Thread by @WesElyMD

1/🧵 Why is COVID hospitalization like 2X sticks of dynamite 🧨?
 
A thread on the ICU portion… #PICS + #LongCOVID.
 
Prevent this w 3 steps:
📌Avoid #COVID by Vax & Mask
📌Avoid severe COVID by Paxlovid & Monoclonal Ab
📌👇 read here about PICS & how to reduce injury in the ICU

2/ Here’s what you must know if you get too sick & land in an ICU.

History Lesson 📝
In the past, too many decisions in #CriticalCare were guided by fear. We oversedated patients for too long out of worry they might self-extubate & pull off restraints.

That’s happening again 🤮

3/ We kept patients immobilized due to an overly conservative approach to fall prevention that precluded us from attempting to walk them early. We kept families away from patients, treating loved ones as visitors rather than members of the healing plan.

That’s happening again.

4/ We sidestepped conversations about death in the ICU, designating it as a place for saving lives, and we avoided updating our culture of care because it was scary to embrace change.

That’s happening again.👎

#PalliativeCare

@pallipulm @AAHPM @ICUsteps

5/ It was especially frightening to admit that we were wrong in adopting a treatment approach that damaged many people’s lives.

For me, the only way to right this wrong is to improve the way we care for the world’s sickest patients in ICUs.

NOW.

@SGFesquire @carsueb
@SCCM

6/ In the unsettling era of COVID-19, trepidation is again a driver of unparalleled upheaval in the medical community.

Doctors and nurses, and all those working in health care, pour everything they have into caring for patients infected w #COVID.

@VinGuptaMD @atscommunity

7/ “The risk of PICS in patients we sedate too heavily & too long seems less dramatic & further away from our thoughts than the need to save their lives, so we give in to more immediate fears and keep people sedated.”
Dr. Beth Riviello, #EDDB p. 235

bit.ly/34PN0bC

8/ ICUs are now #PICS factories all over again & we have an burgeoning #publichealth crisis.

Every day of delirium increases risk of death by 10% and risk of dementia by ~35%.

This compounds #LongCOVID exponentially.

bit.ly/2LzT7ah

9/ My article👇 summarizes all this.

Compliance w ABCDEF Bundle safety steps (eg, waking up & walking patients) has plummeted to 10-20%.

We are re-implementing #A2Fbundle.
 
You are on the team. Speak up.

Here’s how you can #Advocate for your family:
bit.ly/3LETbzX

10/fin
“Humanity has but 3 great enemies- fever, famine & war. Of these, by far the greatest & most terrible is fever.” Osler 1896
 
The pandemic is #fever & when we add #fear to fever, it’s catastrophic.

So be #BRAVE…
📍#Vaxx to ⬇️ fever
📍Walk ICU patients w family to ⬇️ fear