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.

Papers & Pubs!

Is EGFL the way forward or not?!

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

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.

And some thoughts here:

Lessons from nutrition studies

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

Is PEEP the key…?

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

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.

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!

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….

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.

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???

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

Another good point:

And another…

FOAMed advantages:

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!).

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…

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!

If you burn up, you may do better!!

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

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?

EMDocs do a great piece on endocarditis.

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

The Rebels do Washington!

Lovely Pearls here…take a look!

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.

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!

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!

#POCUS!

Small bowel moments!!

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……

Consensus on cardiac arrest POCUS!

Good paper on an agreed protocol set in cardiac arrest.

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.

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!

What Mimics STEMI on POCUS check?

We helped out a baby in distress!

Paradicm PE!

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!

Gastroenteritis!!

Scan…and FAST!

Watch pressure on the right!!

Air Bronchograms explained!

The Paradicmshift of ‘B’ lines!

Dr Chris Fox talks Ted POCUS!

And the picture for me is:

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!