A busy week! There’s a load out there and a lot of activity on the guideline front, of which we have chosen 1 to highlight on VAP and HAP.

Jonathan Downham (@criticalcarepratitioner) and I put our podcast out on last week’s blog. Download and listen here folks!

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So…onward! Antwerp and the iFAD meeting loom, as well as ICS SOA 17 in Liverpool….see both below and hope to see you all there!

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All the best,

JW

 

Papers & Trials

 

An aspirin a day keeps the doctor away….not an apple!

So more on this drug and it’s positive effects in those taking it prior to a septic insult. We need more trials that’s for certain!

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They’re craving for a fag!

We all do it….whack that patch on as you think the cause for their agitation is nicotine withdrawal (heavy smoker). The fact is, it probably isn’t this half the time; it’s more likely to relate to the situation they are in on your unit, fighting a ventilator. This paper demonstrates nicotine replacement therapy certainly does not have a positive effect on outcomes certainly!

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What the experts say on ARDS.

A great review here.

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A small one for High Flow!

Only N=12, but a positive result in support of good old nasal high flow usage in those not yet out of the woods.

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We are checklist obsessed these days!

Indeed we are, but do they actually help us? The WHO checklist has been set-up in lights as the key to stopping never events. But it doesn’t! So, do intubation checklists improve safety? Find out here!

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GOULASH…we all love it!

Apart from the fact I may just have picked myself up off the floor at the brilliant acronym for the trial, this may hold some promise amongst the wealth of nutrition studies that haven’t! Lets keep an eye on this, but suggestions nay be that higher energy delivery early could benefit pancreatic ductal cell regeneration in pancreatitis.

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How much…how long??!

So are we under-doing our Mero dosages in septic patients….urr, not sure really, they seem to insinuate we are OK at it most of the time, but perhaps there are isolated situations where infusions may hit the spot a little better.

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Nice to go completely against the grain sometimes!

A neat little paper on how we might save ourselves losing an airway completely where facemark ventilation is anticipated as difficult. Paralyse! Yes…paralyse the patient! Read on…

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Are we doing the right thing by our ARDS patients??

Interesting look at the management of ARDS patients in a reasonable cohort. Seems we do the right things, is a little outside of convention. But interestingly, some of the less evidence based management strategies are being used….bring on OSCAR!

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So restrict restrict…but we may be being cruel to the elderly!

Well…it appears there may be a cause to be less stingy with our blood then! But at what cost and for what real benefit remains unknown! Read on…

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Make your own mind up!

Not sure about the utility and usage of HFOV in ARDS. Many trials OSCAR and OSCILLATE showed a mortality increase with HFOV Vs conventional therapy, so our excitement waned! But have a read of this further analysis and see what you think now…my feelings….well I won’t be rushing to start it STILL!

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Remifentanil….it should be sold in the market!!

Another paper telling us about the potential this potent drug may have for our ITU patients. It may reduce delirium. But of course, we need a RCT to know for sure!

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Don’t sleep on the job…that’s for your patients!

Another one telling us to ‘suck eggs’ a tad. But goes to show where we, as a safety critical specialty, can come a cropper!

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Guideline of the week!

 

Here’s one on VAP and HAP…we definitely needed this for VAP, that’s for certain. DO the Europeans agree though!?

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Reviews of the week!

 

Cardiomyopathies!

A brilliant review article here simplifying the classification and aetiologies.

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The IJA are on fire! Great review on Pacemakers and anaesthesia here.

Accompanies a blog we did a while ago on this..a well written and thorough piece.

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Pulmonary hypertension…don’t be baffled!

Lovely article simplifying what can be a worry when we are playing about with the physiology of these patients! Bring on the viagra!

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It’s a Trache thing!

This is a lovely review of all you need to know about the two techniques of PT Vs ST. Which is best, which takes longest, what the complication rates are… and the list goes on.

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Sit down….you’ll need to!

This is a seminal read as it explains the world of heart lung interaction beautifully. You’ll need to take your time though!

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Top POCUS!

We are doing CPR wrong …and not just told so by the resus officers!

So the crew at Emcrit point out nicely that good old TEE shows us all up!

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Here’s where you need to tighten up your abdo. US skills.

Beware the pregnant female! Click the image after you’ve had a think about what it shows…clue…abdo pain!

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Here’s another in support of looking at the heart and not guessing!

So get your portable US out and take a look at what’s happening during ACLS protocols for PEA arrest. If the heart shows organised activity, it appears outcome may be better in these patients than in those who had disorganised activity. Outcome being survival to get further hospital treatment that is!Screen Shot 2017-09-19 at 10.33.35.png

Quick…is it heart failure??!

Nice post from the guys at ultrasoundgel this week on a snappy scan series for heart failure diagnosis. It won’t slow you up either….as thats what many cynics seem to think scanning can do!

  • Anterosuperieor lung zones bilaterally – needed 3 Blines per rib space
  • Parasternal long axis – estimate LVEF, qualitative
  • If EF not determined in PSLAX, then could do any other view

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Get on the 60/60 for acute PE!

This came on the back of a paper the crew at TBL put out last week. But stands as solid indicator of trouble if you see 60/60 and are suspecting PE. Just need to practice pulmonary acceleration time measurement now!

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Get on with it!! Have some faith….

Why send your patient away from your unit / watchful eye, when you can Tap that fluid safely at the bedside with your trusty US machine? This blog chats us through…

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Top sites!

Thanks for this…don’t let major incident floor you!!

Thanks to Simon Carley et al from St. Emlyns for this quick and snappy take on preparedness for a major incident….as well as a reference to farts!

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It’s gutsy!!

I loved this look from mouth to anus!! LOL! But a great site all round worth a gander at! A learning set for me as I am just venturing into the world of G.I US as we speak. So thanks to them for this cracker! I have also gratuitously pinched their videos and popped them on here but you can find them on Youtube!

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Top Tweets!

 

Don’t just compress…look for the pulsatility!

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Is it a T-Rex or just Tamponade…both are just as scary!

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See how a vet does it! No Horse’ing around!

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Don’t miss it!

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Clot ahoy!!!

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POCUS for chest pain!

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The Jellyfish is out!

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Eeeeew!!

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Breathless…wonder why?

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Breathless…again?!

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Shocked…!!

Click the pic to read the post..the round should be ready for you.

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RUQ pain…POCUS!

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Another massive PE…!

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Goggle eyes!!

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Don’t fart on!

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Next instalment next week!