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5 Aug, 5 tweets, 5 min read
1/🧵 You are a BAD #GOLFER & have a big day with buddies & are in the tall grass a LOT. Later, you take off a #tick👇and in 7 days develop a fever & headache. You have no rash. The emergency room gives you acetaminophen. Is that OK?
 
#medtwitter #Nurse
2/ Tick bites are a big deal in Summer months. Rocky Mountain Spotted Fever is a concern, and the absence of rash also brings up #Ehrlichiosis. This @NEJM paper showed that worse golfers retrieved balls from the rough & got the dz more often!
 
bit.ly/3e6vQrF
3/ Of those with #Ehrlichiosis, 20% get bad nervous system dz & 20% of those die. If you live in Southern US and find a Lone Star tick (pic above), and then develop fever & headache, get evaluated and probably start the antibiotic doxycycline quickly!
 
bit.ly/3e5ndxF
4/ Another complication of this dz can be a very complex problem called #HLH (spelling in article below). In addition to Doxy, then you’d also need steroids. We see this every year. Pancytopenia & super high ferritin levels. BOLO!
 
bit.ly/3hVwWrw
5/fin
Summer can be fun but be careful out there. Do not take #ticks lightly. If you get sick and don’t know why, time is of the essence. It might NOT be #COVID. Get checked out, please.

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More from @WesElyMD

WesElyMD Profile picture
6 Aug
1/🧵🎥 Leading #COVID19 ICU Doctor @DavidJanz5 in New Orleans, the epicenter of U.S. #DeltaVariant surge, testified before US Senate Committee on Health, Education & Labor. Here is what he said: “Studies of #FrontLine workers caring for COVID-19 patients have shown…👇
2/ that the risk for the development of #mentalhealth problems (#PTSD #Depression) are like 9/11 Terrorist Attacks & Hurricane Katrina. Recent research shows that over 1 in 3 healthcare workers are experiencing anxiety, depression & post-traumatic stress disorder. Image
3/ Symptoms of #burnout are experienced by over half of critical care physicians. This is the state of the workforce asked to return to the #COVID19 #frontlines for a second, third, and now fourth wave.
Read 9 tweets
WesElyMD Profile picture
5 Aug
1/🧵Fluids in sepsis: When a patient’s blood pressure is too low and they are in shock, as happens all the time with #COVID19 viral #sepsis, we give fluids. This @bmj_latest figure👇makes a bit of sense of where the fluid goes. Let me unpack a bit more…

bit.ly/3lvrL50
2/ 👇 @bmj_latest
We talk about 2 categories of fluids: Crystalloids & Colloids. For crystalloids think “thin fluid like salt water with sugar.” For colloid think “thick fluid with lots of protein like albumin.” The figure shows that crystalloids leak out of the blood vessels…
3/ while colloid stays in the blood vessels. But there are several other important teaching points beyond what the figure shows.
✅ If a person has a lot of edema, as we see in heart, kidney & liver failure, colloids pull fluid into our vessels & ⬆️ blood volume to end shock…
Read 8 tweets
WesElyMD Profile picture
5 Aug
1/🧵Disaster in my childhood home of Louisiana ➕Update on Mandatory #Vaccination:
 
Louisiana is leading U.S. in exploding new #COVID19. Hospitals overflowing & admitting young people. But the crisis is also driving some to get #vaccinated.

nyti.ms/2WZzHRP
2/ ICU Dr. Justin Fowlkes: “I feel LESS SAFE in public than I do in the hospital.”
 
Patti Hilbun, 65, was reluctant to get #Vaccinated. No more, as she's spent 2 weeks w #COVID. “I will be blatantly honest,” she said. “This is as real as smallpox & polio.”
3/ Mandatory #Vaccination is becoming a REAL:
 
✅ >400 colleges = on board!
✅ Tons of hospitals = on board!
✅ Federal employers = on board!
Read 5 tweets
WesElyMD Profile picture
3 Aug
1/🧵🎥 Former ICU Nurse with #LongCOVID👇 describes disabling #POTS (Postural Orthostatic Tachycardia Syndrome)
 
“I'm an Ivy League grad & former ICU nurse who got COVID a year ago (before #vaccination). I had no medical problems & now suffering Long COVID so badly…”
2/ …”that I can’t work in the ICU and basically have a desk job. POTS & Long COVID gave me a racing heart, dizzy head & inability to function adequately in life. It’s horrible. My brain fog makes it impossible to execute tasks to care for patients. Life as I knew it seems over.”
3/ …she said, “It irks me to hear people downplay this disease when I'm suffering this badly a year later. I’ve been vaccinated myself now. We are surging again. People are scared. Let’s talk this out & find a way out of the €%£! pandemic.”
Read 9 tweets
WesElyMD Profile picture
3 Aug
1/ How do Children Suffer after ICU?

Today the mom of a 4 y/o boy who is in 📚#EveryDeepDrawnBreath wrote me & said to share this pic (w his twin). The family’s story can help us understand life after #CriticalIllness:

“Dr. Wes, we are 2 years out & he’s got a new limp!”
WHY?
2/ Mom writes: “Many appointments later we have learned that either his septic shock, ECMO, or the strokes caused damage to his growth plates. His left leg & foot are shorter than his right leg & right foot.”

This feature of pediatric #PICS will also affect sick #COVID19 kids.
3/ She goes on… “The doc at the children's hospital who we see said any of these 3 conditions can cause this to happen and our son had all three (strokes, septic shock, ECMO).”
Read 9 tweets
WesElyMD Profile picture
2 Aug
1/🧵Moral Injury: #DeltaVariant surge & ICU beds shortages pose big risk
 
In my last week’s @WashingtonPost piece, I wrote, “Any health-care professional who has to make impossible ethical choices likely incurs MORAL INJURY.”

What is moral injury?

wapo.st/3l0gqJP
2/ This article tackles it: bit.ly/2Vp0Rka
It’s not burn-out, which is characterized by exhaustion, cynicism, and decreased productivity.
Moral injury occurs when we’re forced to make decisions that go against our deeply held beliefs.
3/ Moral injury was used in 2009 to describe Iraq soldiers’ responses to actions in war. It is “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.”
 
bit.ly/37aI3YJ
Read 7 tweets

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