WesElyMD Profile picture
29 Apr, 7 tweets, 4 min read
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...
4/ what drew me into critical care were the beeps and buzzers and interventions that saved lives. But what keeps me coming back is the intimacy at the bedside of both lives saved and lives improved by providing lifting and healing when cure is not possible.
5/ what’s so powerful about the #pandemic of #Covid is that all of us are focused on how to stop it and get out of this cycle of death. When I do that, it keeps my mind on the future, but as an ICU doctor, I must remain in the present moment With patients who need me right now.
6/ today we will take actions to save some lives of those infected w #SARSCoV2, but many actions we take won’t stop the virus from ultimately ending this person‘s life. That’s the reality. For all of those pts, I will stay 💯 in the moment.

#VaccinationCovid #vaxx #vaccination
7/ I will remember to stop and take a moment to consider the depth in the breath of who this person is. I will try to find out what matters to this person. I will ask about and honor any spiritual path this person has chosen. I will be merciful. It is my honor to serve him.

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More from @WesElyMD

28 Apr
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.
Read 4 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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