WesElyMD Profile picture
Feb 1 4 tweets 2 min read
Simulation in ICU - #Empathy👇

A doctor volunteer trying to understand what it’s like to be tied down & sedated.

More & more we must dive down into what we do to others to understand their experiences

To improve our care…#A2Fbundle
Asking:

“What is causing their agitation? How can you respond to it? Do they have contraindications to mobility? How do you start?”
She @DaytonICU gives complex scenarios & walks us through the process of asking, “What is their RASS? Why are we concerned about delirium? What are their risk factors for ICUAW? Why are we concerned about ICUAW? Do they have an indication for sedation?”

“Now what do you do⁉️”
If you are an ICU team that needs a change - to improve and get better…get excited about this approach to actively learn…to understand what you’re working towards and then it isn’t a laborious task…love this!! Call @DaytonICU today & start helping catalyze “better” care

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with WesElyMD

WesElyMD Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @WesElyMD

Jan 30
1/🧵COVID Re-Infection⚠️

Let’s learn
🔹Re-infection is a worry
🔹⬆️ plasma Nucleocapsid (N) Antigen levels predict outcomes
🔹If you get COVID, the best predictor of ⬇️ N-Ag levels (ie, viral replication) is having Spike Ab
🔹You get S-Ab by Vaxx

Read on
bit.ly/3Ha8q2g
2/ These data (N=2540) come from ACTIV-3 study of adults hospitalized for COVID in 114 centers in 10 countries Aug 2020-Nov 2021
 
I’m going back over this because there are so many people walking around without adequate protection due to waning immunity over time.
3/ N-Antigen levels (which we don’t measure in practice) are a measure of viral replication & predict outcomes

Plasma N-Antigen levels are highly associated w Antibody (Ab) status

⬆️ anti-S (spike) Antibodies at time of COVID infection predicts ⬇️ virus & safety

How so?
Read 7 tweets
Jan 17
1/🧵 Real-World Long COVID
 
🔹She got COVID Oct 2020
🔹59 y/o walked 5mi 4x /wk
w no prior cognitive problems
 
🔹“I got better but 4 mo later my memory faded. I struggled.
🔹HR came after me, ‘You can’t do your job.’”
 
Husband: “I want my wife back!”

(Pics & story w perm)
2/ Could her new #dementia be unrelated to COVID?

Maybe, but…
 
Her excellent neurologist feels her negative work-up, young age, speed of demise, temporal onset in relation to COVID all fit LongCOVID-related brain dysfunction & not a pattern of Alzheimers.
 
They want to share
3/ Husband through tears: “I want my wife back.”
 
Her Description – “I walk down the hall & see pictures of family & trips. I feel like a ghost because I don’t remember. My husband cries because I seem gone to him.”
 
“I’m trying to figure out who Barbara 2.0 is going to be.”
Read 10 tweets
Jan 16
1/🧵COVID & Death: #JAMA
 
📍N=1,846 pneumonia patients w versus w/out COVID
📍COVID didn’t “invent” a new lung disease
📍We freaked out saying vents needed to be so different
📍Docs erred as we deviated from our evidence-based

Why should YOU care?
 
bit.ly/3QIp2Tl
2/ COVID is a very long pneumonia process, but we exacerbated it…

This graph shows that Death occurs similarly, but COVID #death takes longer (10 vs. 7 days).

Time to discharge alive is twice as long (10 vs. 5 days) in COVID vs non-COVID pneumonia.

We caused a lot of this 😞
3/ Let’s breaks outcomes down by O2 levels…
 
At 90 days, death rates were same in COVID & non-COVID pneumonia for patients w moderate & severe low O2 levels

COVID was NOT a predictor of more death or liberation from the vent or hospital (after matching & multivariable models)
Read 8 tweets
Jan 6
1/🧵Risk Factors for Long COVID❓
 
📌7k COVID+ healthcare workers followed in clinic
📌Data show being more vaxxed (3 or 4 shots) & <2 COVID infections were both predictive of better recovery at 1 mo
📌But there are limitations

Here are my critiques…
 
bit.ly/3VPt0ul ImageImage
2/ Definitions
Cases: +COVID test & symptoms c/w CDC definition at 1mo N=1.9k (27%)

Controls: +COVID test & resolution at 1mo N=5.1k (73%)
 
Of those w symptoms at 30 dys, 51% had 3 or more👇

IMO the @WHO 90 dy cut-off is more specific & meaningful for #LongCOVID Image
3/Logistic regression found 2+ COVID infxns ⬆️ risk of #LongCOVID by 27% & 3 or 4 vax shots ⬇️ risk.
 
I don’t like CDC’s 30 day definition but these data are c/w other studies showing “less infection & more antibodies” are both protective.

CDC vs WHO
bit.ly/3QiinPq
Read 4 tweets
Jan 5
1/🧵 Fake Science is BIG Business💰💰

What’s a “paper mill?

📍>500 “fake science” papers are being retracted
📍“Paper Mills” create made-up papers, trick peer review
📍People pay for authorship to boost academic credentials

Let me explain

bit.ly/3WXnhDx
2/ In this example👇…

manipulated peer-review was proven & >500 papers are being pulled! 🤯

H/T Neuroscientist @Schrag_Matthew explained:

“It's a bad look for Wiley!”

Investigators found irregular reviewer activity & ‘bad actors’ across publications

bit.ly/3WXnhDx
3/ As a Physician-Scientist at the bedside, it’s maddening & saddening to see people succumb to #misinformation

And then make choices that allow them to fall into severe life-threatening COVID and land in my ICU.

nyti.ms/3VHospA
Read 9 tweets
Jan 3
1/🧵 Our cell’s genes are rewired in MILD COVID 🧬
 
Stunning data in @Nature
 
White Cells (monocytes) switch gene expression from an established innate immune profile to a pro-clotting signature in COVID.
 
We’re immunocompromised.

Let’s unpack this…
 
go.nature.com/3GeDygW Image
2/ These data explain how the COVID virus places our bodies at risk for macro (large) blood clots in acute dz (which we see often), brain disease due to down-stream micro-clotting, and possibly later cardiovascular dz.
 
What did these London investigators find? ImageImage
3/ Taking blood from 2 UK SARS CoV2 studies…

📍They compared COVID🩸(N=62 mild/mod dz) to normal controls
📍Then conducted genetic, metabolic & functional assays
👀 Look how different gene expression was (color difference) in COVID vs. HC (healthy control) pts
 
What’s it mean? ImageImage
Read 8 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us on Twitter!

:(