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

Another fortnightly trawl of the best of the best in infographs, POCUS images, blogs, research and much more. Again, showcasing some of the fabulous stuff the world of #FOAM has to offer.

There is loads here, so scroll and click on what interests you and don’t be bamboozled by stuff that doesn’t!

Best wishes as ever,

JW

News!

We will soon be showcasing more from Hugh Gifford and his amazing art…but in the POCUS world. Watch this space.

You may see a blog from us on the BMC critical Care site soon, as well as a nice shock assessment article with GE…showcasing the Venue machine.

It was National ODP day yesterday, and we paid tribute to the amazing work our 5 ITU ODP’s do for us up here, as well as to those in theatre too. We would be lost without them and their unique, adaptable skillset

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Papers & Articles!

Keep them on the dry side…or perhaps not now!!

I can’t believe we are going against gospel, but this paper from the NEJM is big news in the world of protocolised care in early recovery alimentary surgery!! Read on…undoubtedly, there will be much debate over this for a while…inforgraphic to come too💪👍

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They didn’t get ROSC…bicarb then?

Did administration of bicarb to arrests in the ED, not obtaining ROSC after 10 mins do anything…read on! There is also a related twitter chat below.

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High dose statins may be of benefit to the Japanese!

Well, it may be in those who have stable coronary artery disease.

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Could statins help stroke patients with cancer?

An interesting paper looking at the relationship between stroke patients taking statins Vs those who weren’t and mortality….a data trawling effort, but interesting! Look at the Kaplan-Meier curves, particularly the potency associated set!

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The Hb is dropping!!

Septic patients were assessed and resuscitated in fairly stringent ways in the ARISE trial. So it was only a matter of time before secondary analyses were performed. Below is one interesting one, looking at effect volume resuscitation had in this trial upon Hb values and whether there was a resultant link with morbidity and mortality…take a look.

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 ‘O’ goodness!!

So it seems there could be a link between blood group and your chance of survival following major trauma?! But…were ISS scores high enough and is this again a case of association meets causation floundering? Read on

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The gut talks to the kidneys and vice versa!

We have always said that the G.I tract is often the ‘hub’ in sepsis. This nice review article highlights how one effects the other and how cross-talk can often propagate the septic process.

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Septic cardiomyopathy…the heart that won’t drive!

A nice review article on this topic. There is also a bit of detail on the actual cellular theories behind it as well. Some are not what we thought.

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Totally out of sync!

A fantastic article here, explaining why many patients will fail a CAM-ICU score from the outset! Really worth a read as this is topical at present….circadian desynchronisation is certainly something we will all be hearing more and more about.

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Whiff the alcohol and stop the vomiting?!

An interesting one presented by journal feed regarding the effect of effectively aromatherapy with an alcowipe Vs ondansetron on patients presenting to the ED with nausea. It would be interesting to look at this in chemo patients and post op gynae patients as well IMHO.

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Nasal high flow for pre oxygenation…better get your flows up!

Nice paper here, demonstrating the deleterious effect having nasal cannula under a bag and mask can be on FiO2 levels. Unless you whack up there flows!

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The Netherlands also love it!

So the use of ultrasound is becoming ever acknowledged in clinical practice. Thanks to Adrian Wong for popping us onto this nice little editorial.

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M-Mode only worth it pre-250 scans!

This paper looks at how many scans should be done to pick up pneumothoraces before the user can ditch firing M-mode over the area to help confirmation.

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There has been noise regarding the diaphragm!

A lot has been said lately regarding the assessment of the diaphragm and ‘weanability’ of our patients. This article fully supports the usage of small portable devices in rapid and fairly comparable assessment at the bed-space. A good one for the old Vscan then!

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Scan the chest…it’s insightful!

A brilliant paper on ultrasonography in ARF here.

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Another on the chest!

A nice article on the various useful facets lung ultrasound holds on ITU.

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Is TXA the magic we all thought…in trauma?!

This is a nice chain of correspondence from the NEJM regarding TXA and some caveats to the basic rule…that it’s the best for everything?!

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Lactate clearance in sepsis…surely thats what we all should chase?

A lovely piece as to why this perhaps isn’t the case. Also some revision on the good old metabolic pathways we all hated trying to learn in biochemistry. Nice piece!

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RV failure…need to know’s!

A lovely state of the art review on the subject…intensivists are becoming more and more interested in the more ‘complex side’, of the heart!

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Brilliant Blogs!

Test yourself own lung US!

A brilliant blog and knowledge assessment from AJKDblog

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Hyperthermia… stop the burn!

Here is a brilliant blog & algorithm for this condition, from causative agents, to physiology, to management from ddxof.com.

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Tramadol bashing!

So it’s a commonly prescribed drug, but do you know how it works?! David Juurlink tells us how! Excellent piece.

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Lyness does #LUNG18!

My good friend David Lyness went out to Madrid to cover this event. See his fab summation of the days below!

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What’s best for stroke?

TBL take us through the DAWN trial. So what’s best for acute stroke…double whammy of Thrombectomy and medical therapy, or just medical therapy alone?

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Ultrasound Gel do gastric ultrasound

Take a look at their piece here on the diagnostic accuracy and application of this modality in practice.

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Is RV dilatation over-rated in diagnosing PE in cardiac arrest?

Great podcast and blog on this here!

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Twitter chat also below for you to take a look at.

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Twitter chats!

I started on bicarb!

See the twitter chat here!

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To FICE, or BSE, or EDEC??!

So which course do you do to further your echo skills?? There are a few emerging out there now. FICE takes us through basic and some medium difficulty aspects of critical care echo. E-FICE takes us a bit further and EDEC (European diploma) a TOE stage further as well. SO is there any point in doing BSE L1 then…we aren’t sure!

Click to see the chain regarding this issue and you can decide for yourself.

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Here is an excellent instructional video pointed out to us by Segun Olusanya @iceman_ex. This can also be found here in our basic echo section.

 

Amazing POCUS!

We just love these!

More amazing stuff from Roberto M Lang with his re-enactments of echo phenomena! This time it’s a tight aortic valve for valvulopasty and TAVR!

 

Amazing what chemo can do!

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And post chemo!

Nice case of air bronchograms

A lovely case in Critical Care Medicine regarding the differentiation of pathologies in the lung using US.

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Wow…L atrium!

A massive thrombus in the L atrium of this patient who had cardiac surgery some years ago. Thanks to Loops for this.

Pinball!

Look at this substantial clot in the LV…from Alexandre Azar.

My Gallbladder is moving doc!

Thanks to Dharmesh Shukla for this rather gross US image!

HCM!!

Some record breaking cavity obliteration by a very thick IVS. Thanks to Bonita Anderson for this! Record EF…>98%??!

TR, but not as we know it!

Brilliant image captured here by Leonardo Saavedra demonstrating diastolic TR, as well as the traditional systolic phase.

This is why BP and pulse rate need to be kept under wraps!

AAA transverse view, and look at what happens to the vessel on each systolic excursion! Thanks to Sam Ghali for this!

Justin does liver…and lung!

Thanks to Justin Kirk-Bayley for this brilliant image actually showing how a consolidated lung looks like liver (hepatization)…with a cirrhotic liver to compare it to. Look at the multi nodular border on the liver (right of the screen)

That thrombus trying to escape again!

Thanks to Daniel Saura for this one

Septal rupture in the heart!

This happened after RCA occlusion. 5 days progressive SOB. Would have liked to see colour on it to demonstrate the shunt. Thanks to Johannes Neumann for this.

Cold leg doc…oh, I stopped my anticoagulant by the way!

Tamponade and the ECG!

Thanks to @HeartToProve for this fabulous graphic

Add colour, makes a difference!

Thanks to Eric Abrams for this one. A standard PLAX wouldn’t have told us anything, yet with colour splashed over the valves…bingo!

Be quick in a code!

So Brooks Walsh shows us how POCUS can be done without delaying good CPR during an arrest.

Ultrasound in acute dyspnoea.

Brill stuff as ever from EMATUS and @EkremMusalar.

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Find the cricothyroid membrane

POCUS aids all!

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Bring in POCUS for nephrologists?

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We agree!

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We totally agree…with bias!

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Scan the back

Some nice images on curvilinear scanning of the limbo-sacral spine from Ron George. Sometimes a great help for those difficult epidurals.

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Amazing Infographs

IV/IO flow rates

Salim Rezaie chats us through IV flow rates:

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Then…following a Twitter debate, adds in rates when under pressure👍

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The heart between the lungs

Amazing stuff from @SketchRadiology

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The kidneys in trauma and others!

Again, great stuff from @SketchRadiology

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IBD and rectal cancer!

@SketchRadiology

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Ions and the body!

A lovely simple infographic by Jason Winter Karl Williams.

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TB chest!

@SketchRadiology

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Renal lesions!

From @DocSHannon

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Analphylaxis

From @DocShannon

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Pulmonary hypertension!

From @DocShannon

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A.I won’t replace us…yet!

From @DocSHannon

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RV failure, cardinal signs!

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Another lovely one on those balanced solutions!

Thanks to Tommso Scquizzato for this…see ours here.

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ECMO scribblings!

Thanks again top Tommaso Scquizzato.

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That pesky troponin!

Here is a lovely infographic from the Manual of Medicine on the subject.

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Organophosphate poisoning!

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Anti-allergy therapy

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Delirium in the elderly!

Thanks to Strata5 for this excellent infographic.

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Videos

Airway assessment with insonation

Check out this fabulous talk given by Yasmin Endlich on airway POCUS.

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FAST scanning

A nice instructional video on this from Radiology Nation. Also in our section here.

 

New Sites!

Gastric Ultrasound

Check out this fabulous new resource for all that is gastric US. Added to our recommended sites list!

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Courses of note!

We are running the first of our ED ultrasound courses here in our simulation centre. Headed by Dr Tom Odbert @t_odbert. I will be there teaching as faculty on basic chest and cardiac studies, as well as a bit of abdominal I’m sure. Please email vicky.garrod@ngh.nhs.uk or phone 01604 523282

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