1/🧵#Covid19 is a disease of blood vessels that can affect your lungs, heart, brain, or any organ. Blood clotting sucks life from vital organs. This pt asked to have her story shared so that others may learn & seek #Vaccination. COVID caused blockage of blood to her arms & legs.
2/ During her acute illness, you can see that she had wounds that resembled BURN injury. It took #nurses many hours each day to change her wounds. I am being especially careful here only to show you images that are bandaged to avoid traumatizing anyone.
3/ (trigger warning on image)
As the illness progressed, it became clear that she was going to live, and we were all thrilled. Still, it was sad to think that this young woman would lose her hands and feet as they continued to dry up, lifeless and still.
4/ Over time, it became safe to undergo her amputations, and here she is w a loving @VUMChealth#nurse in the hospital courtyard the following week. Her desire for life became a huge inspiration to all of us. I gained way more from her than she ever gained from me.
4/ A very generous group of UK innovators from @KoalaaCommunity prosthetics made her a set of hands with her sisters and kids names on them to motivate her during recovery (first names shown with permission). This gave her great hope!
5/ Here you can see her during rehabilitation just after she finished doing some amazing planks. Even with healing wounds, she was doing 2 minutes of planking – such is her physical and mental strength!
6/ Her life is forever changed. Look at the bag of >12 medicines she takes every day. This is the reality of what can happen to a very young & totally healthy person. She said, “Please, Doctor Wes, share my story to help others get the #Vaccine. That’s 1 purpose of this 🧵.
7/Another purpose of this 🧵 is to help us all remember that life goes on no matter how hard the curve balls are that we are thrown. There is hope for tomorrow. Love of her kids and sisters is driving her onward. #Healing ❤️🩹
8/ We have become incredibly close friends. I call her my daughter, and she calls me a new dad (who won’t give her advice!). She is a treasure beyond measure for me. I don’t deserve her in my life, but I’m totally thankful she accepts me.
9/ During her long stay, I got the idea to #vaccinate people who consent before they leave the hospital. Here they revisit values & enter a major teachable moment. EVERY patient encounter is an opportunity to protect someone.
10/ Among other hospitalized patients who have gotten #vaccinated in the ICU (for free of course), some of the most interesting requests have come from inpatients who are #pregnant. Soon-to-be moms realize they want protection for their baby and themselves. 👍
11/ When a healing #Covid pt who still on ECMO said she didn’t want to get it again, we knew the best way to ensure she didn’t was to offer her the #vaccine - hands down the best protection. After 4.6 BILLION vaccines given, the safety profile is FABULOUS.
12/ VERY few drugs have such a great safety profile. #COVID patients want to get #Vaccinated and many have asked you to reconsider. 4 out of 5 people in the world still need protection. Do your part & share her story & its message of hope. Make her courage to share worth it!
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2/ Asterixis indicates that toxins like ammonia have built up in the body because the scarred liver no longer filters them out. The brain cells no long function normally (#Delirium or Hepatic #Encephalopathy) & can no longer control muscle movements like posture!
3/ These same toxin cause vessels to dilate and develop problems with blood flow in the skin and lungs. A skin finding is called “spiders.” They look like a multi-legged spider, right? It’s a tip-off.
2/ The difference between R0 of 3 and 6 is massive. With original COVID, 1 person infects 3 who infects 3 more. After 2 rounds, cases would rise by nine (3 x 3 = 9). After 3 rounds, cases rise by 27 (3 x 3 x 3 = 27)…
3/ But with delta, 1 person infects 6, who each infect 6 more people. So after 2 rounds, there are 36 (6 x 6 = 36) and after 3 it surges to 216 (6 x 6 x 6 = 216).
1/🧵 Why have #COVID19 hospital admissions skyrocketed? 🗣
The virus’s spike protein acts like VELCRO in our airway. #DeltaVariant has modified the #SpikeProtein to make it SUPER-VELCRO. When exposed, you’re way more apt to get infected.
2/ “In a completely unmitigated environment—where no one is vaccinated or wearing masks—the average person infected with original coronavirus will infect 2.5 others. In the same environment, #Delta infects >4 other people & grows more quickly.”
3/ Additionally, once the infection takes root in you (most often a person NOT #vaccinated), it has modified itself to increase viral shedding 1000X (ie, 1,000 virions for every 1 that was shed with original SARS-CoV-2.
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.
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.
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…
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…