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grepmeded's profile
GrepMed
GrepMed
GrepMed
@grepmeded

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GrepMed

@grepmeded

Image Based Medical Reference: Sharing crowd-sourced checklists, algorithms, decision aids, #PhysicalExam #POCUS, and more - by @GeraldMDMD + @k00bideh

Sacramento, CA
grepmed.com
Joined March 2018

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    1. Nick Mark MD‏Verified account @nickmmark Apr 25
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      I’m excited to share a project I’ve been working on to facilitate #helmet interface non-invasive ventilation for people with respiratory failure due to #COVID19. This thread is a brief #tweetorial on helmet interface ventilation. 1/

      4 replies 22 retweets 66 likes
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    2. Nick Mark MD‏Verified account @nickmmark Apr 25
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      Projections show that in a severe/continuing pandemic, the # of people requiring MV may exceed available vents. It’s not just the vents but a shortage of medications used to keep pts comfortable on the vent and personnel who know how to safely use them. https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30315-7/fulltext … 2/pic.twitter.com/2DMombPlrk

      2 replies 4 retweets 9 likes
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    3. Nick Mark MD‏Verified account @nickmmark Apr 25
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      So what can be done? One thought is to build more vents, but that’s easier said than done: vents are complex, highly regulated devices. Despite lots of enthusiasm it's not easy/quick to ramp up vent production. It also doesn't fix medication shortages. https://www.npr.org/2020/03/31/824886286/episode-987-the-race-to-make-ventilators … 3/

      2 replies 4 retweets 10 likes
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    4. Nick Mark MD‏Verified account @nickmmark Apr 25
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      Not only are ventilators resource intensive, but patients with #COVID19 who are sick enough to require invasive ventilation often do poorly. This is more a correlation w/ disease severity rather caused by IMV per se. That said, what if we could avoid intubating COVID pts? 4/

      3 replies 4 retweets 9 likes
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    5. Nick Mark MD‏Verified account @nickmmark Apr 25
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      Several studies (and meta-analyses) have shown that in patients with hypoxemic respiratory failure we can avoid intubation by using non-invasive positive pressure ventilation (NIPPV). This can also potentially reduce ICU mortality. ➡️https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6297344/ … 5/pic.twitter.com/Rkwch20EJh

      1 reply 6 retweets 11 likes
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    6. Nick Mark MD‏Verified account @nickmmark Apr 25
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      We also know NIPPV works for coronavirus: In the 2004 SARS outbreak, one group used NIPPV to avoid intubation in 70% of cases (n=14) and pts treated with NIPPV had shorter ICU LOS (3.1 vs 21.3 days). Importantly, none of the 105 HCWs exposed got SARS.➡️https://journal.chestnet.org/article/S0012-3692(15)31228-9/pdf … 6/pic.twitter.com/yyfbQLqUxM

      1 reply 4 retweets 14 likes
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    7. Nick Mark MD‏Verified account @nickmmark Apr 25
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      Unfortunately, there are two big challenges to using #NIPPV in patients with ARDS due to #COVID. 1. Many patients don’t tolerate wearing a tight-fitting mask for days & 2. Air leak around the mask may aerosolize a significant amount of virus, potentially placing HCWs at risk 7/

      2 replies 7 retweets 18 likes
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    8. Nick Mark MD‏Verified account @nickmmark Apr 25
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      This is where helmet ventilation comes in. Instead of a tight fitting face mask think Apollo astronaut. The helmet interface forms a transparent bubble around the patient’s head and forms a tight seal w/ valves around the collar. This is more comfortable and better tolerated. 8/pic.twitter.com/wQYiy59Rsd

      4 replies 12 retweets 38 likes
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    9. Kim Gale‏ @KimGZebra Apr 25
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      Replying to @nickmmark

      Are they also less expensive? What r the chances we can get this Med equipment if it’s more cost effective & better for the patient in most cases...

      1 reply 0 retweets 1 like
      GrepMed‏ @grepmeded Apr 25
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      Replying to @KimGZebra @nickmmark

      < $200 or less than 1/100 the cost of a ventilatorhttps://www.nbcnews.com/news/amp/ncna1173466?__twitter_impression=true …

      7:45 PM - 25 Apr 2020
      0 replies 0 retweets 0 likes

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