This is a quick scout of what’s out there in the ever expanding world of FOAM! We will be broadcasting our podcast excerpt of this too…watch this space!

Congratulations to Rob MacSweeny on Critical Care Reviews 300th newsletter! Accolade!

Screenshot 2017-09-11 13.21.47.png

We continue to expand too, hitting 17th in the biggest Crit Care blogs out there. We are really pleased with this achievement. The Regional anaesthesia section is in development and we may have a Consultant lead for our ED section, bulking up the team!

Onward…..

Blogs

Take a look at the fast lane!

Screenshot 2017-09-11 10.58.00.png

Keep the flow on sepsis and early!

The team at TBL review another paper on those good old sepsis bundles! Interesting stuff and I believe we looked at this in a previous episode. This important paper highlights that more rapid completion of a 3-hour bundle of sepsis care and rapid administration of antibiotics, but not rapid completion of an initial bolus of intravenous fluids, were associated with lower risk-adjusted in-hospital mortality. Have a look at Segun’s take on it here:

Screenshot 2017-09-11 10.54.09.png

PAPERS

 

Surely adding in a PPI is going to stop the stress!?

So you would think adding an infusion of PPI to EN in ventilated patients would decrease the risk of stress ulceration and subsequent G.I bleeding? Read on here…

Screenshot 2017-09-11 12.37.37.png

Are you immunosuppressed after sepsis..?

Some recover rapidly from sepsis and others remain chronically unwell…is there a reason?

Screenshot 2017-09-11 13.16.52.png

 

So pulse contour analysis is so simple!?

So a radial artery pulse contour analysis is is easy…nothing floating down into the pulmonary circulation…and no calibration. How does it compare to PICCO?

Screenshot 2017-09-11 13.07.53.png

 

So we are not crystal ball readers…we can categorically say it now!

I always say this to relatives when pushed to comment on outcome and mortality. ‘I’m not a crystal ball reader…’ This article shows we, a s clinicians may be bad judges of outcome!

Screenshot 2017-09-11 13.13.07.png

 

Look at the gases after arrest!!

A nice little paper here looking at the association between the state of your ABG after ROSC and mortality later down the line!

Screenshot 2017-09-11 13.10.56.png

 

TPD Vs CCE…that’s the question?

A nice paper here looking at transpulmonary thermodilution and trans thoracic FICE echo to evaluate circulatory shock. Were they matched and were they equally useful?

Screenshot 2017-09-11 13.06.31.png

Screenshot 2017-09-11 13.03.55Screenshot 2017-09-11 13.04.06

 

They’re big…but will VL be superior to DL?

Another!! Everyone is looking to prove / disprove the fact VL is better for us! But…seems good old DL is still up top! The old adage of what you know best is best comes to mind!

Screenshot 2017-09-11 12.44.11.png

 

They’ve fought their way off the unit…but it shouldn’t end there!

There seems to be a lot out there on rehab in critical illness, whether intensive physiology in your bed, or exercise programmes once off the ventilator. But…we should now be looking at them on the wards too. Does it make a difference?

Screenshot 2017-09-11 12.40.32.png

 

Presepsin…better than the rest?

So we look at any biomarker we can that might just shed some light on the sepsis sequence. CRP, procalcitonin and many more are in the race to beat sepsis…but could preseason trump them?

Screenshot 2017-09-11 12.55.09.png

 

Get the public involved…people save people!

So getting the public involved in OOHCA might be a king grace….quite literally.

Screenshot 2017-09-11 12.53.26.png

Bring out the REBOA!

I’ve never seen or done this, but desperate times etc. This review looks at the utilisation of REBOA and whether it has saved lives or not. Read on…

Screenshot 2017-09-11 12.46.52.png

Here are some nice videos on REBOA!

It’s ACE-II prevent ARDS!

Athos 3 has been and gone, now we are looking at what the addition of exogenous ACE2 (GSK2586881) may have on patients with ARDS. Could it attenuate lung injury without compromising systemic hemodynamics?

Screenshot 2017-09-11 11.55.35

 

Haloperidol is out, then it was Dexmedetomidine…now Loxapine!

We are always looking to see how we can control agitation when we are desperately trying to wean patients from the ventilator. Haloperidol is frowned upon these days, then cam dexa. Loxapine is a new one and this RCT looks at it’s use for sedation…but was it any good? Read on!

Screenshot 2017-09-11 11.48.08.png

1:1:1??

So you bleed…suggestions have come about that it may be more important to get FFP / platelets, (co-transfusion products if you like), in over RBC’s. In trauma, perhaps, but is this true to life though? Take a look!

Screenshot 2017-09-11 10.41.04.png

Fluid responsiveness using Echo…maybe it should be TOE?

Screenshot 2017-09-11 10.46.40.png

Oxygen…it’s toxic, even bugs hate it!

Screenshot 2017-09-11 10.51.05.png

POCUS!

POCUS too far?!!

Surely not….POCUS during CPR is becoming utilised more and more. But does it scupper you in any way….risk > benefit

Screenshot 2017-09-11 09.36.36.png“Does use of point-of-care ultrasound (POCUS) in cardiopulmonary resuscitation lengthen the duration of pulse checks beyond the guideline recommendation of 10 seconds?”

 

Screenshot 2017-09-11 09.39.11.png

Have look…

POCUS for rapid line placement!

Great video to check out here.

Go higher!

Screenshot 2017-09-11 10.10.31.png

 

How we train in the UK…POCUS the chest!

Screenshot 2017-09-11 10.22.54Screenshot 2017-09-11 10.23.02

Don’t ignore the POCUS…..

Cynical regarding it’s usefulness, many are still and it takes a lot to convince some people. But…positive findings can’t be ignored!

Screenshot 2017-09-11 09.49.55.png

 

POCUS on dissection!

Screenshot 2017-09-11 09.52.59.png

Check out a resource list for POCUS

Screenshot 2017-09-11 10.06.57.png

Be certain and commit to POCUS!

Screenshot 2017-09-11 10.06.08.png

 

BART! No…not the Simpsons!

Screenshot 2017-09-11 09.56.33.png

 

Infograms!

 

If the ED could eat any cereal…it’s be Special K!

Screenshot 2017-09-11 10.29.41.png

 

There’s that encephalopathy!

Screenshot 2017-09-11 11.22.39.png

 

Nerves nerves nerves!

Screenshot 2017-09-11 11.28.25.png

 

Life threatening Asthma!

Thanks to EM3 for this brilliant reminder!

Screenshot 2017-09-11 11.33.10.png

 

Coma!

Screenshot 2017-09-11 11.38.21.png

See you for the next episode and do check out the podcast too.

JW