WesElyMD Profile picture
28 Apr, 4 tweets, 3 min read
Extra-Bad Blood🩸Vessel Dz in #COVID19:

1. Immunogenic HITT (heparin-ind thrombocytopenia & thrombosis) NOT from heparin but #Covid itself. Bilateral arterial clots.

2. TSS (toxic shock synd) + #COVID - nightmarish clotting in legs/arms = like burns

#MedTwitter #Nurse #Vaxx
1/ Since others asked, our diagnosis of “spontaneous immunogenic HITT” was made by positive HIT ELISA (an immunoassay) showing the presence of anti-PF4 IgG antibodies even though he had not been (past or present) on heparin. This in setting of #COVID19.
2/ He also had an abnormal functional assay of platelet-activating capacity of PF4/heparin-Ab complexes, though there are slight differences in results of his assay vs. typical HIT. He now has 2 problems (#COVID & HIT) causing potentially life-threatening arterial thrombosis.
3/fin
We treated him w bivalirudin and he will ultimately be on a DOAC. D-dimer & fibrinogen have been used in these situations to assess response to HIT-directed Tx, though there are no published guidelines on this.

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More from @WesElyMD

29 Apr
1/ End of Life in #COVID19...
yesterday I was removing life support from a patient, according to his wishes as stated by his wife, to convert the goals of care to comfort measures only. I took some time in the room alone with him & considered...
@pallipulm #palliativecare
2/ just for a moment all the very difficult & also excellent things that happened in my own life that no one else understood. Then I looked at my patient & realized he had just as many highs & lows that only he knew. Here was an infinite treasure of a person...
#MedTwitter #Nurse
3/ and the actions I was about to take would allow his life to come to a peaceful natural end. I committed to do everything I could for him to make sure he didn’t suffer as he sauntered out of life. What a privilege & honor to be allowed to enter into the miracle of him...
Read 7 tweets
19 Apr
1/ #Mentorship 🧵

This woman is my #mentor (pic w perm). Joan W Bennett. She’s in @theNASciences as geneticist & mycologist. Today we are at the Parthenon in Nashville TN where after 35 YEARS, she still provides me council…

bit.ly/3mWqDWN

#MedTwitter #Sciencetwitter
2/ Dr. Bennett taught me that mentorship is not a job w an endpoint. She assumed this role IN my life FOR life. Today we talked as much about parenting as science. We are in each other’s front row. This is the depth of a true mentor-mentee relationship.
 
#MedEd @theNAMedicine
3/ Like any relationship, there must be chemistry & connection. If you don’t have that w a “mentor,” maybe you have the wrong person. Build a relationship not a business arrangement. It’s also NOT just a trajectory to promotion. #Mentorship is “whole” person care & development.
Read 11 tweets
14 Mar
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
2/ Excellent #Nurse added:

“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.”
 
#TipsForNewDocs
#medstudenttwitter #COVID19 #pandemic
3/ my Answers:

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.
Read 8 tweets
11 Mar
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... Image
2/ Today we saw an classmate from my grade school & Mom didn’t remember her.

Me: “Mom, she’s really smart, wise, kind, & gentle of heart.”

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!’”
Read 6 tweets
24 Feb
1/ Scientific Discovery: time & patience
 
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.
 
How did we start?

#medtwitter #A2Fbundle #nursetwitter
2/ Scientific Discovery: takes time

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!

#academictwitter #ScienceTwitter
3/ Scientific Discovery: patience
 
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.
Read 5 tweets
16 Feb
1/ Tinkling of Ice: #Alcohol & Me
 
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.
 
#medtwitter #tipsfornewdocs #nurses
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
 
#medstudenttwitter #academictwitter #nursetwitter
3/ I needed to give up, fess up, make amends, and keep up. I stumbled along the way & am thankful to those who supported me & did not judge me.
 
#HOPE = Hang On, Peace Exists
 
#healing #workinprogress #addiction @ASAMorg @AlAnon_WSO @RyanForRecovery
Read 7 tweets

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