but he's only known one pt who got a hemorrhage after being put on heparin; his experience with COVID19 is that the patients tend to be very "clotty" and rarely do anticoagulants overshoot and make patients overly "bleedy".
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do we want to be giving anti-IL6 receptor antibodies to deal with cytokine storms? like tocilizumab.
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retrospective uncontrolled Chinese studies are showing clinical & even mortality benefit from tocilizumab, but as usual, wait for the RCT before jumping to conclusions. (they're enrolling now!)
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should we be worried about giving people hardcore immunosuppressants when they have an infectious disease? well you do NOT want to be giving tocilizumab to anyone with mild disease where their immune system might fight it off.
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do you want to be neutropenic when you're fighting off a virus? you do NOT. L-type patients or milder? not good candidates for tocilizumab.
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is opening up the country with no adequate antibody testing, no prophylactic treatment, no vaccine, and not even knowledge of how long immunity lasts, a good idea? NOPE, says doc.
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for heart problems in COVID19: you can't tell myocarditis from STEMI from EKG alone, "take 'em to the cath lab" (ie heart biopsy) because you treat these conditions very differently.
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scary thing: the EDs aren't seeing their usual *non* COVID19 cases, their heart attacks and strokes and DKAs, because telling everybody to stay home has worked so well. people are showing up to their GP's office with these emergency conditions.
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apparently trying to resuscitate after a non-shockable cardiac arrest has a very poor success rate and can aerosolize the virus, so they're telling people *not* to do chest compressions in COVID19 patients.
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(they recommend talking to your patients about end-of-life plans beforehand, and reciprocally it seems like PATIENTS should think about their end-of-life wishes because I can see a lot of people being very disturbed by finding out that the default is not to resuscitate!)
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End of conversation
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High dose HCQ/CQ was always a weird choice to me - cardiac risk major, probably only likely to have a noticeable impact in early administration (i.e. not severe), and low dose clearly exceeded replication IC90
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