After spending the last four weeks working in an #ICU here in #Seattle, a final set of #COVID19 clinical and general thoughts:

#COVID4MDs #seattlecovid19 #medtwitter (1/10)

Last week’s diagnoses are this week’s admissions. We’ve started to see people admitted to the ICU with known #COVID19 diagnoses but whose condition has worsened. Sometimes, as others have observed, the worsening is quick—in a matter of hours. (2/10)

People admitted to the #ICU with #COVID19 stay for a long time. We have had people on ventilators for well over a week. They have bad ARDS but do seem to respond to LPV, NM blockade, and being proned. Still, most have yet to come off the ventilator. (3/10)

High-flow NC can help prevent intubation. However, patients often have the same extended course of high O2 needs limiting transfer to acute care or home. If they do decompensate, it’s imperative to start the intubation process early because proper #PPE takes time. (4/10)

With long ICU stays and the flatter but wider predicted shape of the curve here in #Washington, we are preparing for an extended period of increased medical needs for #COVID19. It feels exhausting but less terrifying than staring down a giant spiking wave of cases. (5/10)

My biggest fear is of shortages not of #PPE but of essential medications. There are reports of propofol and other sedative shortages. We still have enough, but I don’t want to know what running out would look like. I’m grateful to pharmacy for ongoing conservation work. (6/10)

Success in these times is about communication and adaptation. There are bright spots. Our #PalliativeCare team collected donated tablets so patients’ families can see them. Some patients have had hours-long video chats with family sharing stories, updates, and music. (7/10)

A second piece bright spot is the involvement of our community health workers and cultural mediators. They continue to reach out to our patients’ families and communities and to help the hospital adapt its policies to honor different sets of goals and beliefs. (8/10)

Another reassuring communication has been the steady, clear flow of data from the leadership team. A a brief daily update on issues like testing, blood bank, PPE, and discharges has supplanted the email frenzy. (Thanks, @JohnLynchID, Dr. Chloe Bryson-Cahn, and others!) (9/10)

This is the most exhausting month of clinical service I have done. I couldn't have made it without the hospital's amazing team of medical and non-medical professionals, so many colleagues who stepped up, and my family (esp. @DrSnowInBus). We will get through this together.(10/10)