Best of #FOAMed / #FOAMcc / #POCUS – Oct (1)

Here we go again…the latest trawls and highlights of the FOAM world. A big thanks to all concerned…we have credited most, but certainly not forgotten all! Loads to see, so click away, follow and enjoy!

Meeting of note

Please take some time to go through this case report and answer the questions therein.

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This promises to be an amazing meeting and we look forward to seeing you there. Get registered!

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Forthcoming

 

BASIC…may be all you need to prevent CIAKI!

So here is an interesting one to watch out for the results of. They intend on trialling 2 different pre-contrast IV fluids to see what the impact on AKI may be.

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It’s in our History!

Do you know who this is below? Click the pic to find out…he was a bit of a ‘Godfather’, within medicine and might have done a lot more than you first think! Including tasting pus and other bodily fluids!!

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Papers & Editorials

 

ApnOx…does it really help?!

Take a look. There has been a lot of chat out there regarding apnoeic oxygenation and whether it really reduces significant hypoxaemia. This meta-analysis sheds some light over the matter.

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EGDT and the big trials…what did they do for us?

A nice discussion of the big trials – ProCESS, ARISE, ProMISe and most recently, the PRISM trial, all dissected and summarised.

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There’s also a Holy Grail in the vasopressor world!

Here is a nice article discussing, in the main, what Khanna et al did for us with the ATHOS – 3 trial. We have discussed this a lot, but this article conceptualises things beautifully…

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Protect, protect, protect!

Here is lovely ed piece on lung protectivve ventilation. We are obsessed with this…but we need to discuss more on the spontaneously breathing patient. Herein, they do…

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Fluid therapy…get it right!

One from one of the iFAD legends himself. Therefore…a must read. It explains all of the usual pitfalls and pearls within a very concise overview of what is a massive area!

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Bleach…kills all germs dead, but how did chlorhex / poviodine and alcohol fair?

This also runs in circles, but in this trial, there were a fair number of indwelling catheters studied in a tight enough schedule. So which resulted in the lowest rate of CRBSI and other nasties? Read on…

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We have to do something about VAP…if we can actually diagnose it!

Here is an attempt at minimising the risk. One of the biggest advances in ITU in a while back was the use of the semi-recumbent nursing position to minimise passive aspiration and resultant chest nasties. So why not try to re-invent the wheel a bit….put them in the lateral trendelenburg position!

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So how long do we actually need pain relief for?

This is a neat article from JAMA surgery and uses data from a hell of a cohort of patients! How long is the optimal time for opiate prescription amongst opiate naive patients….have a look here.

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Blogs!

 

Watch it…up, up and away…and tracheal damage!?

Here is a lovely snippet from BadEM regarding cuff pressure measurement on areomed transfers…

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Stop that lysis!

Here is a nice one from 2016. Seems we are seeing increasing numbers of these patients up on ITU as we push the boundaries further and further with cancer therapies…often trying to pick up the pieces.

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There’s a definitive test for it…so the Daily Mirror say!

So even the Daily Mirror are selling cMyC (cardiac myosin binding protein C), as the new troponin within the world of AMI. Have a read through the article from St EMlyns here. This may vibe coming to a hospital near you.

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There’s a bleed….nah, leave it!

Here is a rather nice piece from clinicalmonster.com on surgical interventions in spontaneous intracranial haemorrhage. It includes the results of some of the big trials out there too.

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Top Tweets!

 

Modified Valsalva…

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How do we define the FOAM??

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Manage a drink?! Manage a liver…

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Scan for most of aortic dissections!

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Don’t dither about!

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POCUS

 

The eyes are indeed the window!

This is an area I need to learn more about, as it seems to be hot gossip on Twitter at the moment and is evidently very useful!

All of the other scans are available on our site here

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See this brilliant instructional video on how to do it and (excuse the pun), what to look for!

Normal Vs. Papilloedema:

 

Tamponade like you never saw it before!

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It’s a combination thing!

Both a good echo, a look at the IVC and a check on the bellows together are a very accurate way to point you in the direction of diuretics..read on

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Obliterate that outflow tract…fill to avoid failure!

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Watch again for that dynamic obstruction!

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Great example…don’t pop the bowel!

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Good old Crit Care POCUS…and spine sign!

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Vote now!!

Take a look at this nice concept and promotion of POCUS. Have a look at the cases and cast your vote.

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Takotsubo…don’t be fooled!

Another nice piece by echorespract on this condition…also featured by us a while back.

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Rheumatic heart disease…a rethink and some nice images as well!

Within this article, there is a lot of focus on the mitral valve and pathology you may not see too frequently in this country. Have a look at the embedded videos too.

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It’s stopped….hasn’t it?!

If you use POCUS during cardiac arrest…you can make the call, as in to continue or not with perhaps more backing, yes? Well, actually, potentially no! Seems the agreement between clinicians as to what is standstill isn’t as tight as it should be. And we in critical care could be amongst the worst offenders!

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Here is a clip of genuine standstill…and you can’t disagree, because it is!

 

Another POCUS’d airway…

So here is yet another paper looking at the do’ability of a quick scan of the airway to confirm your ET tube is in the right place. Emergency Medical physicians were blinded to caponography…

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I’ve actually no I&Dea what this is……..

Here is a nice case series demonstrating all is not what it seems at first. Keep yourself out of deep water and scan!

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Images and more images!

Take a look here at Sonosite’s image library. Some belters!

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Take a stab!

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Flash…!!!

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Don’t forget…you can get a SAX on subcostal!

One we often do but seems un-publicised. Take a look.

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What can’t you POCUS these days!

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Fabulous Infograms!

RTA…made palatable!

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Best wishes as ever

JW (10th October 2017)

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