PLR…everyone’s doing it! #FOAMed #FOAMcc #POCUS

Hugely topical at the moment! Lots being batted too and fro at recent conferences and being talked about at #ResusCon17.

It’s what you’d do, perhaps inadvertently, for the poor little lady who faints in the supermarket…you lift their legs up! Everyone thinks you’re odd for doing it, then thinks you’re some sort of magician when she wakes up and asks where her Werthers Originals are seconds after.

You have just done the good old PLR!! Those legs hold a 4-600ml blood reserve, so use it as a fluid bolus.

Do we all do it properly though?? See below:

screen-shot-2017-02-02-at-15-24-03screen-shot-2017-02-02-at-15-24-18screen-shot-2017-02-02-at-15-24-34

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Author Conclusion: “Passive leg raising retains a high diagnostic performance in various clinical settings and patient groups. The predictive value of a change in pulse pressure on passive leg raising is inferior to a passive leg raising-induced change in a flow variable.”

Clinical Take Home Point: PLR is a clinically reliable predictor of fluid responsiveness and can be used with confidence as long as the PLR effects are assessed by a direct measure of cardiac output.

See also:

LITFL blog on this subject here

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