From a well respected friend and intensivist/A&E consultant who is currently in northern Italy: 1/ ‘I feel the pressure to give you a quick personal update about what is happening in Italy, and also give some quick direct advice about what you should do.

Recirculation in VV ECMO. The books describe 2 red pipes and high pre oxy sats but this is the reality - intermittent flashes of red in the drainage cannula. Sometimes you need to watch the pipes a while to see it.

The Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care just published the most extraordinary medical document I’ve ever seen. To help people from Germany to America understand what we’re about to face, I am publishing translated extracts here. [Thread.]

Learn from recent history

@threadreaderapp unroll

@doctimcook @GSTTanaesthesia @RCoANews @elboghdadly @AAGBI_GAT

13/ We have seen it, you won’t be if you don’t take it seriously. I really hope it won’t be as bad as here but prepare.

12/ Another typical attitude is read and listen to people saying things like this and think “that’s bad dude” and then go out for dinner because you think you’ll be safe.

11/ if governments won’t do this at least keep your family safe, your loved ones with history of cancer or diabetes or any transplant will not be tubed if they need it even if they are young. By safe I mean YOU do not attend them and YOU decide who does and YOU teach them how to.

10/ Everything about how to treat them is online but the only things that will make a difference are: do not be afraid of massively strict measures to keep people safe,

9/ 3)Tons of patients with moderate resp failure, that overtime deteriorate to saturate ICUs first, then NIVs, then CPAP hoods, then even O2. 4)Staff gets sick so it gets difficult to cover for shifts, mortality spikes also from all other causes that can’t be treated properly.

8/ 1)A few positive cases, first mild measures, people are told to avoid ED but still hang out in groups, everyone says not to panick 2)Some moderate resp failures and a few severe ones that need tube, but regular access to ED is significantly reduced so everything looks great

7/ We have seen the same pattern in different areas a week apart, and there is no reason that in a few weeks it won’t be the same everywhere, this is the pattern:

6/ My friends call me in tears because they see people dying in front of them and they con only offer some oxygen. Ortho and pathologists are being given a leaflet and sent to see patients on NIV. PLEASE STOP, READ THIS AGAIN AND THINK.

5/ Patients above 65 or younger with comorbidities are not even assessed by ITU, I am not saying not tubed, I’m saying not assessed and no ITU staff attends when they arrest. Staff are working as much as they can but they are starting to get sick and are emotionally overwhelmed.

4/ We’ve stopped all routine, all ORs have been converted to ITUs and they are now diverting or not treating all other emergencies like trauma or strokes. There are hundreds of pts with severe resp failure and many of them do not have access to anything above a reservoir mask.

3/ The current situation is difficult to imagine and numbers do not explain things at all. Our hospitals are overwhelmed by Covid-19, they are running 200% capacity

2/ First, Lumbardy is the most developed region in Italy and it has a extraordinary good healthcare, I have worked in Italy, UK and Aus and don’t make the mistake to think that what is happening is happening in a 3rd world country.

Great talk by @MitoExplorer - leading the way in understanding mitochondrial bioenergetic adaptation in critical illness #hypoxiasymposium2019 #mitOx #criticalillness #bioenergetics #hypoxia #mitochondria @mike_grocott @MitoExplorer @XtremeEverest @denny_levett

Compromised data integrity in studies of perioperative oxygen therapy makes national press in UK @guardian @Anaes_Journal #Hyperoxia #realPaulMyles #realJohnCarlisle