WesElyMD Profile picture
Nov 8 3 tweets 3 min read
1/🧵 Imagine Delirium…#COVID or not…

“Her mind tottered & slithered again, broke from its foundation & spun like a cast wheel in a ditch…She sank through deeps & deeps of darkness…

Katherine A. Porter, “Pale Horse, Pale Rider” on her delirium in 1918 Spanish flu pandemic
2/ Until she lay like a stone at the bottom of life…a stench of corruption filled her nostrils…she opened
her eyes & saw pale light through a coarse cloth
over her face, knew the smell of death was in her
body & struggled to lift her hand.”

Spare your patient. How?
#A2Fbundle
3/fin
This investigation of 13 studies found that earlier mobilization of ICU patients reduced the risk of #delirium by 47% and by nearly 2 days in total duration.

To do this we must stop sedation & have patients safely able to participate in walking.

bit.ly/3gTYvVk

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More from @WesElyMD

Nov 9
1/🧵 Update on Long COVID Prevention‼️

Do meds & vaccines ⬇️ #LongCOVID risk?

1st meet @pamelarbishop, a scientist in forced early retirement due to LC:

“I oscillate between fierce determination to get better & abject horror at the daily destruction of my body."

read on…
2/ A case-control study of 9k unhospitalized COVID pts treated w Paxlovid btwn March & June 2022 versus 47k patients w no antiviral or antibody treatment.

All >= 1 risk factor for hospitalization.

The results are surprising if you think about it.

Why?
bit.ly/3WKmo1V Image
3/ It’s NOT a randomized trial, so we don’t know why people did or didn’t get Paxlovid.

In practice, we givemeds more aggressively (or want them ourselves) if we’re sicker.

So you might think those who didn’t take Pax would be less sick & do better. That’s not what was found… Image
Read 19 tweets
Oct 26
1/🧵 Haldol for ICU patients⁉️

📌 Not so fast
📌 Study of N=1000 backs-up our MIND-USA study - full 🧵👇
📌 Haldol doesn’t treat #delirium
📌 Calms pts & can ⬇️ danger
📌 Delirium care is about non-pharm approaches - the Dr. DRE…

bit.ly/3sz27Pe
2/ Dr. DRE = non-pharmacological approaches to #delirium reduction. Hint - it’s Not about adding drugs.

📍Disease remediation
📍Drug Removal
📍Environment (eye glasses, hearing aids, sleep, light, mobilization)
3/ In this thread👇 I unpack our previously published 2018 placebo controlled randomized trial of typical and atypical antipsychotics.

The MIND-USA study & today’s new ACT-ICU RCT are complementary & should make us unsatisfied w ✍🏻 antipsychotics to treat delirium.
Read 6 tweets
Oct 24
1/🧵 Should Doctors be involved in Lethal Injection?

📍We take an oath to heal
📍Yet Prisons hire Docs to end life
📍I wrote this Op-Ed to challenge the system
📍I’d love your thoughts

(next tweet has a screenshot to bypass paywall)

@GovBillLee

bit.ly/3eZdX1Q
2/ There is a pervasive myth that #lethalinjection is a medical procedure, but this couldn’t be more wrong.

This was a falsehood created by someone with no scientific training.

Suffocation…imagine you’re suffocating…feeling like you’re being buried alive…

@SteveCooperEsq
3/ The force you’d exert to breathe would suck water into air sacks of your lungs.

This is what’s seen at autopsy in the lungs of 77% of prisoners after execution by lethal injection.

Pulmonary Edema. Drowning in water.

bit.ly/3SA2BPj
Read 16 tweets
Oct 20
1/🧵What do ICU survivors tell me about PICS…(post intensive care syndrome)⁉️

Former ICU patient: “I’m angry. I’m furious because the doctors who injured me aren’t willing to help me recover.”

Is this fair?

I think so.

Why?

Read on…(perm to share)
2/ I just got off the phone w a patient who has had PICS for 12 years since nearly dying in the ICU. His story is included in #EDDB…he granted permission to share some thoughts today that I think are eye opening…in terms of how poorly we’re doing w Chronic Disease management
3/ people who never had PTSD before critical illness, leave with inexplicable experiences of road rage, rejecting their spouse, acting in ways that are so foreign to them that they don’t recognize themselves.

They also have tremendous problems with lack of self worth because…
Read 7 tweets
Sep 13
1/🧵 Land Mines in Long COVID - @BostonGlobe

Alex was training for 2024 Olympic Trials 🥇

That dream exploded 💣
 
New #LongCOVID science
📌Viral reservoirs at 1 year
📌Cardiac edema at 1 year
📌Dementia at 2 years
📌Hijacked mitochondria

ScreenShot👇
bit.ly/3U77u4r
2/ It’s one thing to concede that Long COVID exists as a societal problem for those w vulnerabilities like advanced age, pre-existing health conditions, or nearly dying in ICU.

What about nationally ranked D-1 long-distance runners⁉️

Paywall so read 🧵
bit.ly/3U77u4r
3/ Alex Schell is 21 & based his life decisions on making the 2024 Olympic trials.
 
“Not only can I not run due to #LongCOVID, I’ve also lost everything I hoped for. Who I envisioned myself to be is a past idea. It’s a monumental loss.” (story w perm)
 
What causes LongCOVID?
Read 22 tweets
Sep 12
1/🧵🎥 How do “Dominoes of life” fall in critical illness⁉️

A pt arrives awake & talking but vomiting. In just 8 hrs he nearly dies of sepsis 🤯

Lung & kidney failure, heart attack, coma.

How can this happen & can we save him?

This🧵can help us understand the “arc of illness”
2/ His disease is Ascending Cholangitis

A gall stone lands in his common bile duct

📍Pain & vomiting
📍He’s admitted to the ICU
📍GI performs an ERCP to place a stent, bypass the stone, drain pus & control the source of sepsis
📍Add fluids & antibiotics
📍But he gets worse
Why?
3/ We bypassed the septic source (stone) & drain the pus, but dominoes were already falling.

Bacteria had gotten into his blood.

Too much inflammation & capillary blood clotting occurred, just like in COVID.

What happens when “cellular” dominoes start to fall uncontrollably?
Read 11 tweets

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