🎥 Contrast Pt 1 with this Pt 2 video of me doing the same test. This person had delirium on earlier days & is now improving. He gets 8/10 correct responses, which means he’s attentive and not delirious any more. This day he walked & talked for the 1st time!

#Recovery #nurse
Read 7 tweets
14 Jun
1/🧵 🎥
This week I met an extraordinary #COVID19 survivor who lost both hands, both feet & the tip of her tongue. @ccquad was featured on BBC as WINNER of the Queen’s MBE (Member of British Empire) award. Listen to her #Wisdom & teaching point on #Vaccination.

#LongCOVID
2/ @ccquad reached out to my #COVID patient, Autumn, who is now also losing her hands + feet & keeps asking me to share her story so all can learn. She went completely deaf as part of her viral sepsis & blood clotting. Her hearing is back & she’s getting koala prosthetics…🎥
3/ Watching these 2 powerful women meet and share their drive & passion is a major gift to me. They define #resilience. Rebooting life & finding the best way forward regardless of obstacles. Here is what Autumn told @ccquad… “I live freely. I live one day at a time…” Image
Read 6 tweets
14 Jun
1/🧵 I’d like to think as a medical community that we have changed & no longer discharge people w/out appropriate follow-up, but just last week I met a #COVID19 survivor who was discharged from the ICU simply to follow up w his primary care physician.

#LongCOVID #PICS #A2FBundle
2/ He couldn’t return to his job, was fired & had no income for his family. That resulted in him not having enough money for medications, gas, or bills. He missed his doctor’s appointment, his electricity was turned off, so he is unable to apply online for disability. 😤
3/ The cycle continues. I usually see these pts when they get septic again & end up back in my ICU on life support.
Read 4 tweets
7 Jun
1/🧵#SEPSIS is URGENT. Here it was caught way too late! Sepsis is marked by WBCs (White Blood Cells) either too high OR too low. If someone’s WBC drops from 14k to 6k to 3k WITHOUT antibiotics, that’s a total catastrophe & usually means death is closing in.👇

#MedTwitter
2/ So hypothetically (& I’m changing details to make this situation unrecognizable to the real patient my comment is based on)…if a month after a knee replacement someone comes in complaining of NEW knee pain and no fever…

#COVID19 #nursetwitter #TipsForNewDocs #nurse
3/ …with a WBC count of 14,000, scans & xrays not showing an abscess, an infected prosthetic joint is still my #1 Dx unless there is a completely obvious other cause of infection. Said another way, this is sepsis due to an infected knee until proven otherwise.
Read 10 tweets

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