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Lakshman Swamy Profile picture
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21 Oct, 7 tweets, 3 min read
i mean, this is gonna be great. #CHEST2020
These cases are great, and the vent sim is really top notch. here is a takeaway slide re: elevated peak pressures #CHEST2020
Love this framework! #CHEST2020
Dropping MV can improve PCO2 because of avoiding alveolar hyper-inflation. Note the universal sign of hyper-inflation in the top right. #CHEST2020
"walk the circuit" to find leak #CHEST2020
Not totally sold on treating SILI, but I like the idea of putting a patient on a rate and seeing what the driving pressure is, getting a better sense of what is happening instead of just looking at the Vt #CHEST2020
'I look at it less about the pressure and more about maldistribution of volume across the lung' - Dr. MacIntyre on driving pressure & SILI #CHEST2020

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More from @laxswamy

Lakshman Swamy Profile picture
21 Oct
And you thought we were done talking about burnout!

WINTER IS COMING #CHEST2020 @niven_alex @md_ritwick @susan_corbridge and Curtis Sessler!
#COVID19 'reminded me a lot of my prior deployments as a military physician' - @niven_alex

This feels more accurate than the usual military analogies - deployed _as a clinician_ #CHEST2020
Dr. Sessler highlighting this important framework: An Official Critical Care Societies Collaborative Statement-Burnout Syndrome in Critical Care Health-care Professionals: A Call for Action #CHEST2020

(I've cited it 😉, you should read it!)

pubmed.ncbi.nlm.nih.gov/27396776/
Read 20 tweets
Lakshman Swamy Profile picture
21 Oct
Well, a crying child slowed me down, but better late than never. Excited to see @RanaAwdish @WesElyMD @hopealuko @BrendaPun

Rana: "Wanting the patients to be comforted and having almost nothing to do that except for the medications..." #COVID19 #chest2020
'are coma and deep sedation just markers of severe ARDS?'
@WesElyMD - absolutely NOT- they are independent!
#chest2020 #COVID19
Oooh. @hopealuko - we should be careful about what is 'severe' or 'mild' #COVID19 -- listen to patients! #CHEST2020
Read 19 tweets
Lakshman Swamy Profile picture
21 Oct
Now hearing from @sameepsehgal9 on VTE in #COVID19

Wide variation in incidence of VTE in COVID-ICU patients. Meta-analysis in middle -- about 30% #CHEST2020
'at least in sick ICU patients, the incidence of thrombosis in #COVID19 is probably higher than other diseases like influenza' @sameepsehgal9 #chest2020
Who clots and who doesn't with #COVID19? @sameepsehgal9 synthesizes the literature. Not too surprising overall. #chest2020
Read 14 tweets
Lakshman Swamy Profile picture
20 Oct
I'm now in "How to Identify Distressed Physician Colleagues and Stop Them From Dying by Suicide"

...will tweet any highlights. #CHEST2020
this is incredibly powerful. opening with a physician with a substance use disorder... this is intense

first highlight: he noticed the gross inequity evident to him in his work and it affected him

then, personal tragedy

then, opiates for pain #CHEST2020
now detailing how he lost his professional life, became actively suicidal... unbelievable

lost a colleague to suicide...

no one talks about this (except we do at #CHEST2020)
Read 21 tweets
Lakshman Swamy Profile picture
18 Aug
THREAD PART 2: DIAGNOSES/ COMPLICATIONS! Patient interpretations of ICU jargon @Saramerwin1 & I are writing for @CritCareGame- feedback welcome!
🔑Must be concise to fit on the cards
🔑Pt-centered clarity more important than accuracy
🔑ICU focused
Please share & comment!
Acute Myelogenous Leukemia/AML
“Blood Cancer”
Rapid growth of blood cells that don’t work properly in the bone marrow, crowding out healthy cells.

Is that clear for patients,@vsanchorawala @Jmarksloan @VincentRK @MikkaelSekeres
Meningitis
“Brain Infection”
Inflammation of the meninges (lining around the brain), often caused by an infection.
@doctorORbust @AllisonRBond
Read 30 tweets
Lakshman Swamy Profile picture
17 Aug
THREAD: Patient interpretations of ICU jargon that @Saramerwin1 & I are writing for @CritCareGame - would love your feedback!
🔑these have to be REALLY short to fit on the cards
🔑 pt-centered clarity is more important 💯 accuracy
🔑Setting: general ICU
Please share & comment!
Do Not Resuscitate
An order that prohibits CPR & restarting the heart when it stops beating. Often paired with Do Not Intubate (DNI), prohibiting the use of a breathing tube. Ordered after discussion with patient/family.
Sedation Vacation
For patients on the ventilator, we routinely stop sedatives (medications which keep the patient asleep) to allow patients to wake up and try to breathe on their own, getting them off of life support faster.
Read 47 tweets

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