Best of #FOAMed #FOAMcc #POCUS finds – Oct (2)

News

There has been so much action on Twitter his week, I have focussed almost solely on this, rather than digging about like DJ Shadow in a record shop, for papers! Focus on portable ultrasound, being dead, or not! Loads of great POCUS, fluids and the usual capture of top tweets. We have also dug out a lot of excellent video resources for you all….so enjoy!

We were very proud to become officially affiliated with the International Fluid Academy this week, and are looking forward to what is going to be an amazing meeting 23-25th November in Antwerp! Come and meet us there…

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To start!

Please check out the JICS this month! Now indexed and FOAM!! We love it….loads of great stuff to peruse and we will be featuring it each release on our blog.

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Those care bundles again!

A great paper from @Flaviasepsis on those good old bundles, the time to sepsis diagnosis, but not the compliance with bundles, was associated with a reduction in the risk of death. Good stuff!

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Now what do we think of this?!

So this paper appeared to look at a fair cohort of patients 13,000+ and makes a very bold conclusion regarding saline Vs balanced crystalloid solution in the ED and overall outcome measures. As many have said – there are certainly big numbers, but was it a RCT? They used very low volumes, and of solutions you could argue weren’t truly balanced.  MAKE30 as a composite endpoint is also debatable. So; bold results and we would like to see the full paper…read on!

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Top Blogs!

Sepsis in all its glory!

Check out this brilliant series on sepsis from EMCrit! Take your time, as there’s a hell of a lot to get through!

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Are you sure?!

Here is a rather scary one…the Lazarus phenomenon. Could be where POCUS plays a big part again…and maybe 10m minutes after death!

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The Bottom Line got eating!

Surely then, getting early goal directed nutrition into your patients is going be of overall benefit to your ITU patients? It might even have a mortality benefit? Read on……perhaps not!

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You gotta love Smith’s ECG cases!

And this one is a belter! I find it amazing what that pink ‘wiggly thing’, can tell us! Excusing the unintended rude pun!

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The ABC’s of extubation with Dr Rishi!

So, we should all check they are really ready…but how do we know? Extubate’abilty is something you just feel ‘in your waters’ as they say. Well, you do with experience, and often thats what counts more than following an EBM approach to it with SBT’s etc etc. Dr Rishi explains…

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Anaemia…remember the causes and types?!

CanadiEM takes us through a brilliant interactive session here.

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Adrenaline…who needs it?!

Interesting table this…always gets me!

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Start it in the ED!

So it appears, despite bizarre numbers actually entered into the overall intervention arm (far less than the standard arm), that starting lung protective strategies in the ED may decrease the incidence of ALI / ARDS later. But….bigger trial needed as ever!

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And from ACEP17:

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Platelets are where it’s at…clearly!

A very interesting article on the role of platelets in the septic process. It appears that platelet cross-talk occurs on a fairly widespread scale and goes to show just how complex

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Want to revert that SVT with success…?

So…it appears the good old modified Valsalva trumps standard attempts. I believe we have featured this before…see the REVERT trial.

Top POCUS!

Which bloody one!!!???

I have been engaged own a debate regarding which portable probe is the best! Watch this site as we plan top review with pro’s and cons!

Wireless or not…portablilty seems to be the key here! Here is a video of a few to watch…

And one on one of my favourites (and I just might own one!)….

 

Pleural Vs Pericardial effusion…a reminder!

A nice little reminder which is which on POCUS!

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How to Lung Ultrasound

Another great guide from Phillips! Take a look!

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Don’t base everything on research!!!

Wow…not a phrase you thought we would use! But the crew at ultrasound Gel explain why:

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Check out the Atlas…ever growing!

Fabulous resource of images from clincians all over the world…the focus is POCUS and this is a #POCUSfans dream site!

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We need to teach em’ young!

So this paper adds fuel to the fire that we need to start teaching POCUS early. Get them before they leave the nest I say – med school!

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Unintended advert for Phillips…but helped heart failure!

 

Don’t underestimate the power of G.I ultrasound…DPL is definitely dead!!

Lovely case from the chaps at the Emergency Medicine Association of Turkey US group. Shows free fluid and artefacts around the belly are not to be ignored!

 

Look at this for a belter!!

So portable POCUS is where it’s. I carry a GE Vscan almost everywhere…except to the pub! But.. this looks amazing and we are all getting excited about it already. The seller for me however, will be just how versatile this thing is going to be. Will it offer linear high freq ability, phased array and echo ability, as well as the ability to fire out lower frequencies to scan abdo’s and chests. The GE does with it’s dual probe…but can this. We will soon see and hear undoubtedly!

I may have ordered one…ooops!

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And some vids for you on it too…

 

 

Top Vids!

Just look at what a ‘wrong’ position can do!!

A brilliant Tweet from @chrisck!

Some great ones from the Osmosis crew…

 

Hyponatraemia confusing…not any more!

Check out this brilliant video animation

 

Top Tweets!

You can see it, even when you aren’t necessarily looking for it!

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Can’t seem to get interest??

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Plop goes the tumour!

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EF.. what EF!!!

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Echo is great!

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EF…what EF…again!

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EF, more EF and what EF….again!

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Critical Interventions!

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Not working…might be the pads!

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That probe is causing a stir!

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And the winner was….

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Look at this PMVL!

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2 organs…and potentially out unfortunately

Nice ePoster from Nitin Arora et al, demonstrating escalation and often futility

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Don’t leave POCUS out…even if you don’t yet believe in it!

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TAPSE and PE..not to be missed!

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Liver met on incidental Scan!

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PSAX…lives on in Infograph!

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Woah!

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You can POCUS for your NG placement!

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Until next time!

JW 1/11/17

 

 

 

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