An important piece by an excellent communicator laying out what it means when the NHS is 'overwhelmed'
@chrischirp

-first more difficult to provide care
-then standards of care reduce
-finally inability to provide even that care to some needing it

theguardian.com/commentisfree/…
Important to remember that pressure on NHS will last longer than high rates of mortality

As @chrischirp says if we reach the point where we cannot deliver care to some patients there need to be a plan

The @ICS has perhaps produced the best 'organisational overview'
ics.ac.uk/ICS/patient_an…
But we also need an operational bedside plan for care when demand exceeds capability to deliver it

This is the worst situation we can imagine

We have published a discussion document on how decisions might be made ethically and fairly
@chrischirp

jme.bmj.com/content/early/…
This is the correct link
bit.ly/ICSDeciGuide
Thanks @Ganesh_ICM

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More from @doctimcook

12 Jan
@nico111111 @rupert_pearse @JeremyFarrar An important piece by an excellent communicator laying out what it means when the NHS is 'overwhelmed'
@chrischirp

-first more difficult to provide care
-then standards of care reduce
-finally inability to provide even that care to some needing it

theguardian.com/commentisfree/…
Important to remember that pressure on NHS will last longer than high rates of mortality

As @chrischirp says if we reach the point where we cannot deliver care to some patients there need to be a plan

The @ICS has perhaps produced the best 'organisational overview'
ics.ac.uk/ICS/patient_an…
Read 4 tweets
22 Dec 20
Not sure altmetric is be-all & end-all but it looks like
the meta-analysis of ICU outcomes from COVID by
@drrichstrong @adk300 has just become @Anaes_Journal no. 1 using that metric
Quite a feat during a pandemic while doing your day jobs
Well done🎩

altmetric.com/details/849725…
1/n
The article is here - obviously free to all
…-publications.onlinelibrary.wiley.com/doi/10.1111/an…

Thanks @Anaes_Journal for publishing it and handling it so expertly and promptly, as usual

2/n
Unlike most papers this year it had a somewhat positive message showing how in-ICU mortality has fallen over the first months of the pandemic
- from around 60% in Jan-March
- to less than to 30% in May

An awful disease but one in which we have been making improvements

3/n Image
Read 8 tweets
21 Dec 20
Coughs make aerosols

It's long been time for ward staff to upgrade to FFP3 around coughing patients and those with COVID

The urgency for this is dramatically increased by the new variant virus

No one seems interested....

@TheLancet @bmj_latest @PHE_uk
It is very clear that anaesthetists & intensivists were at lower risk of infection and harm in 1st surge

There are several plausible reasons but until it can be shown that it is not because of better PPE surely ward based PPE needs to be revisited.

…-publications.onlinelibrary.wiley.com/doi/full/10.11…
HCWs at 3-4x higher risk of infection ImageImageImageImage
Read 8 tweets
22 Oct 20
Out in all its glory the Bristol Aerosol paper

Ready for tonight's debate
This study showing precious few aerosols generated at intubation
@Anaes_Journal @drjulesbrown @TonyPi314 @_andyshrimp

…-publications.onlinelibrary.wiley.com/doi/10.1111/an…
Lots of respiratory aerosols with a voluntary cough
Almost none during intubation sequence - anaesthesia/BMV/suction/intubation

Note the log scale
Read 9 tweets
6 Oct 20
@BJAJournals @Paul_Barach @AirwayHub @AirwayInfo @AirwayMxAcademy @Milenio This is an interesting take.
To be clear, every harm or death of a healthcare worker from COVID is a tragedy

However despite anaesthetists/intensivists proximity to the airway it's far from clear that this raises risk of death compared to other HCWs
…-publications.onlinelibrary.wiley.com/doi/10.1111/an…

1/n
@BJAJournals @Paul_Barach @AirwayHub @AirwayInfo @AirwayMxAcademy @Milenio Rather than emphasising increased risk the editorial by @emirakur with @DrSimonLennane highlighted the international evidence showing lower than expected mortality among anaesthetists/intensivists and our co-workers
…-publications.onlinelibrary.wiley.com/doi/full/10.11…

2/n
@BJAJournals @Paul_Barach @AirwayHub @AirwayInfo @AirwayMxAcademy @Milenio @emirakur @DrSimonLennane Three analyses of HCW deaths were published in the @HSJnews

They're all here
hsj.co.uk/tim-cook/30082…

The notable findings were
- a marked excess of deaths in non-white frontline staff
- the absence of impact on anaesthesia/ICM

3/n
Read 13 tweets
4 Oct 20
Important
At 0.7% this is about 3x the community rate
Depressingly familiar

Surge of Covid cases in London health workers sparks fear of spread on wards | Hospitals | The Guardian

amp.theguardian.com/society/2020/o…
We’ve seen it before ImageImage
While the balance between allowing access to hospitals & preventing unknown Covid infected patients in is a tough one - it needs to be addressed to protect patients and staff ImageImageImageImage
Read 7 tweets

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