Here are a batch of my usual trawls of the FOAM world. I didn’t make DasSMACC (gutted), but many of you did and I am sure the themes within here reflect much of what you may have picked up there.

I have also procured a lovely little book on POCUS …you may have seen me bleating about it on Twitter!! We will be reviewing it tomorrow for you all!

Below is the podcast discussion of this week’s blog!

Without further ado…here we go…

Blogs

Our thanks go out to the whistler!!

You have to check out Abbey’s notes. As you know, I am a massive fan of all that is infographic…pictures say a thousand words!!

Have a look at her take on DasSMACC and the rest here:

POCUS – its just so ace isn’t it?

Take a look at this blog, running along the track of Pro-POCUS (Obviously). But…is it as good as we all say it is. The authors discuss sensitivity and specificity profiles and its usage in the ED.

Everyone want to use Ketamine…are we scared?

Another great snippet from Pharmacy Joe on this subject…with Twitter opinions, SMACCDub feeds and a poignant statement at the end!

Everything EM DasSMACC edition!

Great blog this week from the First10EM guys! Have a read through as they discuss some of the articles that caught their eye and were influenced by the crowds and experts at DasSMACC. There’s also a bit on digital rectal massage and how it can cure many complaints…!!!

CPR…how does it work?

Heres a nice one from the Sydney HEMS group with some brilliant video links embedded. Reminds us of just how clever CPR is!

Articles of Note

The higher the flow…the longer your circuits will go!

Well..perhaps not. Have a read here.

VAP! Do we all treat recognise it and treat it appropriately..??

Interesting to see what the evidence over the years has unfolded on this area of crit care. VAP is not only hard to get a solid consensus definition on, it’s also hard to know when and if to treat it. The authors have done a good sift of the evidence here for us.

Get someone else to do it…or some thing!

Is it more effective to use an automated device to do your CPR for you? Perhaps…but do they cause more harm than help?

Cool down those bleeds?

Seems to be the ‘cool’ thing to do for many potentially life threatening conditions these days…but does not work for this SAH category?

Hypersensitvity and immunology – all very relevant!

Ever wondered how drug hypersensitivity happens, we’ve read loads on this I am sure. This article also goes into the intricacies of mast cell behaviour and also desensitisation as well. Moreover, the authors discuss the molecular and pharmacological mechanisms whereby desensitisation can be of therapeutic benefit. After all…no one wants to deal with a cytokine storm!

Pain relief, but perhaps with more nausea?!

Here is a very interesting snippet regarding the fact ondansetron (which I’m sure you all use), might actually be antanalgesic!! SO…there’s perhaps 2 side effect profiles now then.

Is the IVC all it’s cracked up to be…rhymes as well!!

I don’t like it when papers come out suggesting we might want to devalue POCUS in any way….but, this is about honesty and getting the word out. So, this volunteer study suggests, the IVC collapsibility index is good for detection of fluid responsiveness, but it won’t tell you the degree of intravascular volume expansion after you plough in the IV fluid!

To decannulate, or not to decannulate…that’s the question!

A difficult one! When and how? We all seem to differ in our opinions and approach as the evidence base is so variable. This article give some excellent insight into practices from a review of a multitude of papers. There is also an interesting decannulation algorithm to have a look at.

Good old NAC…this may be a positive trial for it’s usage then?!

Do you go down the Rivers route…or use what’s in front of you?

I loved this one here. You have a septic patient…which treatment route do you take. Do you navigate via Rivers, or do you traps through the jungle using your experience and instinct?! You will see what I mean!

Aspirin on ITU…is it actually doing the job you want it to?

A great drug, historically. We give it as an anti-platelet fairly routinely in many patients. There are also may other trials looking into NSAID’s and aspirin referenced, worth a look. But, is it having the correct effect with the many other things that trash normal pharmacodynamics in our critically unwell patient population? The authors found out…

More on blood sugar…but this is different!

Many studies have looked at the association between mortality / morbidity and blood sugar levels; this one looks at a slightly different aspect. What were the differences between survivors and non-survivors as far as blood glucose controllability is concerned? Take a look…

Get those calories in early…surely it’s better for ARDS??

You would think getting calories in to patients so catabolic with ARDS would be a good thing? Perhaps think again…

Forthcoming

Now here’s one that could finally help to clear up the vast confusion over saline and balanced IV fluid solutions and outcome. Here’s hoping it will anyway!!

A website worth a commendation!

This is a fabulous Italian site geared to friends, family and the general public, explaining the in’s and out’s of the ITU. As they say, they can be intimidating places, but the site aims to de-mistify the confusion and allay fears.

The publication can be found below:

POCUS!

Watch for that tamponade!!

Check out USOW #78 – pericardial effusion and tamponade. They discuss what we all know is fairly obvious, but also some of the more complex and diagnostic advanced echo variables/calculations to aid in the diagnostic process. We love their stuff!!