Best of #FOAMed #FOAMcc #POCUS – March (1)

It never ceases to amaze me what is out on Twitter! A wealth of POCUS with some fabulous images, some really interesting infographs, trials, reviews and resources. I have done my usual trawl to try to snapshot what I see as the best of the lot this week.

Sit down, caffeinate and digest….

Big News!!

So the great fluid debate runs on…and on and on!

But the last week saw the release of 2 studies that stimulated a storm on Twitter and in the world of Crit Care. Is it time to put N saline to bed?? My takes on whether balanced crystalloids are better than N saline for critically ill patients are summarised in 2 infographs below. Click them to download them and look here for more infographs!

SALT-ED

What about whether balanced crystalloids had a benefit in patients admitted to the ED Vs N Saline?

Screen Shot 2018-03-02 at 12.43.32

SMART

And whether there was a difference amongst the critically ill patient too!

Screen Shot 2018-02-28 at 15.13.17

Please also take a look at what Salim Rezaie and the RebelEM crew said about both:

Screen Shot 2018-03-09 at 17.41.21.png

You can also see the TBL take on them:

SMART

SALT-EM/D

 

Papers Etc!

 

The Fluid debate…as above!

A lovely paper from Saudi here which discusses the here and now of IV fluid therapy.

Screen Shot 2018-03-11 at 12.04.43

LV diastolic dysfunction for the Intensivist!

This has always vexed me…now clearer on reading this.

Screen Shot 2018-03-11 at 12.16.36.png

 

Sudden Unexplained Nocturnal Death Syndrome…a real worry!

This its a nice article, focussing on SUNDS…which does not sound dissimilar to SIDS. Much of this is not research based, but anecdotal and retrospective, but makes for a really interesting read.

Screen Shot 2018-03-11 at 14.35.14.png

 

Don’t over-test!

Screen Shot 2018-03-11 at 12.45.36

 

Pace them!

A nice article on endocardial pacing in the critically ill.

Screen Shot 2018-03-11 at 11.58.28

 

How high is bad?

A nice article on pre-operative hypertension. Are we getting our ‘knickers in a twist’, too often?

Screen Shot 2018-03-11 at 12.31.26.png

 

Long-term Ventilation…nightmare!

We all get the patients on the unit we can’t seem to get off the ventilator. This article takes us through some of the logistic nightmares involved in this sort of care.

Screen Shot 2018-03-11 at 12.19.58

 

Another reason why patients in corridors could be at risk!

A great paper from the EMJ focussing on behaviour of clinicians when seeing patients in the dreaded corridors of overcrowded hospitals. Did they alter their standard practice?

Screen Shot 2018-03-11 at 10.37.58.png

 

On demand might be superior to the routine!

It appears that on demand nebulisation of acetylcysteine and salbutamol may be non-inferior to routine provision in patients struggling on ventilators.

Screen Shot 2018-03-11 at 10.34.18

 

Sepsis in Africa…

So  lactate clearance may be even more inmortant as a prognostic marker for sepsis. This rather nice paper looks at it in the 3rd world and is worth a look.

Screen Shot 2018-03-11 at 10.14.17.png

 

Drive yourself to failure!

A nice article on why high respiratory drives can scupper you as far as liberation from artificial ventilation is concerned. Also, diaphragm thickening is mentioned, as well as other techniques for assessing Resp drive.

Screen Shot 2018-03-09 at 16.30.54.pngScreen Shot 2018-03-09 at 16.32.49.png

It may not be as simple as a PLR!

So Mean systemic pressure analogue is where it’s all at in order to determine whether your patient is going to be a responder to a fluid challenge or not. Forget CVP!

Screen Shot 2018-03-09 at 15.21.04.png

 

Get the Azilsartan in for hypertension!

A new drug that may have a real effect…but I wouldn’t want to take it and stand up too rapidly! See the trial here.

Screen Shot 2018-03-09 at 17.36.12.png

 

Pulse Ox’s are good!

So this article runs through the effectiveness of our good old pulse ox’s at measuring SpO2 during movement and low flow states…

Screen Shot 2018-03-09 at 15.28.30.png

 

A harrowing article published about our ‘state’

From the Faculty of Intensive Care Medicine. An article on the state of our ITU’s which made the Guardian. Main points below, click the messages to see the Guardian article, the main article can be found here.

Screen Shot 2018-03-09 at 15.04.29.png

 

 

Blogs!

Duncan takes us through coping with the Coroner!

Duncan Chambler takes us through what to expect at a visit to the coroner’s court. Sadly, this is a large part of what we have to do on the ICU , but can be daunting for trainees or court naive people.

Screen Shot 2018-03-09 at 16.01.13.png

 

Burnout!

Matt Rowland has a nice blog here all about physician burnout and the trouble we face if we get, the all too easy to do, work life balance out of kilter!

Screen Shot 2018-03-11 at 10.40.16.png

 

Infographs

We love TXA!

Screen Shot 2018-03-09 at 14.43.57.png

Protect those Kidneys!

A nice little reminder!

Screen Shot 2018-03-09 at 16.03.21.png

 

Plague on Glomerulonephritis!

Screen Shot 2018-03-11 at 10.25.23.png

 

Plague on the ECG leads 1!

Screen Shot 2018-03-09 at 16.08.17.png

 

Plague on more leads!

Screen Shot 2018-03-09 at 16.09.59.png

 

Plagued with Shunt and VQ mismatch!

Check out the Plague as he tackles shunt and VQ mismatch. Click the first image to take you to his page.

Screen Shot 2018-03-09 at 15.44.57Screen Shot 2018-03-09 at 15.46.49Screen Shot 2018-03-09 at 15.47.02

 

Reminder of those enzyme tests!

Screen Shot 2018-03-11 at 11.32.13.png

 

Want a game of ‘Rock, Paper, Scissors’?!

A fabulous representation of the peripheral nerves of the hand and wrist and a way to test them!

Screen Shot 2018-03-09 at 16.11.58.png

 

 

 

Mechanisms behind Herpes induced encephalitis

If you are a subscriber, you can read the article as well! Click image..

Screen Shot 2018-03-09 at 14.54.03.png

 

Do spinals save that #NOF?!

Screen Shot 2018-03-09 at 16.24.14.png

 

Prognostication after CPR!

Screen Shot 2018-03-11 at 10.31.06.png

 

POCUS!

 

How long to train the newbe’s??

We have pondered this for some time and I have made waves to try to get this introduced onto the undergraduate programme here at Northampton (Affiliated with Oxford and Leicester deaneries). Here is a paper looking at how much manpower was needed to facilitate and introduce / run a programme scoping the whole of basic ultrasound.

Screen Shot 2018-03-11 at 10.27.31.png

 

Is the Stethoscope R.I.P?

Screen Shot 2018-03-09 at 18.03.46.png

 

Is the stethoscope R.I.P…part 2…maybe not?

Read this brilliant article discussing the addition, not replacement of the stethoscope to traditional auscultation. Insonation….like it!

Screen Shot 2018-03-11 at 10.48.24.png

 

LV Pseudo Aneurysm

PE and LVOT!!

 

Poor LV!

 

Myxomas and more myxomas!

Click the link here for a library of the critters!

 

Mitral Valves can be done without surgery!

Use a balloon to open up your rheumatic valve!

 

Sometimes, the lungs are for more than breathing…they’re for seeing!

Cian McDermott reminds us you can get great views of the heart through the lung!

 

Tamponade and it effects elsewhere!

 

So a double barrel septum??!

No…just an enormous moderator band! And another below:

 

Manu reminds us why they may be hypotensive!

 

Massive hydronephrosis!

 

The IVC…with caution!

Screen Shot 2018-03-09 at 17.21.41.png

 

Watch it when your draining!

Screen Shot 2018-03-11 at 10.59.19.png

 

Get it right!

@EMugs_ tell us how to measure the IVC correctly!

Screen Shot 2018-03-09 at 16.15.09.png

Further slamming the IVC!

We CAN use hot to predict fluid responsiveness in the ventilated patient…but what effect does IAP have on the values? Will it cause inaccuracies?

Screen Shot 2018-03-11 at 11.16.20.png

 

 

So use the SVC….not IVC!

Screen Shot 2018-03-11 at 11.00.21.png

Use M-mode!

Screen Shot 2018-03-11 at 11.01.50.png

 

Another giveaway in Tamponade!

Screen Shot 2018-03-11 at 11.03.09.png

 

 

Amazing Vids!

Is EF misunderstood?

  • EF is a characterization of ventricular ejection: the stroke volume (SV) expressed as a fraction of end-diastolic volume (EDV)
  • Knowledge of EDV is essential to translate SV expressed as a percentage (EF) into absolute SV, a quantity of more physiological and clinical significance, hence our admonition that no one should ever mention EF without, in the same breath, diastolic volume
  • The long-standing emphasis on ejection fraction (EF) is misguided. EF is erroneously assumed to be a measure of myocardial contractility
  • Of greater concern is the widespread classification of patients with heart failure (HF) based on whether EF is preserved (HFpEF) or reduced (HFrEF). In fact, EF does not provide any specific information on causation or underlying mechanisms.

And a brief overview of what EF is:

How to measure it with echo:

 

The Long and Short of it all!

Aidan Barron takes us through both techniques in a fabulous video!

 

Understanding Lactate!

Brilliant stuff by Resus.me.

 

Fascia Iliaca Block

Another great from Jacob Avila.

Screen Shot 2018-03-11 at 11.04.25.png

 

Posters!

Look at the Diaphragm to predict weaning

Goes with what we said above, but download the poster from iFAD here.

Screen Shot 2018-03-09 at 16.46.25.png

 

You want to be Blood Group AB!

It appears that Matt Morgan and colleagues may have hit onto something here!

Screen Shot 2018-03-09 at 17.04.45.png

 

Resources!

 

Bronchoscopy Simulator!

Check out this fabulous bronch simulator. Get’s you around the anatomy beautifully. This will be brill for trainees, particularly those going through thoracic anaesthesia modules.

Screen Shot 2018-03-11 at 10.19.09.png

 

You want to ‘bling up’ your presentations!?

Take a look as First10EM guide us through the best sites.

Screen Shot 2018-03-09 at 17.32.14.png

JW 9th March 2018.

Thats it for now….but do also check out our fave companion sites:

Life in the Fast Lane

Critical Care Reviews

Propofology.com

The Bottom Line

Advertisements

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 )

Google+ photo

You are commenting using your Google+ 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 )

Connecting to %s

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Blog at WordPress.com.

Up ↑

%d bloggers like this: