Folks - if your covid patient is doing well respiratory wise but suddenly starts to become delirious and agitated and hallucinate -> tachypnea - it is due to SEROTONIN excess and they respond to treatments for it:

Precedex

And far more easily a simple pill called Cyproheptadine

This agitation is the beginning of the end for some that leads to re-intubation and is major source of morbidity and mortality.

Vast majority of the world doesn’t have access to Precedex due to cost. There is an easier way to address this important and life-altering issue.

Just because the micro-thrombi leading to respiratory worsening have been avoided on proper anticoagulation, it does NOT mean that platelets have also reversed their hyper-reactivity due to COVID, and it does not mean pulm endotheliopathy of COVID has been "healed" ....

Those two processes, platelet hyperreactivity of acute COVID and pulm endotheliopathy of acute COVID are STILL ongoing, leading to elevated serotonin release by platelets and reduce reuptake/regulation by (injured) pulm endothelium ...

Serotonin excess will CONTINUE acutely

Leading to ...
(1) myoclonus
(2) CPK elevation
(3) agitation, delirium, hallucination
(4) hyperpnea via CAROTID SINUS action of 5HT

Eventually P-SILI of some sort, tenuous and ineffective respiratory status, and reintubation -> VILI -> worsened pulm endotheliopathy -> mortality

And eventually ...

5HT mediated REDUCED renal blood flow -> AKI (which is erroneously attributed to high CPK)

Once you have renal failure on top of reintubation, with ventilator dyssynchrony due to untreated serotonin excess -> mortality risk

To be avoided are serotonergic medications, with a main culprit not-well-known to many being FENTANYL, which unfortunately is what will be started upon intubation ....

High PEEP to be avoided due to worsening of pulm endotheliopathy of "healthy" alveoli getting overdistended

I will keep repeating these series of Tweets until the world understands ...

To add Haldol, intubate, and add neuromuscular blockers will achieve not much, likely worsens this

Folks need to understand the BIOLOGIC effect of pulm vessels beyond gas exchange: serotonin regulation

And those COVID Toes, appearing like thromboangiitis obliterans, are most likely due to this dysregulated excess extracellular serotonin, per below:

(Image from a publicly shared post)

https://pubmed.ncbi.nlm.nih.gov/8376917/