The week’s best #FOAMed #FOAMcc finds (3 – Jan 17)

Loads to get through here…so if you’re looking at this in theatre (ensuring your patient is safe as No. 1 priority, obviously), you are probably doing it during a long case.

To the rest of you, grab a large coffee and relax as you read. Lots of the screenshots may also have links, so do rest the mouse over them in case. Lots of the articles found are linked from CCC46.

All the best

JW

Best of Twitter

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Airway

Surely video is best then?!

This paper looks at whether we should be reaching for the videoscope straight away in our ITU patients needing intubation. The results are very surprising. For me…I will still reach for the standard scope FIRST. Backs it up! We await the results of the MACMAN trial

Seeing is not believing then…

Another article warning us about the artificial safety hammock we shouldn’t necessarily sleep in when approaching ITU airways!

the fundamental problem with video laryngoscopy: it generates excellent views of the larynx but may not facilitate tracheal intubation. The use of video laryngoscopy can lead to the creation of blind spots, both visual and cognitive.

Ultrasound for airway management.

Have look at this…we are using this more and more on our unit and in particular, pre-perc trache insertion.

Ultrasound

See here for the consensus recommendations for the use of ultrasound (POCUS) in crit care.

Resuscitation

Don’t leave them lying!

A very ‘neat’ little study here on the role of the head-up position in CPR. Is this going to get u more ROSC as compared to supine. Tilt them all??

Is early intubation during cardiac arrest going to scupper your outcome?

This paper looks at outcome of 2 cohorts of in hospital cardiac arrests. Thos intubated during the first 15 minutes and those not. It appeared that early intubation led to poorer overall outcome (survival).

Are you really hypovolaemic in sepsis??!

There was a little debate between Rupert Pearse and Manu Shankar-Hari at CCC46 regarding the fluid responders…’true or false’. This then led to highlighting of this great article discussing whether sepsis is really a state of hypovolaemia or not….which goes against what most of us may think.

More ‘ribbing’, of qSOFA!

This article shows a massive patient cohort and debates the sensitivity of qSOFA Vs. good old SOFA score changes in the critically ill. Have a read here.

Fluids are drugs and don’t you forget it!

Manu writes a great little gambit in Intensive Care Monitor regarding IV fluid safety. This is a huge area of focus in our trust at the moment, as we strive to reduce error in prescription of what are essentially quite dangerous drugs! Please have a read.

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More on the colloid delusion

Please have a read of this article discussing the myth that colloids are the ‘best’ replacement medium in shock. The article explains the relationship between the capillaries and the glycocalyx and the way things change in sepsis…it almost clears uo the colloid / crystalloid debate!

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General papers

Don’t spread yourself too thin!!!

This article here discusses the ideal Patient to Intensivist ratio (PIR)…7.5 is the magic number…so when we are on call over night, covering 16 beds plus…is one of us enough!?

Low readmission rates = quality….No!!

This article is fascinating. We all focus on readmission as being an indicator of ‘poorer care’, and thus this ends up being one of the managerial / governance targets and quality indicators. Maybe we should focus on this less, as this large cases series demonstrates.

Although readmissions are associated with increased mortality and an increased length of stay, “readmission per se is not a risk for mortality,” Dr Santamaria explained.

Dex dex and more dex!!

See here for a great free article on Dexmedetomidine. This is a very concise look at what I think is a brilliant sedative drug and a must on any ITU formulary.

You get onto ECMO, can you get off!

This paper looks at the mortality associated with ECMO and

Breath sounds and burning up

This paper here looks at a defining subset of clinical signs we should look for predominantly, when trying to differentiate pneumonia from chronic bronchitis.

Don’t break your fractures even more!

See here for this comprehensive look at recommendations for the management rib fractures.

BNP…should we chase it??

Not really sure what value it is when you look at thisnpapaer, however, quality of evidence is weak on most fronts here.

Vancomycin + Tazocin…is it the answer to all ills?

See this paper here.

Intra-abdominal Pressure…get it right!

Have a look at this brilliant piece of work from Manu et al on IAP measurement. I quote ‘measured at the end of exhalation in the supine position after ensuring that abdominal muscle contractions are absent and with the transducer zeroed at the level where the midaxillary line crosses the iliac crest’. Do we all do this right? Interestingly, having a ‘6-pack’, may hamper your abdominal compliance! Also…see our section on this here. The section on now to improve abdominal compliance is particularly good.

The ED take on qSOFA.

Have a read, shows how difficult the new sepsis scoring can be at the hospital door. A great debate worth thinking over.

More bashing of the Hard Collar!

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Are you sure you’re empathetic??

And Tagg discusses this within the contexts of clinical practice here. A nice read!

Don’t leave them hanging!

See here for an excellent and brief article on hanging injuries.

Look at that waveform!

Here is a lovely article from the emDOCS crew on capnography analysis. One to rival an anaesthetic blog!

#FOAMed

Here is a great article from the JICS this month, written by Olusanya et al on FOAMed and it’s impact, accessibility and resourcefulness. Please take a look. We didn’t quite make it into the table of resources, but we will keep striving to do so.

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