Best #FOAMed #FOAMcc #POCUS finds – Nov (1)

Its another edition and another trawl of a vast amount of activity. iFAD 2017 approaches and we will be out there bringing you all the best FOAM from the meeting. I feel proud to be one of the leads within a core SoMe team of 6 other clinicians. Duncan Chambler, Cian McDermott, David Lyness, Adrian Wong, Manu Malbrain and myself will be co-ordinating a team of around 30 or so others who will help bring this amazing meeting together for you all. Watch the #IFAD2017 twitter hashtag….you won’t want to miss out!

Here we go….

A great resource!

We discovered WikiDoc. Brilliant resource with simple guides and how to’s.

Screen Shot 2017-11-15 at 14.39.34.png

Papers & Pubs!

 

Is EGFL the way forward or not?!

An interesting discussion amongst the many regarding early fluid resuscitation in sepsis – friend or foe?!

Screenshot 2017-11-19 15.17.02

 

Rest is best…or is it?

After a SBT, patients can feel like a marathon has be run…rightly so! So this trial looked at 1h rest after a SBT and whether it affected re-intubation rates of not.

Screenshot 2017-11-19 16.01.54.png

And some thoughts here:

Screenshot 2017-11-19 16.00.24.png

Lessons from nutrition studies

Not the Singer we all know…but a nice letter regarding the minefield of iCU nutrition.

Screenshot 2017-11-19 15.30.41

 

Is PEEP the key…?

So we use it to improve hypoxia, but does it lead to it? Read on…

Screenshot 2017-11-19 15.22.21

 

Should we be on site, or just provide a dedicated rota!?

Debatable! Have a look, but certainly the ‘skeleton crew’ out of hours in then hospital may not be the best for our patients.

Screenshot 2017-11-19 14.58.19

 

Preserved EF or not…it’s still bad!

Whether you have a preserved EF, borderline EF or poor EF with heart failure, the outcomes are surprisingly similar!

Screenshot 2017-11-19 12.41.44.png

 

Don’t waste your time…be less invasive!

So it seems poking about with non-invasive tests when you suspect ACS in patients may be a waste of time and money in the ED! This paper examined the differences in outcomes with clinical evaluation and noninvasive testing (coronary computed tomographic angiography [CCTA] or stress testing) vs clinical evaluation alone. Read on….

Screen Shot 2017-11-15 at 14.27.50.png

 

So what’s the score??

Take a look at this paper in anaesthesia, looking at the predictive values of various scoring systems / identifiers in sepsis.

Screenshot 2017-11-19 12.07.09.png

 

Now here is an interesting one…

Here we see top influencers in the FOAMed world perhaps swaying the opinions of others; even becoming celebs!! We don’t all believe what one political side tells us is correct, if we did that, the world would end! What we do is use our intelligence, reason and sensibility to sift out what we believe to be correct….and thats the beauty of FOAMed! You do the same with any Journal you read…just because the NEJM / BJA / JAMA or whichever says leap….you don’t have to…do you???

Screenshot 2017-11-19 11.31.08

As has been put nicely by Simon below….this also happens with Journals / Talks etc etc as well.

Screenshot 2017-11-19 11.36.25.png

Another good point:

Screenshot 2017-11-19 11.40.34.png

 

And another…

FOAMed advantages:

Screenshot 2017-11-19 14.51.18

 

Anaphylaxis is bad…worse in pregnancy!

Here is a nice little case report and reminder of what anaphylaxis is…in case you forgot (gets coat!).

Screen Shot 2017-11-15 at 12.18.02

Is Angiotensin II really that good?

A nice letter here regarding the shining light that is AT II. ATHOS-3 told us it had promise, we know its replacement in sick patients may be of benefit…but we have no real data on certain patient sub-sets and we still don’t know the ideal time to start it either. Read on…

Screen Shot 2017-11-15 at 12.12.10.png

 

Look at how thick it is!!

So we look at the diaphragm on POCUS scanning of the lung bases…but we should be looking at the thickening fraction or DTf. Particularly where prediction of ‘weanability’, is concerned. It may be a tad ‘faffy’ to do though…but there is evidence there!

Screen Shot 2017-11-14 at 17.26.39.png

 

If you burn up, you may do better!!

Screenshot 2017-11-19 11.46.30.png

A very interesting look at presenting temperature in the ED and what happened to your outcome in sepsis…you may get a surprise! Great blog on it from the stem crew here

Screenshot 2017-11-19 11.49.10.png

Blogs!

 

TBL do it again!

A look at whether the initiation of a resuscitation protocol implemented early after presentation with sepsis and hypotension in Zambian adults improved in-hospital mortality compared with usual care?

Screenshot 2017-11-19 12.46.10.png

EMDocs do a great piece on endocarditis.

Have look..short, easy to digest and clear on this ‘not to miss’ pathology.

Screenshot 2017-11-19 11.53.53.png

The Rebels do Washington!

Lovely Pearls here…take a look!

Screen Shot 2017-11-17 at 18.08.57.png

So they don’t like fluoroquinolone then!

Seems these drugs are fairly evil. Look at the listed Sfx profile on this piece. But then, you could do this for many drugs out there.

Screen Shot 2017-11-15 at 14.47.34.png

 

Interesting when tradition gets challenged!

Surely it increases diastolic filling, thus decreasing angina due to better myocardial O2 supply….isn’t that right sir? Well perhaps we don’t actually know really!

Screen Shot 2017-11-15 at 12.21.20

See also the RebelEM take on this:

Screen Shot 2017-11-15 at 12.29.35.png

See also the original ADHERE analysis:

Screen Shot 2017-11-15 at 12.27.39

NSTEMI…or is it!?

Have a look at this lovely article from the crew at emDOCS. STEMI / NSTEMI…or something else? Some good ECG revision too!

Screen Shot 2017-11-15 at 12.04.24

 

#POCUS!

 

Screenshot 2017-11-19 14.34.27

Small bowel moments!!

Screenshot 2017-11-19 14.39.17

Look very closely…all is not normal!

Here is a great case whereby if you just did a POCUS look at a few zones in the lung, you may miss the rather cheekily hidden pathology. Scan them ALL! Lovely……

Screenshot 2017-11-19 14.16.07

Consensus on cardiac arrest POCUS!

Good paper on an agreed protocol set in cardiac arrest.

Screenshot 2017-11-19 14.06.07

SHoC-hypotension core views consist of:

  • Cardiac
      • Additional views when clinically indicated
      • Subxiphoid or parasternal cardiac views, minimizing pauses in chest compressions
  • Lung
  • Inferior vena vaca (IVC) views
  • Both protocols recommend use of the “4 F” approach:
    • fluid
    • form
    • function
    • filling

 

Put the ‘M’ mode across to differentiate!

The presence of B lines on lung ultrasonography is a characteristic feature of both cardiogenic pulmonary edema (CPE) and non cardiogenic alveolar interstitial syndrome (NCAIS), so their presence does not allow the clinician to differentiate between the two entities. This study used M mode ultrasonography of the pleura to differentiate cardiogenic pulmonary edema vs. non cardiogenic alveolar interstitial syndrome.

 

Screenshot 2017-11-19 13.56.53.png

 

Watch it…echo can be done wrong!

A great article here highlighting the point that it can be so so useful, but can be done so wrong. This emphasises the need for good mentoring and peer reviewing of technique in order to ensure you haven’t got too many bad habits. Hopefully it won’t end up being like taking your driving test again….and failing due to all of those bad habits engrained within!

Screenshot 2017-11-19 13.00.34.png

 

What Mimics STEMI on POCUS check?

We helped out a baby in distress!

Screenshot 2017-11-19 12.00.46.png

Screenshot 2017-11-19 12.01.44.png

 

Screenshot 2017-11-19 12.03.10.png

Screenshot 2017-11-19 12.03.54.png

Screenshot 2017-11-19 12.05.23.png

 

Paradicm PE!

Screenshot 2017-11-19 13.04.21.png

Rule out and rule in for PE POCUS??

Take a look. A lot of chat out there at the moment regarding the fact POCUS can back upon your diagnosis of PE. But watch the normal echo for rule out folks!

Screenshot 2017-11-19 14.49.14.png

 

Gastroenteritis!!

Screenshot 2017-11-19 13.07.32.png

 

Scan…and FAST!

Screenshot 2017-11-19 13.09.14.png

Watch pressure on the right!!

Screenshot 2017-11-19 11.51.25.png

Air Bronchograms explained!

Screen Shot 2017-11-15 at 16.43.38.png

 

The Paradicmshift of ‘B’ lines!

Screenshot 2017-11-19 12.49.45.png

 

Screenshot 2017-11-19 12.49.45

 

Dr Chris Fox talks Ted POCUS!

And the picture for me is:

Screen Shot 2017-11-15 at 16.39.10.png

And his video!

You can even POCUS your way to greater airway management!

Another great one in the series from Phillips! We do love their interactive educational stuff. Take a lookout this one…it may prepare you for that dreaded FONA better than not!

Screen Shot 2017-11-14 at 17.33.23.png

Best of Twitter!

I Scanned and found some rather revealing stuff…..

Screen Shot 2017-11-14 at 17.37.37.png

Screen Shot 2017-11-14 at 17.38.47.png

Screen Shot 2017-11-14 at 17.39.31.png

Screen Shot 2017-11-14 at 17.40.08.png

 

RTA…whats there?

Screen Shot 2017-11-15 at 12.16.07.png

 

Get that LDL DOWN!!

Screen Shot 2017-11-15 at 12.01.09Screen Shot 2017-11-15 at 12.00.58

Hyperkalaemia…’the syphilis of ECG’s’

Take a look at this thread with all sorts on hyperkalaemia…the hidden nightmare!

Screen Shot 2017-11-15 at 14.35.17.png

 

Myxomas!

Have a look at William’s collection here!

Screen Shot 2017-11-15 at 15.00.40.png

A load on pregnancy and the CVS!

Screen Shot 2017-11-15 at 15.28.13Screen Shot 2017-11-15 at 15.28.19

 

Toxins and OD’s

Screen Shot 2017-11-15 at 15.31.00Screen Shot 2017-11-15 at 15.31.09

 

Infographics!

Troubleshoot that Vent!

Screen Shot 2017-11-15 at 12.09.08.png

 

MI Territories and ECG leads!

Screen Shot 2017-11-15 at 16.21.59.png

 

Top Vids this week!

An excellent explanation as to why we see ST elevation and Non-ST elevation in the evolution of myocardial infarcts.

Another with slides

Another explaining M.I and coronary territories from Armando

Fabulous ‘Hand Sign’ to remember the territories!

ECG and M.I

 

Until next time and see you at iFAD 2017….hopefully.

JW

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Blog at WordPress.com.

Up ↑

%d bloggers like this: