We are going to try to produce regular sections on the best of FOAMed. Here’s the first! Sit down with a coffee and enjoy….more to come!

Great Papers

Fits or frozen?!

The Bottom Line Crew (Adrian Wong), debate the HYBERNATUS Study looking at whether we should cool status patients to improve outcome. Thanks again team see here.

This is in our Top Papers section here.

They say…

Authors’ Conclusions
In critically ill patients with convulsive status epilepticus receiving mechanical ventilation, the addition of therapeutic hypothermia to standard antiepileptic therapy showed no significant benefit with respect to good functional outcome

Strengths
RCT
Incidence of primary outcome in control group in line with power calculations
Standardised initial treatment with anti-epileptic drugs similar in both groups
Standardised sedation protocol
Separation of temperature between intervention and control group achieved
Hypothermia target achieved in 98% of patients randomised to intervention group

Weaknesses
Only 25% of patients were in status epilepticus as defined at the time of randomisation
Early utilisation of hypothermia not standard practice

The Bottom Line
This study only looked at patients with status epilepticus requiring mechanical ventilation. Despite the early use of induced hypothermia, the lack of clear functional benefit means that I would continue not to use it in my current practice.

Pressing pressors

See here for a brilliant blog discussing the VANISH trial. You can find the link to this trial in our top papers section.

Inhibit or stimulate?!!

This paper debates whether we should be damping down the immune response or indeed encouraging it in sepsis. See here

Keep em’ cold or warm care!?

This paper initiates a hopeful RCT based look at what we should do with temperature management in sepsis. See here.

Get the nurses to do it!?

Should we place more focus on our nursing staff in allowing them to be the effective first responders to sepsis…afterall, aren’t they better with protocolled care than we are? See here.

Let them talk!

See here for another paper acknowledging how we should communicate with patients on the unit. See our take on this here too….

Fluid debate

David Lyness points out this article on IV fluids in sepsis. What’s the right resus fluid and the colloid crystalloid debate. No one it seems can make their minds up on this one. Have a look at the article here.

 

ECHO & Heart Stuff

PE again!

This article briefly highlights the importance of McCOnnel’s sign in the identification of PE. Also see our vid links below:

POCUS to help us resuscitate

The guys at St Emlyns talk about the role of USS in resuscitation after cardiac arrest and the REASON Trial. Basically, you see initial heart activity, then you are more likely to get ROSC and a better outcome, (unblinded observational study though so care in interpretation). To me, this again supports USS and utilisation wherever you are! Needs RCT and more robust studies though. See here.

Here is a brilliant article on the RV and adaptation to Pulmonary Hypertension.

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Trauma & Resus Stuff

The good old C-Spine collar!

Our friends at SCANCRIT have some brilliant articles debating the usage of the C-Spine collar. They debate it’s usage here. The Norwegian trauma guidelines are also worth a look here. Have a look at their topics on the C-spine collar too.

There has been a lot of controversy recently over this part of ATLS mantra! Including a lot from my good friend Matt Wiles on the subject as he circulates around the UK talking on counter-ATLS topics. Have a look at their FOAMed site as it’s full of good stuff. He debates ATLS and the c-spine collar in links here,  here and here.

The TV is a right load of old Bo@@&%ks!

See here for a fantastic reprise on what we see on Holby / Casualty / ER etc etc. Might this just influence what our relatives and patients demand of us?

Don’t forget the triad!

I mentioned this earlier this week…nice article on the bad old triad in tamponade with lovely vid. links too.

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Fluid resuscitation in Trauma

See here for a paper on the correct products to infuse in trauma.

General ED

Epiglottis rearing it’s ugly neck again!

Here is a nice article on EPIGLOTTITIS. Pitfalls and treatment options. We have seen a few of these recently as those horrendous resistant bugs circulate round! Not just pads I hasten to add!

Pain relief in the ED

Here’s a nice little study on the efficacy of various Ketorolac doses at point of care.

Comparison of Intravenous Ketorolac at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department: A Randomized Controlled Trial

Also…see here for another one on the ‘sore throat’. Nice discussion on differentials, including the nasty EBV!

Anti coagulated heads…what’s the risk in head injury?

See this paper discussing the good old fear…the raised INR and the head injured patient. There must be a bleed….surely?!

THE AHEAD STUDY: MANAGING ANTICOAGULATED PATIENTS WHO SUFFER HEAD INJURY

Medicine

Fits, Faints and floppiness!

Here’s an interesting one…Dr. James Riviello lectures on the overlap of autonomic dysfunction in seizure disorders, and the important of distinguishing between syncope and seizures. See here

Signs of the week

Remember Corrigan’s Sign? No…look here!

 

Apps of the week

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Click the pic to download this lovely app. It has a wealth of quick access pharm info, as well as a photo identifier of commonly used ‘pills’ by look!

  • Drug Information
  • Medical Calculators & Conversion Tools
  • Drug Identification
    • Verify drug name, strength, detailed characteristics and viewing images of any matching drugs after entering the imprint code for any medication based on Medi-Span drug database
  • Therapeutics Consult
    • Providing treatment options for thousands of diseases and conditions

Discovered sites worth a gander…

Have a look at this great site and test yourself on ECG stuff. Ver nice!

Twitter screenshots we loved

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Physiology Stuff

Lactate lactate lactate!

Here is a nice case report and debate on good old lactate…it gets everywhere!

See ours here too.

Microbiology Stuff

Thus is not a UK article, but it debates antibiotic usage in the US. Nice blog. See here.

It is a handy one to have a look through as their regimens match ours more or less…bar some weird nomenclature antimicrobial equivalents….’tomaaato tomato’ etc!

Sedation Practice Stuff

Olanzapine…any use in sedative practice? The debate continues in this field…which one, right or wrong?? QT problems, over sedation, intubation rates etc etc. The Pulmcrit lot debate the use of Olanzapine in sedation here.