1/🧵#SEPSIS is URGENT. Here it was caught way too late! Sepsis is marked by WBCs (White Blood Cells) either too high OR too low. If someone’s WBC drops from 14k to 6k to 3k WITHOUT antibiotics, that’s a total catastrophe & usually means death is closing in.👇

2/ So hypothetically (& I’m changing details to make this situation unrecognizable to the real patient my comment is based on)…if a month after a knee replacement someone comes in complaining of NEW knee pain and no fever…

#COVID19 #nursetwitter #TipsForNewDocs #nurse
3/ …with a WBC count of 14,000, scans & xrays not showing an abscess, an infected prosthetic joint is still my #1 Dx unless there is a completely obvious other cause of infection. Said another way, this is sepsis due to an infected knee until proven otherwise.
4/ This patient had a BP of 110/55 & Creatinine of 2.7 (no hx of kidney problems). That is an acutely failing kidney situation (called AKI – acute kidney injury) & it signals that the dominoes are starting to fall in this person’s body! They should NOT be admitted to the floor.
5/ This pt needs TWO things straight away – Source Control if possible (consider drainage of an abscess or removal of the prosthetic joint) and Antibiotics. Delay of either into double-digit hours is 💯 NOT OK.  It’s essentially an emergency & needs to be handled immediately.
6/ Waiting 12 hours to remove the source and get antibiotics is like knowing that a bridge has fallen into the river and allowing a train to keep going toward the river. It is going to crash into the water unless you remove the source and kill the bacteria.
7/ I am writing this so that families feel empowered to be a squeaky wheel about getting timely management of sepsis AND so that we in the medical profession don’t allow silos of communication to get in the way of best care.
8/ I’m recalling Eugene Stead’s call-to-arms for physicians entitled - What this patient needs is a doctor!

"No greater opportunity, responsibility, or obligation can fall to the lot of a human being than to become a physician…

read on👇

#TipsForNewDocs #MedStudentTwitter
9/ “In the core of the suffering, one needs technical skill, scientific knowledge, and human understanding. He/she who uses these with courage, with humility and with wisdom will provide a unique service for others and will build an enduring edifice of character…
“…The physician should ask of her/his destiny no more than this and should be content with no less."
Stead: What This Patient Needs Is a Doctor, ed GS Wagner, Durham, NC, Carolina Acad Press 1978.
@MedHumChat @MedBookClub1 @danielleofri @danielalamasmd @RanaAwdish

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More from @WesElyMD

7 Jun
1/🧵An Epiphany: #delirium treated w touch & eye contact, day by day...his mom cried, “He won’t let us help him shake this damned disease.” Finally his mind cleared. “What matters to you? How can I help?” Slowly, surely, he asked, “Doc, can you help me stop drinking?”💔
2/ #GroundZero. What a privilege it is to witness someone enter a long-awaited epiphany that opens the door to so much recovery. Unfortunately, in my early years as a doc, I thought, “Well, this isn’t critical care, so I’ll move on & let someone else take over.”

#shame on me
3/ But what is a doctor for?

1. To reduce human suffering & heal people where they are.
2. Plus the Latin root is “docere,” teacher.

It’s a dual vocation: healer + teacher. Because of the “Law of the Gift,” I know that the more I give, the more I receive, so…

Read 7 tweets
2 Jun
1/ 🧵Wisdom in Medicine
What’s going on here? And why it’s key in #COVID19
It’s quite simple: we finally had the #wisdom to ask Mr. D the right question! He and his wife encouraged us to use this picture to teach what we learned.
#PalliativeCare #MedTwitter #NurseTwitter
2/ What we learned was to switch the preposition!
Mr. D was a pre-#COVID patient. On this day, he was taken off the vent after a MONTH. The incessant mantra had been, “What’s the matter WITH Mr. D?” He was surprised when we asked, “What matters TO you, Mr. D?”
3/ He has a tracheostomy, as you can see. We insert this airway through the neck to improve #comfort when someone is on a vent well beyond 10 days. He’s more comfortable because he no longer has a tube in his mouth. We used a program called the #A2Fbundle to reduce his #delirium.
Read 13 tweets
1 Jun
1/🧵 AGEISM: Never be discouraged by age AND don’t judge others by age. Chronological age is a bogus constraint in life. I read today of some great examples of iconic people who did crazy cool things after 7 decades of life. See these & realize age is NOT a limitation...
2/ 👏 Major late-life #winners: 👏

#NelsonMandela, president of SA at 75 y/o
#Michelangelo started on St. Peter’s at 72
#GrandmaMoses folk artist sold her 1st painting at 90!
#ArthurMuir just scaled Mt Everest 🏔 at 75 (pic)
#JohnGlenn went into space at 77 y/o!
3/ Bonus 😀: German athlete Johanna Quaas at 86 y/o is the world’s oldest gymnast at age 86. She’s a retired P.E. teacher & started in this sport at age 56.

#NoLimits 🧠

Read 7 tweets
31 May
1/🧵The Nightmare of #COVID19 & #LongCOVID
Im a doctor who is now spending more & more time daily caring for #LongHaulers (pts w LongCOVID). I just got a TINY dose of what it must feel like to be unheard and unseen…AND I want to apologize to you.
#MedTwitter #NurseTwitter
2/ I just keep hearing you say, “Doc, why doesn’t anyone believe me? My friends look at me and think I’m fine, even as I feel further and further adrift. I’m not myself and I can’t tell if I ever will be again. #COVID has ruined my life.”
3/ Yesterday as my plan landed, my phone vibrated. It was the wife of a former ICU #COVID pt, now trached & living on a vent in an LTAC, asking how she can get his new docs to understand & carefully manage her husband’s ongoing #LongCOVID & Post-Intensive Care Syndrome (#PICS).
Read 13 tweets
26 May
1/🧵 Imagine 2 people, madly in love & married 28 years, in an impossible situation, both lives on the line & separated by different hospitals. Then imagine 2 sets of #nurses & #doctors separately determined to overcome ⛰ of obstacles…
(shared w perm)

#MedTwitter #NurseTwitter
2/ Last night this is what happened…

NOTE: the family wants to share their story to offer a glimpse of love ❤️ on all levels

For 3 years, Mark took care of Sharon, his #bride, as she battled breast #cancer. It relentlessly spread to her bones. He never stopped giving.
3/ She could tell he was spent and getting sick himself. “Mark, let’s get you to the doctor!” “Not until you are well, Sharon.” He remained laser focused on her every need. As she became weaker, he took her to get admitted yesterday.

#marriage #life #caregivers
Read 13 tweets
25 May
1/🧵 Lung Scarring in #COVID19 – what’s the deal?
I got a birds eye view of #LongCOVID yesterday from my patient who’s still on Oxygen at 8 months. WHY?

Let’s unpack what happens in the 🫁 and why it’s such a life-changing disease is for so many...
#MedTwitter #NurseTwitter
2/ 4-months after #COVID, this @JAMA_current study found 51% of N=478 pts had >=1 #LongCOVID symptom that wasn’t there before. 63% of those w CT scans had lung problems, with 1 in 5 showing scarring. What else?...
3/ This JAMA study also showed this important array of symptoms that essentially constitute #LongCOVID – 31% gross fatigue, 21% cognitive problems, and 23/18/7% anxiety, depression & PTSD. Their outsides look normal, but they aren’t!
Read 7 tweets

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