Best #FOAMed / #FOAMcc / #POCUS – July (2)

Here are a few trawls of the world of FOAM.

Plenty to look at to keep you going. Thanks to LITFL for their usual fab posts, The Bottom Line, EmDOCs and many other sites where a lot of this material came from.

As ever, the POCUS world continues to grow, there’s a lot of focus on NIV / High Flow Nasal Cannulae, a look at arrhythmias, as well as a lot of interesting pathophysiological topics this week. How do you see critical care in the future…someone has discussed this below, and the good news is…POCUS features heavily, of course!

Another 2 Jonnys podcast to come next week as well as another book review too!

Happy reading all.


Papers and Stuff

NIV might just keep you out of the woods in COPD!

This Cochrane review looks at the application of this respiratory support modality and tells us the results of various studies…read on for the outcome.

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Want a nice article on TTM in neuroprotection…look no further!

The authors discuss TTM and it’s merits / mechanisms in neuroprotection. They outline the various techniques and methods to achieve it and if anything, it’s a nice recap on neurophysiology too.

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  • Fever control should help to improve clinical outcomes in patients admitted in Neurological ICU.
  • TTM is the most potent neuroprotective treatment due to its numerous effects against ischemic/hypoxic injury.

Did you know this much about respiratory disease and it’s treatment?!

Here’s a rather good article regarding the minutiae of advances in both drug technology and genomic manipulation of bacteria. Sounds chalky…but there are some really interesting discussions regarding many drugs and therapies we use day-to-day and don’t even think about it!

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Nutrition…something we ignore too often!

Speaking from a personal POV! This is an area I certainly feel a tad lost in and this article highlights just how difficult it is in the Catabolic, sick patient. When things ‘go to pot’, we need vigilance…as recovery will never happen in a malnourished patient! How are you looking at nutrition…bioimpedance, daily weights, biomarker analysis? They are all discussed here.

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Pulmonary hypertension…a killer of a management issue!

Here is an article examining the intricacies off this condition. There is also a great discussion regarding TTE evaluation and clinical signs etc. An interesting adage to the discussion regards exercise induced PH, which is an area I certainly had not thought about! Not quite feasible in the ICU patient though! Bring back the Swann??

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Avoid the Storm!

Electrical storm (ES) is a life-threatening condition characterized by ongoing ventricular arrhythmias leading to appropriate implantable cardioverter defibrillator therapies. It is associated with increased mortality and requires urgent medical care. In this review the authors summarize the prognostic implications for ES as well as available treatment strategies to manage ES.

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Non-Inferiority…what’s it all about?

Here, the authors run us through non-inferiority trials and the stats behind them. An good one for a quick ‘chew over’.

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Remember the liver and Bilirubin…no, well read this!

A great review article on all that is jaundice. Brush up on your gastro skills…there’s even a list of all of those funky disorders of metabolism for you!

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Good old Spironolactone…maybe not so good for CHF?!

The ATHENA-HF trial may scupper the usefulness of this drug in CHF as it was not associated with greater improvement in natriuretic peptide levels, symptoms, congestion, urine output, weight loss, or clinical outcomes than treatment with usual care. Read on…

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Ventricular arrhythmias…manage them properly and the killer is kept at bay!

Here is a nice article on a subject, excusing the pun, close to our hearts here. The latest PPM techniques, ablative therapies and pharmacological therapies for various causes of ventricular arrhythmias, rare and common. They include a lovely table containing the various classifications and genetic variants as well.

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VTE therapies…take it orally, why get stabbed!?

We get sick of this obsession with prevention of VTE in hospitals, and it’s bread and butter to us! But there are a multitude of DOAC’s out there we should all familiarise ourselves with. Have a read here. Great review.

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After ATHOS came the safety show!

So, ATHOS 3 has just been completed and results for efficacy of the ATII analogue were excellent. But historically, what has the safety profile of Angiotensin II itself been? This article has sifted 000’s of papers and the results are worth a look!

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Could Post-pyloric feeding be the key to VAP reduction??

A rather nice meta analysis of many studies, the main aim was to see whether belting your NG/NJ tube in further is of morbidity benefit…read on!

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Get the high flow out……for HRF!

A nice review by a saudi group on this ‘trendy’ respiratory support modality everyone is raving about! Explains the principles and action. Worth a read.

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Another plug for High Flow?

So as not to ruin the thunder here, read this large meta analysis. The authors compared COT to HFNC and NIV as regards morbidity and mortality…and intubation rates of course.

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Here it is again!! But here’s the bottom line folks!

David Slessor takes us through whether HFNO is as good as NIV at keeping patients free of the blue cigar!

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The future…or it could be you now??!

Funny this, reading the second paragraph, I thought this was most of us already! I also thought, ‘crikey, which unit is this, I want to work there!!!?’

“Ultrasonography performed by the intensivist is the indispensable imaging tool and has replaced the stethoscope. The intensivist masters cardiac, general ultrasound (US) and guidance of invasive procedures. Every intensivist carries a pocket sonography probe in order to diagnose and guide the treatment of patients in and out of the intensive care unit (ICU)”

Then I woke up….but this makes a brilliant read and offers food for thought, displaying what we are capable of within our Intensivist’s armoury! Great article concept!

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DKA…a constant headache!

Here is a great blog on DKA. It’s from a bunch of foundation Docs (Chester UK). They have rather a nice site set up, geared to the more fledgeling aspects of medicine. Makes for a breath of fresh air compared to the resources we had in my day (Old!). We see more and more DKA’s, seemingly on a daily basis at the moment. Does it reflect poor modern diets?? Read their take on it…very nice.

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Pulmonary Hypertension…what the hell can you do with it!?

We talked about this topic above, and looked at a great review on it. But check out what the guys at EmDOCs put together, really clear and palatable. Do read on here.

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Case Reports

Pneumothorax…simple isn’t it?!

Here is an interesting one from the JICS…a pneumothorax and cardiac arrest; nothing new there, but there is if it’s a rare cause!

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Farmer gets shafted!!

The JICS are rocking out the case reports this week. Here is another…hypoxia in a train patient; be vigilant!

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Good to see ‘our Nitin’ taking POCUS by the hand!

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You would not want this rolling about in your attic!

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Don’t forget there are other causes of drop in urine output apart from the heart chaps!!

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What do you do with this one then?

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The good old lung point…or is it?

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Until next time!

Also check out:

Our section on more advanced cardiac indices, including PA pressure and pulmonary hypertension:

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Our section on DKA:

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