1/ Home w my 84 y/o Mom for 1st time since 2019 because of #COVID19…She raised 3 of us alone on $17k/yr as a lit teacher after dad left. A few things she’s said that are hilarious...
2/ Today we saw an classmate from my grade school & Mom didn’t remember her.
Mom: “So I guess that’s why you didn’t hang out with her much.”
😳 Zing!
3/ Mom thinking 🤔 ...“Wes, remember when I got us a tent to take you kids camping? I had you set it up in the backyard to make sure we knew how. Then I thought, ‘Hmm, this is good...why don’t you 3 just live out here from now on!’”
4/ Mom and talked a bit about Christmas’s last. “Wes, remember how sad you were when Santa didn’t bring the submarine you asked for? I took you to a hardware store to buy WOOD 🪵🤷♂️ to make your own. You sure did sink fast in the bayou, but you outswam the gators!”
True story!!
5/fin
I love ❤️ my mom. She’s rough and tumble. As a teacher she directed the Shakespeare in town & her students went on to write good books (& dedicate them to her!), design rockets, and become University Deans. Many still come by monthly! Not shabby. Go, Mom.
Such wit from my #Mom!! Makes me think about other #parents who raised docs...at 84 she’s still #sassy ...LOL we me @ what she sez
thank Heavens she didn’t get #Covid19 and her 🧠 didn’t get stilted by #LongCovid. Keep vaxing!
1/ Do data support pt trial off sedation for “SAT” when pt is comfortable on current dose? Yes
Shared w permission:
“Dr. Ely, yesterday our ICU #nurses went over #A2Fbundle in Epic for implementation. Do you recommend SAT at RASS Goal of RASS -1 to +1? #medtwitter#criticalcare
“We are currently not doing SAT (Spontaneous Awakening Trial) but keeping pt’s RASS -1 to +1. Just want to make sure we are interpreting #A2Fbundle correctly.”
Great questions. I don’t think +1 (anxiety) is ever a good goal but 0 to -1 is a 👍 default target RASS if we acknowledge there are times when sedation target should acceptably be set as deep as -3/-4 in bad #ARDS or -5 transiently when pt requires paralytics.
Be patient in science. 25 yrs ago, I & others felt we were harming ICU patients by deep sedation & immobility. Our goal: PROVE IT & change culture in #criticalcare.
There weren’t tools 😤Reluctantly, I had to go “backwards” to validate CAM-ICU & RASS (@JAMA_current X3). A DECADE later we produced studies lightening sedation (MENDS/ABC trials JAMA/@TheLancet). Be patient!
Give yourself space to be creative! Science takes time & Data must lead you. All our 1st grants & papers were rejected for 5 YEARS. NIH said: #Delirium in ICU is not a viable topic or a “thing.” Go away. Persistence paid off for patient safety.
Personal Share: As a 1st year #MedStudent 35 years ago (#MardiGras 1986), I was a cyclic, binge-drinker. It threatened my future as a physician & my personal safety. I draw on these experiences with pts.
2/ For me, #recovery meant detaching from harmful zones of behavior. Years of ups & downs. I often share my story w patients when it comes up. I find this builds a powerful connection between us and helps us both. #healing
....will be seen in #COVID – Why? Massive use of Propofol. While Green Urine is Benign, effects of prolonged over-sedation & immobilization ++ #DELIRIUM are not 😤 Wake them up & get out of bed. Start w/SAT…#A2Fbundle & #PICS
1/ re: SATs to avoid over-sedation in #COVID19 pts, Thx @phanton_icu for Protocol Blindness caution & @Nitkjain reminder “Easier said than done.” I’ve been pondering your comments all day & think them ripe for further conversation on #A2Fbundle
2/ Remember, protocols like #A2Fbundle are guides & not “1-shoe-fits-all pts.” Correct, we must deviate when needed. However, these 6 principles (ABCDEF) are derived from 35 NEJM, JAMA, Lancet papers +400 others & now >25,000 pts of data. Not chump change. bit.ly/2JwVA4E
Trigger alert 🚨: Hard to stomach but this hits so hard I want to face it. Segregation of Blood🩸by color of skin went on until 1972 & the “1-drop rule” persisted until 1983 in my home state of LA. 😩 👀 labels.
I pledge to fight #racism & lift each person.
1/ Dr. Charles Drew, an African-American surgeon & father of blood banking, perfected techniques that saved countless lives. Yet he was prohibited from donating blood himself over “fear” of his black blood. Read #2 w/ ✍🏻 bit.ly/2IRvJDW #MedTwitter#MedStudentTwitter
2/ Dr. Drew ✍🏻 this letter of protest because he wasn’t being allowed to🩸: “I think the Army made a grievous mistake, a stupid error in first issuing an order to the effect that blood for the Army should not be received from Negroes. My 3 reasons are...”
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.
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