1/ There are clinically relevant differences between #COVID19 #Sepsis & typical bacterial sepsis, but they are Quantitative rather than Qualitative. That is, all clinicians have seen them before in other sepsis pts before this #virus https://abs.twimg.com/emoji/v2/... draggable="false" alt="🦠" title="Microbe" aria-label="Emoji: Microbe"> infected its 1st human.

#medtwitter #meded

2/ Quantitative septic findings are more commonly part of daily care for #COVID patients than we have been used eg, near total loss of the tracheobronchial tree’s muco-ciliary escalator due to destruction of ciliated respiratory epithelium.

#pulmcc #tipsfornewdocs #criticalcare

3/ Classically in #Influenza pneumonia/sepsis, this predisposes to subsequent superinfection from bacteria like Staph & Strep. In #COVID, we are always on the ready to begin antibiotics to cover such complications of what initially was a pure viral infection.

#medstudenttwitter

4/ Where #SARSCoV2 stops & superimposed bacteria start is a conundrum. With #Flu, bacterial problems usually followed the virus, whereas with COVID, to add insult to injury, we are actively dealing with organ damage directly & indirectly (eg #brain https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧠" title="Gehirn" aria-label="Emoji: Gehirn"> #delirium) simultaneously.

5/ Another difference in #SARSCoV2 sepsis is the extremely long duration of illness (weeks vs days) & that late complications are so frequent even when everything is improving. Eg, notoriously late resurgence of coagulopathyhttps://abs.twimg.com/emoji/v2/... draggable="false" alt="🩸" title="Tropfen Blut" aria-label="Emoji: Tropfen Blut">even once ARDS is better & pt extubated. https://abs.twimg.com/emoji/v2/... draggable="false" alt="💀" title="Schädel" aria-label="Emoji: Schädel">

#Blood

6/ The exquisitely prominent #COVID19 endothelial dysfunction & coagulopathy, characterized more by clotting than by bleeding, though both occur, is begetting heavy use of prophylactic & Tx blood thinners & monitoring of Factor Xa or “LMWH” levels.

#medtwitter #meded #pulmcc

7/ Awareness of #COVID as #ARDS due to #sepsis is not window dressing. Our care, #DRG coding, public health communication & research depend on us calling something what it is, especially perhaps because this #pandemic version is a bit GNARLIER than most.

#pulmcc #tipsfornewdocs

8/fin @ElieAzoulay5
As soon as I sent these Qualitative Differences in #COVID19 #Sepsis, I realized I left off the most dire & omnipresent of all: Sky-high angst https://abs.twimg.com/emoji/v2/... draggable="false" alt="😫" title="Müdes Gesicht" aria-label="Emoji: Müdes Gesicht"> at EOL, emptiness that must be met with our #alasdempathy & creativeness to amp up #humanity

#MedTwitter #family