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!

News!

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

Part 2 here

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.

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?

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?

The elusive RV!

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

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.

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.

Alternatives

Obituary

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

Not Sure

Complications

Steroids for ARDS – are they really beneficial?

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

Don’t be liberal in cardiac surgery

Another transfusion trial in a specific cohort…

Blogs

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

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.

Papworth Anaesthesia bring us their journal watch next edition

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

POCUS!

It’s my belly doc!?

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

Use the power of POCUS

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…

AAA!

We love to hate a thrombus in transit!

Thanks to Vishesh Kumar for this one!

High velocity…drive safe!

PE on POCUS!

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!

1988!

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

Great article!

Nice article on pneumonia!

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

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..

LITFL and pulmonary hypertension

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

The #NAUGHTYFELLOW is back again

LVOT obstruction due to cardiomyopathy and SAM! Brilliant!

AVSD with AV canal #naughtyfellow

Pneumoperitoneum detection with POCUS

Thanks to Giuseppe Sfuncia

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!

Tips on POCUS!

Thanks to Josh for these top tips.

Make your scans holistic!

Don’t just focus on the obvious!

Appendicitis!

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

And the paper…

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.

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