Next up for me: Changing Landscape of Prone Positioning with @sqsimp @GallodeMoraesMD @md_ritwick and Dr. Bosch.

Follow this thread 🧵 for pearls from this session.

#CHEST2021 #CHESTtrainees Abbreviations:
PP = Prone Positioning
APP = Awake Prone Positioning
ARDS = You know it!
ARF = Acute Resp Failre

So then, let's learn!

#CHEST2021

Attending "Approach to Management of Pulmonary Infections in Immunocompromised Patients", LIVE right now on the #CHEST2021 platform, a thread🧵 . @kriscrothers: Diagnostic evaluation in patients with HIV include (pic 1)
* Historical elements
* CD4 count
* Chest imaging pattern

Know you infectious and non-infectious processes that can happen with decreasing CD4 counts (see pic 2)

#CHEST2021

Live-tweeting #PardonTheInterruption with @davidschulman

1. Will Bender
2. Bennett Deboisblanc
3. Ronald Goldenberg

Some punches are being thrown already ..

Somehow we brought up national chocolate cupcake day, whut? :-p

#CHEST2021 Topic: Role of Remdesivir for COVID-19:
WB: No data to support, even @WHO doesn't support it.
BD: Cost for quality low. Mortality benefit from best MA shows mortality benefit.
RG: No way, we don't do that up north! Maybe there is dec LOS, hell no on mortality.
#CHEST2021

There's a lot to take in on the #CHEST2021 platform, but don't forget to check out the e-posters. I want to highlight a few that caught my attention!

Pic 1: Aerobic exercise improves #Asthma phenotype in severe asthma
Pic2: Positive correlation b/w ONSD and ICH volume #POCUS1st Silvestri & co:
** Remimazolam safe & effective to achieve moderate sedation for flex bronch
** Faster sedation onset & recovery vs. placebo w/ rescue vs. open-label midazolam
** Ready for discharge sooner

#CHESTIP #Bronchoscopy #CHEST2021

Done with the talks for today at #CHEST2021 .. Now to the opening session. So nice to see leaders sharing gratitude and giving thanks. It’s the small things that matter! @CHESTPrez .@CHESTPrez acknowledges massive amount of work performed diligently by the #COVID19 task force and the @accpchest staff who led this virtual pivot with aplomb.
#on a personal note I’m so proud of my friends @GallodeMoraesMD @drdangayach for the presidential citation

#CHEST2021

Live at 1400 ET: chestmeeting2021.junolive.co/live/mainstage…

"Airway management in the era of severe pneumonia" with #CHESTairways experts from the Airway Domain Task Force.

Will live tweet this talk on this #CHEST2021 thread.

Speakers:
@Chaeface @KDoerschug @J_Mendelson_MD and yours truly! Let's get started with WHY our session is important:
🔥 Appx. 10% emergent intubations may result in failed airway
🔥 It's not just anatomical challenges, but physiological ones that have to be considered, esp with severe pneumonia
🔥 Lessons from the pandemic

#CHEST2021

Spoke to three close friends today. Just checking in on them since they are working at hotspots.

Here are direct quotes from those very people working >16 hours a day battling #COVID19

“I am suffering panic attacks.”

Think about that
Let me share with you why “Coworkers are falling sick left & right. Every night as I lie in bed away from my fiancé, I think about falling sick, getting intubated & dying”

“What will my parents do”

“I can’t get over the fear in my fathers voice. I tell him I have #PPE, fact is he knows, and I know too.”

Everyone is busy at this time. Want to provide a summary of the @SCCM guidelines on #COVID19. Summary in tweets and details in accompanying pics.

Summary: We are dealing with viral ARDS albeit with it's own quirks. PPE, clean hands, standard high quality ARDS mgmt

#COVID19 Re: Infection control, diagnostics:
- Respirators for aerosol gen procedures + PPE
- Usual care: Surg masks + PPE
- bronchs, NIV: Highest risk for aerosolization
- Intubation by most exp provider
- In intubated pts, obtain lower resp samples over NP/OB swabs

#COVID19

.@ammo_uw is kicking off the Educator’s Development PG course at #CHEST2019 with Mark Lavercombe (ML), @pkritek and @williamkellymd .. follow this thread for #CHESTMedEd updates from this day long session! Also engaging us today will be Dr. Lisa Moore. Here are all the sessions for all you clinical educators at #CHEST2019 #CHESTMedEd

Saw a patient in clinic today who I’ve not been able to provide answers to on why she’s feeling the symptoms she is feeling. I reviewed her complete history, we went over numerous aspects of her symptoms, how she gets on despite them, her life .. 1/ Performed a complete review of her chart, including a through review of other specialists’ and PCP notes going as far back as possible; together, with her .. 2/

#Tweetorial: Diagnosis of Malignant Pleural Effusion (#MPE) to accompany publication in @AnnalsATS: bit.ly/2XM65pD

⚓️#MPE: Pl. Effusions (#pleff) w/ neoplastic cells/tissue
⚓️Paramalignant eff: related to malignancy but not due to it eg: endobronchial obstruction or PE Answer me this dear folks!
Why is it important to diagnose #MPE?

While you ponder, LUNG and BREAST are commonest primaries metastatic to the pleural space! PMID: 24360987

I'm not a big #tweetorial person, more a #bitesized learning guy.
But important topic + healthy peer pressure =
Let's talk about #Delirium in the ICU (#DICU)!
For the most part, this is applicable to most patients.

Q: Do you regularly assess for #DICU? What does delirium look like?
<5% "hyperactive": EASY TO JUDGE these pts
95%: "hypoactive" or mixed: somnolent, not accepting feeds, withdrawn:
EASY TO MISS these pts

What's the big deal?
Vent time 🔼 8d
Hosp LOS 🔼 by 8d
Cognitive impairment at D/C: 50%, long term: 33%

@hskulkarni @NitinSeam @KaminskiMed @Twitter We could do the following to make #BATS (Best of @atscommunity Tweetorial series) a reality:
1. Participants do a tweetorial (5-15 threaded tweets) or many at their convenience over a time period.
2. They submit links to their tweetorials (2 per participant max) to ATS 1/ @hskulkarni @NitinSeam @KaminskiMed @Twitter @atscommunity 3. A committee judges them using a pre determined template (originality, relevance, use of enhancements such as links pictures and polls), engagement (RTs likes and comments) etc
4. Top 5 participants are invited for a final round where they have to do a three part challenge 2/