Thread by @WesElyMD

1/🧵ROADMAP: What should you know before someone you ❤️ lands in the ICU? @TheDailyBeast
 
I whittle down IMPORTANT PEARLS & pro-tips about how to approach acute #COVID19 and non-COVID care to avoid life-changing disabilities later.
👇

bit.ly/3oRVZRt

2/ #COVID pts return home after cutting-edge medical care but many survivors are now living with massive & likely life-long disabilities that include dementia, PTSD, depression & major weakness from muscle and nerve disease. #PICS #LongCOVID

https://twitter.com/WesElyMD/status/1414467258781519872?s=20

3/ These two entities, #LongCOVID and #PICS, have many overlapping forms of suffering that must be acknowledged by healthcare professionals and loved one for survivors to feel validated & heard. People throughout society in all our communities will benefit.

4/ 40-60 million people will be admitted to an ICU in the US alone in the next 10 years. Nearly everyone knows someone who’s been in #CriticalCare w #COVID19. Like it or not, YOU will also likely end up there yourself (avg 1-2 ICU admissions per person over a lifetime).

5/ How do you ⬆️ likelihood of full recovery?

Knowledge is power. We have LOADS of data from many thousands of pts, but unfortunately, #COVID caused known/proven practices to be discarded. If you go in armed, you can advocate for best care.

wapo.st/3oRQPEV

6/ Over the past 25 yrs, we in #criticalcare learned that some standard treatment protocols—including sedating & immobilizing patients while on ventilators for days & weeks—caused patients long-term harm even while bringing them back from the brink of death. We have options.

7/ ADVOCACY - If you are sitting next to a family member on life support, introduce yourself to the medical team as they “round.” Let them know you would like to be involved & inquire (when you see the opportunity) as to how closely the team plans to follow the #A2Fbundle.

8/ The 6-step #A2Fbundle provides structure & guidance for you during a chaotic time & will help your loved one receive the best treatment. Here is what you can expect from this well-validated checklist…

bit.ly/2YuoRlC

9/ A - ASSESS & treat pain. Your goal is not only to keep your family member out of pain but also to minimize risks posed by overuse of dangerous meds. Doctors & nurses err on the side of giving too much & while sometimes wise, it can be detrimental.

bit.ly/2YCToAc

10/ B – BOTH an attempt to remove sedatives & ventilator. Leaving either on too long causes #delirium. Tests called the SAT & SBT must be used daily to see when it’s safe, but believe it or not, during COVID we found they weren’t being used often at all.

bit.ly/3iRhNc7

11/ C - CHOOSE sedatives wisely & avoid certain dangerous meds like benzodiazepines whenever possible. Research clearly shows that use of benzos as a sedative is associated with brain dysfunction. Shorter acting meds are often safer.

bit.ly/3mPDTgm

12/ D - DELIRIUM management. Delirium triples the risk of death at 6 mo and is a predictor of newly acquired dementia months & years later. Be with your loved one at the bedside, interact, talk, & tell stories to help lessen delirium. More…

bit.ly/3lwXa6P

13/ D – DR. DRE…Make sure there’s a way to tell day from night by adjusting light & noise levels accordingly (and turn that TV off at night!). Provide eyeglasses, hearing aids, dentures. Remind him that he is a person with a life beyond the ICU.

14/ E - EARLY mobilization out of bed with encouragement from nurses + physical & occupational therapists. It’s important for you to ask when it will be safe to try getting her/him out of bed & walking even while on the ventilator.
 
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15/ E – EARLY…Getting active again, as early as possible on the ventilator, will lessen muscle wasting, decrease delirium, and allow your loved one to be involved in her/his own care. This is much more likely to happen if you push for it.

Watch 🎥s here:
bit.ly/2YF64G2

16/ F - FAMILY involvement in medical rounds. Remember that information flows both ways between you & the medical team. They can care better for your family member if they know who she/he is & what matters in terms of life goals & spiritual values.

bit.ly/2X0QBjc

17/ Family is crucial. Carolyn Rogers, a COVID-19 survivor, told me one day she was so desperate for human touch & connection that she sobbed to her nurse, “Please lower your mask just for a moment. I have to see a human smile, or I can’t go on any longer.”

17/ We learned from 15,000 pts that ⬆️ #A2Fbundle compliance = more lives saved. But it only works when you use it. We want ✈️ pilots to adhere to flight safety checklists when we travel from LA to New York, right? This is no different.

bit.ly/2YI1Z3S

18/ An ICU stay is a fraught time for patients & families. It may seem impossible to involve yourself in your own or a loved one’s medical care.

IT’S NOT.

Becoming an active participant in key decisions during #CriticaiIllness can stave off silent but deadly new disabilities.

19/ We need YOU to be part of OUR medical team to remind us that every patient is more than a beating heart or breathing lungs to be saved. This patient is a whole person—your person—whose mind, body, and spirit are at stake.

@ZDoggMD: bit.ly/3mEx2pM

20/fin
Your insistence in pushing us to combine humanity & compassion can be lifesaving. Your advocacy at the bedside is a stalwart force toward avoiding unintentional harm & accelerating both the patient’s & family’s long-term healing & recovery.

bit.ly/3iNJtP1