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COVID19: Managing Autoimmune, Psychiatric and Trauma ResponsesMarch 31, 2020
Joel Lamoure, RPh, DD, FASCPTelepharmacist, The Northwest Company
Canadian Section Chief, Medical Bioethics, UNESCO
Email: [email protected] Twitter: @JoelLamoure
LifetimeDisclosures
Research Funding: Eli Lilly Canada, Sanofi Canada
Advisory Boards: Janssen-Ortho, Pfizer Canada, BMS Canada, Lundbeck Canada, Pfizer Global, Sunovion Canada
Speaking Honoraria: Eli Lilly, Janssen-Ortho, Pfizer, Astra-Zeneca, Shire, LundbeckCanada, Valeant Canada, Otsuka Canada, Sunovion Canada, Pediapharm Canada, Medexus Canada
International Congress Funding: Pfizer Canada, Lundbeck Canada
Medical Writing Consultant: Medscape, Canadian Journal of CME (STA Communications), Canadian Healthcare Network (Rogers Healthcare)
Other Related Financial: Online shopping platform store
To cite this presentation (APA Citation): Lamoure J., COVID19: Managing Autoimmune, Psychiatric and Trauma Responses. (Webinar) Canadian Society of Hospital Pharmacists. Ottawa, Canada March 31, 2020
Disclaimer: Note that all slides in this presentation are copyright by the authour and the opinions contained are those of the presenter. Contact by email at [email protected] for any queries. This presentation is not designed to be a substitute for medical care or advice. If you have urgent clinical symptoms, please contact 911 or consult a health professional immediately.
Learning Objectives
Provide an overview of COVID-19 medical psychiatry and autoimmune cascades in a pandemic situation
Review and apply pharmaceutical learnings from previous pandemics to nCov-SARS-2 2019
Discuss impacts of non-prescription and alternative interventions used by the population
Empower clinicians and patients’ safety and HOPE/resiliency through an overview of trauma-informed care
Touch on RNA and intergenerational trauma and mitigation of trauma risk factors in a crisis
Initial Thoughts
How do we grieve for a culture and societal connections that have been abruptly taken away from us?
Introversion vs extroversion
FMEA and desire to lay blame in the face of powerlessness
Humanity means that we have the wherewithal to engage in intelligent concern for each other
Its not about age, race, sex, gender or religion
Its about responding to the threat by an unknown assailant with unconditional embracing of our equality
A lot of very complex theories are being condensed and pulled together into short, bite sized encapsulations. The interpretations are mine and each of these topics blow out into their own literature and theories. In my defense, this is a 2 year course being condensed into 20 minutes…
Ident-A-Kit. The Perp: COVID-19
Observed and reported up on unusual signalling in Oceania Summer 2019 in WHO data with potentially zoonotic etiology
Clinical Observations (not present in all and not inclusive) Increased SCr/ BUN
ARF
Fever
Hypotension
Marked left shift ( greater than 90% neutrophils: WBC)
Fatigue and malaise
Opacities on CXR.
Co-existing autoimmune cascade that coexists (psychiatry, RA, transplant, DM, autonomic, dyslipidemia, asthma). I include psychiatry in here as there is a good body of evidence regarding interleukins, cytokines and psychiatry.
Potential- later stages present with a type of MSOF, RBC dyscrasias
Dengue fever and COVID-19 and geopolitical/geographic exposure and clinical experience observations
What is Medical Psychiatry?
The interface between all things psyche and all things physical and how one impacts on the other
This works two ways, both positive and negative
Lessons Learned: Autoimmune
Spanish Influenza 1918-1920
nCov-SARS-1 2003
H1N1 2009-2010
What populations may be at risk?
Cytokine review and interleukins (esp. 6 and 8) Review of systems including psychiatry
Diabetes, RA, ESR/CRP impacts,Neuro (MS etc), Crohns
Weathering and awareness of the upcoming cytokine storm
Neurological vs cardiac perspectives and observations 2009 to 2020…what is different?
Relationship Status: It’s Complicated
Relationship Status: Managing Loss and Divorce
#1- Understand yourself and relationship with the “Ex” Respect the your thoughts and feelings
What do visitation rights look like?
There is going to be a change in dopamine and serotonin
Past traumas, ADHD, learning disabilities
Drug interaction impacts
Trauma and psychology
Grief and grieving
Acknowledging and accepting the grief
Validation of emotions
Kubler-Ross model cycle of grief and loss
Pavlov, Maslow and Toilet Paper
Its all about the safety No safety means no executive higher processes
We hear the panic bell on the media and do more than just salivate
No higher processes means non-clear thinking
Non-clear thinking means we operate at a root animal emergency level mindset
Means impaired critical thinking
Means we as clinicians and patients may make improper choices
Action and reaction and the impacts of PROJECTION
Products/ Cures/ What stocks Should I Buy ?
Think of the impact of the words and semiotics
There is no cure. This presentation will not go into septic or ventilator management, antimicrobial options, ARDS, VAP, PPI’s, NSAIDs, inotropes etc.
Far more skilled clinicians than I speak to these evidence based guidelines
What are patients trying? Chloroquine, Hydroxychloroquine Including tropical fish grade chloroquine!
Licorice, umckaloabo, periwinkle, DHG, zinc, elderberry, echinacea, capsaicin, garlic, vodka, filtering Scotch through a kilt etc. etc.
What does that mean to clinicians and patients?
Trauma and You, and our next three generations…
Story time about the Great Depression Potential impact on abdominal girth
Its takes 21 days to change a behaviour
RNA memory encoding of the interface impact from the trauma and behaviours
HOPE, Resiliency and Empowerment Holistic, Outcome, Personalized, Empowerment
Mitigating Risk and Staying Sane Its all about you and your desires
Play therapy
Online shopping
Learn a new language
Take a course
Phone-a-friend
The list is endless
Caveats and cautions
Medications and You and Your Patients
Evidence based medicine to make evidence based decisions
Let your prefrontal cortex work, not your amygdala AKA- think smarter, not harder
Don’t be afraid to think outside the box, there is no playbook Don’t be paralyzed from critical decisions if 100% of the information isn’t available Non-maleficence, benevolence, autonomy and justice must guide us
TAIDCC- #COVID19RX must fit each of the pieces in this mnemonic
Trauma history means when dealing with serotonin, dopamine, norepinephrine- start and go EXTRA slow. There will be more activation and adverse effects across body systems
“Home remedies” that pop up on patient BPMH’s will have drug interactions too -> even the licorice root, zinc and the kilt-filtered Scotch
Stressed traumatized people going through grief will almost always not make the most logical, safe choice
We need to be there for them and their families.
It’s complicated and like a bad romance, but look after yourself and pleasepractice good caring and sharing
Final thoughts
“We have one of the most important commodities right now in our health and knowledge. Giving and sharing with those less fortunate or struggling is another way to share that, which is what we call humanity. The best way to manage a crisis is controlling the narrative, planning, then practice literally one minute, one patient, and one case at a time.”
“To do too many risks being overwhelmed. In closing, losing self‐care is to lose your higher‐level thinking, as well as your knowledge and skills for patient advocacy and care that improves patient outcomes. And that would be a loss to all, the most tragic COVID casualty.”
Resources
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Contact Information:
Joel Lamoure, RPh, DD, FASCPTelepharmacist, The Northwest Company
Canadian Section Chief, Medical Bioethics, UNESCO
Email: [email protected] Twitter: @JoelLamoure
Copyright notice: This presentation will be available through open access by the Canadian Society of Hospital Pharmacists to help inform and fight #COVID19 by permission of the authour. Please contact the authour for permission to reproduce this material in part or full.
To cite this presentation (APA Citation): Lamoure J., COVID19: Managing Autoimmune, Psychiatric and Trauma Responses. (Webinar) Canadian Society of Hospital Pharmacists. Ottawa, Canada March 31, 2020