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

Greetings! I hope this finds you all well. I’ve been busy as ever, ploughing through another load of the best hand picked gems from my SoMe trawls….so here are some #FOAM dazzlers for you!



We blogged out about SoMe

Adrian Wong, Manu Malbrain and myself teamed up with the guys at Biomed Central (BMC) to bring you a 3 part series on social media in critical care. We talk you through what this ‘revolution’, is all about. Watch out for part 3 coming Monday!

Part 1 here

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Part 2 here

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The POCUS Atlas goes from strength to strength!

Not only has a vast amount of work gone into it with image supply and acquisition, they  have now sub-divided into some exciting new sections! Invaluable site.

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Papers, reviews and stuff!

Decontaminate that digestive tract

Selective Digestive system decontamination was the buzz back as early as 2002. But what have the multitude of trials shown us?

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Does echo actually improve sepsis mortality?

A fabulous paper, thanks to Segun for this one! So does what we do with echo guided resuscitation in the septic patient actually benefit them from a mortality stand-point?

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The elusive RV!

Which variable should we look at to assess this ‘wrap around’ structure?

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Get your Fascia Iliaca Block in asap!

The elderly suffer huge morbidities and potentially mortality from #NOF. So why leave them in acute pain…at least sort this out for them, it’s a given right?! Great review article by Anaesthesia here on the subject and Fascia Iliaca Block link here.

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The death of a swan…does the Queen know?!

Rob MacSweeny and Crit Care Reviews point us in the direction of some nice papers on the Swann again.


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‘Yes’ and ‘No’ arguments can be found here

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Not Sure

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Steroids for ARDS – are they really beneficial?

There always seem to be controversies over this…read this letter, they have some relevant points.

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Don’t be liberal in cardiac surgery

Another transfusion trial in a specific cohort…

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TBL on stroke…again!

Tenecteplase is one of the newer generation thrombolytics out there. So, in patients with anterior circulation strokes undergoing endovascular thrombectomy, is IV thrombolysis within 4.5 hours of stroke onset with tenecteplase non-inferior to alteplase at establishing reperfusion? Read on with this fab review by Fraser Magee

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ECMO…after CESAR?!

Controversial. How early do you refer these patients to your nearest ECMO centre? Is there one near you? Is it effective from a mortality standpoint. This analysis by Aidan Burrell is brilliant and looks at whether 60 day mortality was improved in patients with severe ARDS who received early initiation of Extracorporeal Membrane Oxygenation (ECMO), compared to standard care.

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Papworth Anaesthesia bring us their journal watch next edition

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So the SSC guidance updates cause a stir again. Are ED’s being slammed with this?

Great podcast by the crew at Total EM here

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It’s my belly doc!?

A great one from the might POCUS Atlas – this time on RUQ pain.

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Use the power of POCUS

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The sun never shines on an empyema!

Here’s one from Rajiv Thavanathan. The CWR shoed a query right upper lobe consolidation!

PICC’s can be a nightmare!

Take a look at these fabulous images from Juan Lopez Mattel. PICC removed, but there’s something suspicious in there!

…then after some antimicrobials and anticoagulant…


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We love to hate a thrombus in transit!

Thanks to Vishesh Kumar for this one!

High velocity…drive safe!

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Thick pathological B-line seen too…

Then there’s a dilated RV….

Ouch…RUQ pain!

Thanks to Phillipe LeConte for this

Alcoholic Cardiomyopathy!

Reduced EF here too…20%

 Urinary bladder diverticulum

Percutaneous drainage of a gallbladder!

Thanks to Robert Ryu for this.

PCP pneumonia on POCUS!

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So even back then, they were warning us of the POCUS revolution?!

Great article!

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Nice article on pneumonia!

Lovely short snippet from Christine Butts on CXR / US for pneumonia.

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Keep things tight and you’ll go far!

Governance in POCUS is becoming a key issue of late. More and more of us are reaching for portable devices, or scanning by the bed space. But are we keeping accurate records, storing images appropriately and indeed….imaging not imagining?! Have a read..

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LITFL and pulmonary hypertension

Chris nixon takes us through the indices used to calculate PA pressure.

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The #NAUGHTYFELLOW is back again

LVOT obstruction due to cardiomyopathy and SAM! Brilliant!

AVSD with AV canal #naughtyfellow

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Pneumoperitoneum detection with POCUS

Thanks to Giuseppe Sfuncia

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They’re just holding their breath!

As Josh Bramwell points out, quite rightly…do not be fooled by the barcode! This is someone holding their breath…so pleural sliding is absent.. you won’t see a nice ‘seashore sign’. But, the interferences we see here are transmitted cardiac pulsations you WON’T get if it’s a true pneumo. Subtle! Oh, and on B mode, you also won’t see many A lines beneath…just saying!

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Tips on POCUS!

Thanks to Josh for these top tips.

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Make your scans holistic!

Don’t just focus on the obvious!

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Use the probe…is it helpful? US Jelly tell us.

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And the paper…

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Controversial – we were SHoC-ED!

So this is the SHoC-ED trial. We have been chatting together about this and do expect a forthcoming podcast on it.Screen Shot 2018-06-06 at 18.57.14.png

Our thoughts:

  • They seem to have excluded a ton of patients in whom POCUS is actually indicated
  • The paper is an incredible amount of work, but by limiting POCUS to just the RUSH protocol and excluding a ton of views and patients that would benefit it hamstrings its results
  • It is a very limited selection of ED patients vs usual care



Tweets and screenshots!

Matthias Eikermann on fluids

Warns us regarding under and over doing it, then the ‘sweet spot’.

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Delirium prevention

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Zsolt Molnar explained fluid boluses!

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Limit the damage

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Know your limits

Damage limitation in surgery.

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Family fortunes!

Deal with your relatives with empathy and sympathy where possible!

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Watch your biases!

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Who are they?

Let’s get know a bit more about our patients.

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Challenges in education at the workplace

Tatjana Dill snaps these from Euroanaesthesia

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Salim reminds us to be CAREFUL!

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Airways, nutrition and the obese

Thanks to Andy Campbell for these

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Hyperoxia – it kills!

Anna Williams took a screenshot of this at Euroanaesthesia.

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here is the paper…IOTA!

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Not all the same!

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Cardiogenic Shock

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Pregnant patients!!

Nightmares occur in Obs anaesthesia…keeping them well oxygenated is key.

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Lung brain cross-talk

A nice slide explaining many of the interactions between the mother-ship control centre and the rest of the body…..the lungs in this slide!

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Don’t jump in on that INR just yet!

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Quit the fags and don’t O.D!

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Antibiotics on ITU

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Head injury damage control!

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Which one does what?!Inhalers in COPD

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Pain free ED with Salim and Ketamine

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Which line then??

A lovely table from Casey Parker.

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complication rates….

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They’re drunk again…there’s no head injury!

So this may be why NICE guidance recommends CT heads in the majority of intoxicated patients. Cry wolf?! See the St.Emlyns bit on this here

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A new approach to pain!

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Pacemaker nomenclature!

Goes with our section here

Thanks to @emswamy for this

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College of Intensive Care Medicine of Australia and New Zealand

Please take a look, particularly at the publications section. A brilliant resource.
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Check out this rather handy resource fro the John Hopkins.

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We love their stuff!

Check out some of the USOTW brilliance! They have some fabulous tools to help you analyse your US clips. This one, M-mode.ify! Also see their others.

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Brilliant Prezi for you

Take a look at this fabulous resource from Luke Howard here. You can download and run some brilliant Prezi presentations and learn heaps!

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More great stuff from the Osmosis crew!

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Until next time,

JW 10th June 2018


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