It’s clear from speaking with peers around the country that we’re running into shortages of medications like fentanyl, versed, propofol, and paralytic. Why these particular medications? And why do we care? A #WeNeedMeds thread. 1/

(*paralytics, sorry)

If you mention these drugs to any ER or ICU doc or nurse out of context, they’ll say, “who’re you intubating (putting on mechanical ventilation)?” These are the combination of medications often used to induce the kind of deep sleep that allows ...2/

... us to place a breathing tube in someone’s trachea, which is then hooked up to a ventilator. In this way we are able to support those whose COVID19 lung disease is severe, no longer allowing them to oxygenate well enough on their own. 3/

After the initial placement, sedation and pain control continue in a infusion, to help people tolerate having a rigid plastic tube in their throat and a machine doing the breathing for them. Without appropriate meds, that experience can be agonizing. 4/

You’ve heard about all those patients with #COVID19 who are on ventilators? You’ve heard about the vast numbers of extra ventilators we need? 5/

Those ventilators can’t really be used without a similarly vast supply of coupled medications to get people *on* the vents - and keep them on humanely. Hospitals are already experiencing shortages, before we even hit disease apex. 6/

These medications are not specific to COVID, of course; we will need them in buckets in this disease, but we also need them for many other situations, too. And we won’t have enough for any of it. 7/

Trivia from a toxicology friend: what’s the treatment for chloroquine (one of the potential treatments for COVID) overdose?

A: lots and lots of benzodiazepines (one of the sedation meds we’re running low on)

Yikes. 8/

So what can we do? First, I hope frontline healthcare workers will share their #WeNeedMeds stories, as they are able to without risking jobs. We can’t get the kind of push we need on this issue if people don’t see the problem. 9/

I coauthored this piece with @VincentRK about a range of things that need to happen at the national level https://www.nbcnews.com/think/amp/ncna1172371. Please feel free to post and tag your electeds. /10

Please understand that most of our proposed solutions will take many weeks / months to implement. In other words, we’re already in the doodoo on this issue, but we can mitigate if we move fast, now. 11/

Oh, and to risk repetition, STAYING HOME and FLATTENING THE CURVE is one of the few things everyday Americans can do for us - if we can slow the numbers of sick patients, our meds can be spread out and we have more of a chance to build up our supply. Cool, huh? 12/

Other good reads: https://statnews.com/pharmalot/2020/03/31/a-new-covid-19-problem-shortages-of-medicines-needed-for-placing-patients-on-ventilators/… by
@foxerinr
and this thread https://twitter.com/WilliamVincent3/status/1244666650189758464?s=20… by
@WilliamVincent3 13/

Just to be clear: the med shortages go way beyond the few I have mentioned here. And if you think of who will be most affected, and who will have the least ability to ride it out, it becomes really a desperate and heartbreaking issue. / Fin (for now) #YouNeedMeds so #WeNeedMeds