WesElyMD Profile picture
8 Oct, 7 tweets, 6 min read
1/ ICU #diaries for Good #Death:
Especially at EOL, ICU #Diary is part of #A2Fbundle. My pt w/ home-hospice told me details recorded in #ICU by #nurse allowed her to decipher cryptic #delirium memories she was struggling with.


#medtwitter #meded
2/ Then she told me of hours spent reading big-hearted comments others had written in her ICU diary, making her realize how much her life meant to others. It was a priceless gift to her at a critical juncture in what had a time of deep poverty in her life. #PalliativeCare
3/ ICU Diaries give family members at bedside a practical way of helping w/ loved one’s care & can help channel their worries in a focused way.
#criticalcare #pulmcc
4/ ICU diaries help the medical staff in unanticipated ways. I have found the very act of taking a moment to write in my patients’ ICU diaries always results in a better personal connection with them. I find out things about pts I didn’t know.
#tipsfornewdocs #medstudenttwitter
5/ For example, a diary entry above one I made was from the pt’s old friend who thanked her for the time her winning run in a high school softball game earned them a title as state champs. That event gave the friend confidence to do more with her life at a critical juncture.
When she awoke, I asked my pt about her championship game. She perked up in a way I’d not seen & we made a much better connection. The diary opened a world between us. I became more empathic in our time together & a better #physician

#empathy #healing #love
re: Tweetorial on ICU Diaries...

Unroll please @threadreaderapp

• • •

Missing some Tweet in this thread? You can try to force a refresh

Keep Current with WesElyMD

WesElyMD Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!


Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

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...


#medtwitter #TipsForNewDocs #tipsforolddocs #MedEd
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...)
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
4 Oct
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.
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:
#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.

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.


#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

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!