Loads of action this week. But here is a pick of some of the best of FOAM / POCUS. Click the pics to go to the linked articles.

General Papers

ARDS and its after effects…beyond the trial info!

Frailty…not just mortality!!

I think this is very poignant. We quote mortality when putting patients through horrible things in hospital…it’s 50:50 you’ll live etc etc! But in fact, frailty is extremely important, so we need to pay attention to it. After all, we don’t want to render any of our patients worse off than when we started!

Speaking of frailty!

Unfortunately, when we get a referral from Harm/Onc, our hearts sink. Will it be hours they survive for? What new drugs are they on we know little about, which organs have already failed and which others will go…no physiological reserve! The list goes on…but is my pint glass half empty not half full?

Checklists and stuff!

Here is LocSSIPs. Evolution of safety checklists and our seemed obsession with the airline industry are discussed here. The fact is, these checklists DO NOT STOP NEVER EVENTS. But, nonetheless they are here to stay.

Take NIV to the wards!

Res your centre have the capability to offer this bridging therapy? There needs to be governance over it, if it is to be deemed safe enough, but it undoubtedly keeps patients away from critical care who we might have ventilated!

Chase the MAP…but what is it really?!

This article gives a nice, brief outline of what we are all concerned with chasing on the ICU.

Cure cholesterol…and delirium!?

This paper form Watford looks into the neuro-inflammatory propertiesmodulation this statin has and whether is it of relevance to delirium on ICU…..look for yourself! Will we be prescribing it to our patients?

Too cool for school!?

So cooling down to 33 Vs 36? 24 or 48 hours post cardiac arrest with ROSC? Those were the questions and now we may have some more answers! Evidently (excluding powering), there may be no benefit to any longer than 24//h on neurological outcome.

For FICE sake…just scan as many as you can!!

Always the advocate of this…but what impact does it have on your patients and how does it compare to the ‘professional scan’? Another point to note is that this is an ever growing and ever learning process…so if in doubt, get expert advice! Other thing to note is that further scans did not contradict one of ours, but they added further diagnostic information. Look here…

Scanning’s best, particularly the chest.

Here’s a nice paper in press regarding the usefulness of chest Ultrasound and it’s diagnostic importance.

What’s new in ARDS therapy?

This is a nice review of the existent evidence and anything new too. It doesn’t contain a magic recipe to success, but it does recap on what we should be doing to keep our sickest, safest!

The airway of doom…update!

What do we do when it all goes a bit ‘south’ during an intubation on ITU. These are sick patients from the outset, and the environment we are in is often totally different to the calmness of theatres when dealing with a difficult airway. We don’t want top get involved with the Scalpel, finger, bougie unless we really have to; do we?!

Bugs, bugs and more bugs!!

Pathogens are continuously and rather ruthlessly outsmarting our drugs and us!This article highlights the important impact our future practice has on what will, undoubtedly, wipe us all out if we are not careful!

Don’t just slam in the drugs for delirium!

Delirious patient…the usual response is to use pharmacology to counter it! But, we may be doing many of our patients a dis-service. This paper nicely describes the adjunctive usage of our allied professionals to tackle it. Clever mnemonic at the end too. Read on…

Drugs / Environment / Light / Initiate Cognitive Tasks / Routine / Integrate MDT / Under hydration / Nutrition / Mobility

Seems Japan are getting it right?!

One of the most heavily populated countries in the world, yet they struggle with a shortage of dedicated critical care physicians. A panel convened and reviewed best practice for ARDS patients according to graded evidence. Have a look:

All about those enzymes folks!

This is a great little paper discussing the evolution and relevance of the various cardiac biomarkers we all fret about! Also, towards the end is a discussion on monitoring the cardiac patient.

Blogs

The usual must read review!

Have a look at one of the best trawls of t’internet and the FOAM world courtesy of one of our favourite partners.

NAVA…or Nada?!

TBL crew review a paper on whether neurally adjusted ventilatory parameters will aid patients returning to more invasive ventilation.

A snippet on assessment of fluid responsiveness!

More on Rivers…and why EGDT doesn’t seem to match!

Have look at this article…re-enforcing the fact no-one can replicate his work and why!

Use your PERC to rule out PE…no, not for difficult airways!

Have a look at this brief discussion on the use of PERC (PE rule-out criteria. Nice mnemonic too.

Let’s reciprocate!?

Here is a great reminder of the importance ion reciprocal changes on ECG by the RebelEM crew. Don’t ignore it!

Special Article

Trauma care…past to present!

Here is a brilliant little piece on how far we have come, mainly in the field DCR (damage control resuscitation). Of particular poignance is resuscitation during coagulopathy. This young, fit cohort often hold the key to further research in the sick, in-hospital cohort. Read on:

#POCUS!

Just one look…that’s all it took!

So, we know that US is very good at detecting a lot of chest pathology, particularly pnumothoraces. Here is an article outlining the fact it can snappily be done in a single look too!

Good old FAST…is it really good though?

It’s every A&E physician’s favourite, and of course its POCUS, so it must be amazing?! Have a read, as this paper goes through the pearls and pitfalls.

Blast that PE!!

Another role for US…it’s kind of in the right place there, though not quite POCUS as such! A novel technique that is propertied to decrease the other risks of chemical thrombosis..i.e catastrophic bleeding. Read on: