Another edition and loads to talk about, as ever. Let’s crack on…lots to click on and catch up on at your leisure. I hope you enjoy it.

 

News!

CCR 19 is coming!!

Get booking here

Is this for real?!

At first, I thought this was an April fool…then realised its May! Exciting potential to convert your laptop into an US machine??

We made LITFL again! 

Thanks to Segun Olusanya and his keen eye…we got spotted again. It always gives me a rather warm feeling inside when this happens. So thanks for the mention again!

Log those Echo’s!

Download the Echolog app below. A great way to keep up to speed with your scans!

We did an ankle block video

One of those you need to continuously, so we got one of our podiatrists in to show us how to do it the anatomical way! I for one am so ultrasound guided these days…so this was a real help!

Also check out this brilliant site on the subject…and more.

 

Papers and articles!

Heterogeneity…it’s rife!

There have been so many sepsis trials recently, but why are the results amongst controls so diverse? This article looks into it…

Dreaded ‘kissing disease!

So over 90% of us carry it, some were poleaxed by it, others suffer no ill effects. But it can be nasty.,…read on!

Which to taper?

So you have a patient on concomitant Norad and Vasopressin. Which do you wean off first? This paper looks at a rationale for doing one over the other.

Check out what FOAMed can do for your altimetrics!

A lovely paper highlighting much of the work of the International Fluid Academy and Manu Malbrain et al. This soared to number one within the Annals of Intensive Care’s output altimetrics.

Pulmonary hypertension – reviewed!

Lovely piece here on the condition we all love to talk about, but hate treating!

Intervene or not?

A lovely article looking at PCI and the pitfalls. Is it the be all and end all in chest pain / ECG changes?

Tube them pre-hospital – will it give them a better outcome?

Take a look at this paper looking at the outcomes of EMS placed supraglotticc airways Vs intubation in out of hospital arrest. Caution – there is rather a large confounder for poor outcome from the start…cardiac arrest! Interesting nonetheless.

Do we go for pro-calcitonin guided management across the board?

Perhaps…I suspect immediate benefit may be on cost, rather than mortality untill we see larger papers.

Check out Papworth Anaesthesia’s Journal watch!

Swan Ganzers!

A great series of editorials on whether we should bring back the good old-hat method of monitoring cardiac output and EVLW. What’s your view?

Swan or none – Yes to the catheter! 

Swan or none – No to the catheter 

One size does not fit all!

It may be down to where you are from as to whether much of the research we do actually applies to you!

MAPSE and GLS…is the combo better?

So we all consider MAPSE to give us a semblance of LV function, when considered with other measurements. But what if we adjust it for patient demographics and in particular, with global longitudinal strain in mind?

Blogs!

TBL take us through another interesting TTM trial!

In septic and mechanically ventilated patients aged 50 or over, does 24 hours of induced hypothermia followed by 48 hours of normothermia improve 30-day mortality compared to routine care? TBL go through the paper for us.

Hyperkalaemia…make it less life threatening!

EMDocs take us through the fundamentals of management of this heart stopper!

Sepsis-3..lets continue ripping into it!

Since it’s conception, which in fairness was to increase sensitivity in pickup, it has been pulled apart a bit. So see what the RebelEM crew wrote below.

They might collapse…but they have an arrhythmia!

Journal Feed take us through this nice discussion regarding those arrhythmias you may not want to see associated with syncope in the elderly.

10 loads of bo****ks to do with neurocritical care!

A brilliant piece from Josh Farkas as ever.

New therapy for heart failure!

Heard of Sacubitril?? Well nor had we until this from RebelEM. Does it work for heart failure and does it improve outcome….?

 

Endocarditis…the Plague way!

Augusto takes us through this pathology, with the Duke criteria. Brilliant work as ever!

POCUS!

The guys at USOW are so busy!

This podcast discusses the good old McConnel’s sign to diagnose PE…is it really that useful or specific?

Another case!

Check out this brilliant piece on Takutsubo  syndrome.

Don’t be fooled!

Don’t just press with the probe when looking for DVT, use colour flow too to visualise flow. There may be some, so it may not be an occlusion DVT! Great blog on this here by Alex Hart.

EM Vs Radiology!

Were EM physicians as comparable to radiologists in diagnosing nephrolithiasis?

PE….massive one. What would you do?

Check out the discussion on this within the chain. Really interesting to see everyone’s takes on what to do with the patient.

Spine sign!

Another note to us all…if you see the spine like this on chest US, there’s fluid or consolidation involved allowing the US through to the back!

Window to the soul…

Well, to the heart anyway! Monica Romeo demonstrates how we can effectively use the liver as a window to many of our ultrasound views.

Pulmonary Hypertension – pathology combo!

Gonzalo Garcia-Cassasola shows us how CT, doppler and echo images can combine beautifully to demonstrate pathology.

Another what would you do case!

Nice case from Yale EM Ultrasound on a 80YO female with malignancy, and this on the echo. Thrombolyse, heparin?

Enormous PE!

From the Yale EM US posse again. Look at the LV…I’m surprised this patient made it through this episode. tPA given apparently!

Cardiovert away

Thanks to Cian McDermott for this!

Stones, bones, abdominal moans and…emboli!

Thanks to Juan Morales-Torres for this. Right flank pain not caused by a suspected renal stone…an embolus from this!

Look at the size of my guns!!

So weight lifting +/- steroids…plus an ultrasound. Ever seen rhabdo on a scan…you have now!

Ruptured kidney

Thanks to Yale Tung Chen for this view of a ruptured kidney cortex.

Endocarditis!

Thanks to TRematus for this scan of the PMVL and some vegetation’s harboured thereon!

Check the spine sign!

Sloshing about with small bowel obstruction!

RUQ pain and renal failure?!

Golden Rules of Ultrasound!

The POCUS course UK show us the rules!

Subclavian – the ultrasound guide way!

See our lines section here too.

And a blog on the same!

See emDocs blog on ultrasound guided SC vein catheterisation.

 

Infographics!

Usama Nasir does prednisolone

A great infographic on the subject of alcoholic hepatitis and the role of prednisolone.

Avascular necrosis!

Nice mnemonic from Pastest

Hypertension

Hannah Abrams shows us the basics in a lovely infograph!

Press on!

Casey McQuade talks us through the action of pressor drugs….

It’s the triple!

So is single dose triple inhaler more effective in COPD than standard single meds?

Combine the scores with POCUS

The Wells score in combination with ultrasound…any better? Thanks to Giuseppe Sfuncia for this.

Get the Resus right…wet flag!

Salim Rezaie takes us through WET FLAG in paeds arrest.

What’s the antidote?

A nice visual of some common antidotes for common overdoses / poisionings.

PERC the PE!

A lovely infographic on the PROPER trial…

See RebelEM on this below.

Tweets!

Segun finds a belter here!

Click here to download the document. Thanks Segun!

Watch where your pacemaker leads go!

AF…defibrillate!!

Follow the chain!

A great chain to read on the assessment of diastology from some brilliant contributors. Click the pic…

Sleep is important!

 

 

Sites we discovered!

As well as the Vault for regional above, we also love:

For all that is Echo!

 

Videos!

Pulmonary physiology by the Guru!

A fabulous one by the great West himself…..you know, the guy who wrote that book we all obsessed about in anaesthesia!

How to order blood products appropriately!

Use a TEG…here is a nice video on the subject.

Elevated Lactate….another run through!

Nice video here, simple and sweet!

See our guide here too.

Talks to download!

The end of the world as we know it!!

Brilliant series by Ales Psirides, we picked up whilst doing our blog on the SGANZICS meeting. Alex has provided links to them below!

Until next time

JW