WesElyMD Profile picture
4 Oct, 6 tweets, 4 min read
1/ When I play the #criticalcare movie 🎥 of me as an intern or resident back in my head, I see myself as much too robotic 🤖 with my patients, as if plugging in kitchen appliances.

#medtwitter #meded #tipsfornewdocs #medstudenttwitter #nurse #pulmcc #COVID19
2/ The nurse would slip a Foley catheter up his urethra into his bladder. I’d go to the stockroom to get all the materials to slide a plastic endotracheal tube down his trachea to become command-central for his breathing on the ventilator.
3/ Next, I’d methodically place a Swan-Ganz catheter by serial insertion of a needle first, then a wire through the needle, next a dilator over the wire, and finally the catheter itself down into his great vessels and heart. And start the ‘pressors.
4/ “Fix the kidneys! Fix the lungs! Fix the heart!” These commands occupied all my thoughts & actions. Only many days into an ICU stay, when she was comfortably off the ventilator, free & clear of imminent death, would I even begin to consider what might happen next in her life.
5/fin
My concept of the “back-end” of critical illness was that I only had the luxury of caring about a pt’s thinking & walking once things were at a snail’s pace after life support was removed. I must remember that #PICS begins on day 1 in the ICU.

#A2Fbundle #SCCM #medtwitter
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More from @WesElyMD

5 Oct
1/ #COVID19 Journal: New Yorker

Dr. @danielleofri has gifted us w/her #COVID journal. Her beautiful edifying ✍🏻 is a treat for your 🧠 and super instructive about #Pandemic.

👀Excerpt next tweets...

bit.ly/36vddL7

#medtwitter #TipsForNewDocs #tipsforolddocs #MedEd Image
2/ Dr. @danielleofri writes in NYer:

“On Friday, the magnolia tree next to the #covid tent bursts into riotous blossom despite the chilly weather. Until now, the flowers have been delicate cups of pink and lavender, spaced along the spindly gray branches...”

(She shared pic...) Image
3/ Dr. Ofri continues...

“Now they’ve abruptly reversed their concavity, spilling open into an unbroken blanket of defiant white.

Normally, the inner workings of the hospital are invisible to doctors and nurses. We show up every day and the patients are there, the beds...”
Read 6 tweets
30 Sep
1/ In #COVID19, we must learn from #BRAIN masters Engel & Romano, who described #DELIRIUM to #DEMENTIA relationship in the 1950s! Here are my TOP 10 CLASSIC quotes from their famous 1959 article:
bit.ly/2SePA1a
 
#medtwitter #meded #tipsfornewdocs #neurology #geriatrics Image
2/ The problem of delirium is far from an academic one. Not only does the presence of #delirium often complicate and render more difficult the treatment of a serious illness, but also it carries the serious possibility of permanent irreversible brain damage.
 
#dementia #COVID
3/ The deficiencies in the education of many physicians ill equip them to recognize any but the most flagrant examples of delirium.
 
#A2Fbundle #tipsforolddocs
Read 12 tweets
27 Sep
1/ There are clinically relevant differences between #COVID19 #Sepsis & typical bacterial sepsis, but they are Quantitative rather than Qualitative. That is, all clinicians have seen them before in other sepsis pts before this #virus 🦠 infected its 1st human.

#medtwitter #meded
2/ Quantitative septic findings are more commonly part of daily care for #COVID patients than we have been used eg, near total loss of the tracheobronchial tree’s muco-ciliary escalator due to destruction of ciliated respiratory epithelium.

#pulmcc #tipsfornewdocs #criticalcare
3/ Classically in #Influenza pneumonia/sepsis, this predisposes to subsequent superinfection from bacteria like Staph & Strep. In #COVID, we are always on the ready to begin antibiotics to cover such complications of what initially was a pure viral infection.

#medstudenttwitter
Read 8 tweets
13 Sep
1/ Vaccine Hope in #COVID19: JAMA

Mechanism & Facts -
After #COVID, only 1/3 have Ab w low spike Pr titers & viral neutralizing. Given variability in Dz severity, this is expected. Highest Ag burden & Ab titers seen in severe disease.

bit.ly/32lhQ87

#medtwitter #meded Image
2/ Vaccine Hope in #COVID19: JAMA

SARS-CoV-2–specific CD4+ and CD8+ memory T cells are also generated across asymptomatic to severe disease that express antiviral cytokines, control viral replication & should prevent recurrent severe infections.

#tipsfornewdocs #pulmcc Image
3/ Vaccine Hope in #COVID19: JAMA

Abs to #SARS-CoV-2 spike protein show there may be 10X more SARS-CoV-2 infections than reported cases (=40-50 million or 15% of US population) to date. 

#tipsforolddocs #criticalcare
Read 4 tweets
9 Sep
1/ Women in #CriticalCare: #Anesthesia/CC

Four EXPERT MD mentees in our CIBS Center (clockwise top left): Heidi Smith (R01 funded for Mini-MENDS), @kimberlyrengel (studies prehabilitation), @christinahayhu2 (pain after ICU) & Tina Boncyk (FAER awardee).
 
#medtwitter #heforshe Image
2/ Women in #CriticalCare: Biostatistics

“Stats-magicians” bring truth from darkness to light at CIBS Center. Our EXPERT is Dr. Rameela Raman (e.g. MIND-USA NEJM). Dr. Ayumi Shintani & @jent103 did stats for CAM-ICU, MENDS & ABC trials & BRAIN-ICU NEJM.

#biostats #epidemiology Image
3/ Women in #CriticalCare: #Surgery

Dr. @MinaFaye = bada$$ #surgeon runs CIBS weekly ICU Support Group w @CLG_PhD & 2 major studies: ISOLATE-ICU (COVID isolation on pts & families), RETURN III (VA Merit RCT of Cog-Rehab post ICU). All this & new mom of Milo James!

#heforshe Image
Read 5 tweets
8 Sep
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
Read 8 tweets

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