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Salim R. Rezaie, MD

@srrezaie

9 Mar

@TessaRDavis

Great time chatting with @TessaRDavis @VenkBellamkonda @marco_propersi @M_Lin on productivity...here are some thoughts from me...

#MedEd #productivity

Email

-Focus on Task Zero NOT Inbox Zero
-Email for me falls into 4 categories:
1 Actionable item (>5min to accomplish)->Task manager
2 Junk->Delete
3 Reference->Evernote
4 Quick action (<5min to accomplish)->Answer right then

Goal isn't zero emails but zero tasks in ur email

Time Management

-Schedule things into your calendar
-Review your calendar the night before for next day
-Review your calendar Sunday night for upcoming week
-Make sure you schedule downtime for yourself

Read 8 tweets

Salim R. Rezaie, MD

@srrezaie

12 Oct 20

@ACOEP

COVID-19: An EBM Take Part 2 at #ACOEP20

-Anticoagulation
-Awake Proning
-Invasive Mechanical Ventilation
-ECMO
-Hydroxychloroquine

#FOAMed #FOAMcc @ACOEP

@ACOEP

Anticoagulation in #COVID19

-Admitted pts = weight based prophylaxis (unless contraindications)
-IMV = therapeutic anticoagulation
-Intermediate dosing has ZERO evidence base
-Thrombolysis --> Only if other indication (i.e. MI, PE, CVA)

#FOAMed #FOAMcc @ACOEP

@ACOEP

Awake Proning in #COVID19

-Will not work on everyone
-Longer duration is better than shorter duration
-Pts require frequent assessments as they can become prone and O2 dependent (DO NOT ADMIT to Regular Floor)

#FOAMed #FOAMcc @ACOEP

Read 6 tweets

Salim R. Rezaie, MD

@srrezaie

12 Oct 20

COVID-19: An EBM Take Part 1 at #ACOEP20

-When to Change Practice
-N95 Reuse
-Corticosteroids
-Remdesivir
-Convalescent Plasma

#FOAMed #FOAMcc

When to Change Practice

Expedited thirst for info & rapidity of pandemic lead to abbreviated peer review, publication of unvalidated data, retraction, and dissemination through press release

When to change = multidisciplinary discussion to set standard care at each institution

N95 Decontamination and Reuse

Make sure technique kills virus BUT doesn't affect filtration or fit
Best options: Vaporized H202, UV Light 260 - 285nm, or Time based strategy
2nd Best options: Autoclave 121C or Dry Heat 70C
Not an Option: 70% Ethanol

Read 7 tweets

Salim R. Rezaie, MD

@srrezaie

3 Apr 20

@DFarcy

Fascinating paper shared with me via @DFarcy Preliminary Observations on the Vent Management of ICU #COVID19

sfar.org/preliminary-ob…

COVID-19 ICU pts are NOT similar to ARDS pts. They have profound hypoxia with pulmonary compliance that is generally high

#COVID19FOAM

High-Pulmonary Compliance: Hypoxic vasoconstriction. Major issue is lung perfusion. Increasing PEEP and prone positioning are of minimal help with recruitment of collapsed lungs. In these patients high PEEP (>15cmH20) may compromise right cardiac filling

Oxygen Alone vs Ventilation: High FiO2 more important in the short run, other interventions (i.e. intubation) may be more harmful than buying time

Read 7 tweets

Salim R. Rezaie, MD

@srrezaie

17 Mar 20

Australian Safe Airway Society Consensus Statement of Airway Management and Tracheal Intubation in COVID19 Adult Patients – Preprint Only

bit.ly/3d4Ud77

#COVID19FOAM

Aerosol Generating Procedures

Suggested Contents of COVID-19 Intubation Tray

Read 10 tweets

Salim R. Rezaie, MD

@srrezaie

13 Mar 20

Airway management recs from Hong Kong on #COVID19

Aerosol generating procedures, such as NIV, HFNC, BMV, & intubation all high-risk

≥6L/min of O2 are considered high flow & use should be discouraged if airborne isolation room unavailable

ncbi.nlm.nih.gov/pubmed/32105633 #COVID19FOAM

In pts with suspected COVID-19, airborne precautions, hand hygiene, & donning of PPE is recommended

Double gloving, as standard practice might provide extra protection & minimize spreading via fomite contamination to surrounding equipment after intubation

Have a backup airway plan ready to go prior to intubation

Most skilled person at intubation should perform the procedure to minimize attempts

Read 6 tweets

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