Hello to you all and here we go with another session of Tweets, POCUS, papers and the rest, from the best…..

News!

We made LITFL again!

Thanks Segun, for putting us into the fair dinkum section!

We promised Part 3…here it is!

Part 3 of our series on SoMe here!

Debate…not an arguement!

I got into rather a long debate with a colleague and some of my POCUS buddies regarding pre-hospital US and it’s usefulness. It actually started with regard to a paper you will find later in this post. I mentioned training paramedics to perform pre-hospital US. The whole thing then transcended into a chat regarding POCUS governance and application in the hospital setting. Have a read…I feel a blog on this coming on!

Papers!

Albumin…historical and physiological perspective.

Here is a nice piece by, well, possibly some eminent authors! Takes us through how this plasma protein we love to hate to give is synthesised etc. This came off the back of a discussion I was having with a colleague as to why he was giving it to our patients in what I thought was a rather random fashion. The ‘vogue’ is to give it in septic patients who’s albumin level is <20 apparently?

Below is an interesting one regarding it’s provision after major abdominal surgery too…

Is POCUS unnecessary flash!!?

This paper debates whether we are getting a little too over-excited about good old POCUS. I still think it beats the stethoscope for all that isn’t wheeze..but there you go!

Prognostication after cardiac arrest

Prognostication in hypoxic brain injured arrest survivors has always been contentious. This review discusses some of the in’s and out’s including the good old 72 hours after ROSC ‘golden point’.

It’s almost 50 years

The Harvard brain report was one of the first and caused a lot of controversy. It laid the foundations for what we now rely upon to diagnose and justify death (brain death). Take a look at this interesting discussion…follows on nicely from the above paper!

Cardiogenic shock after MI!

A great paper pointed out to us by Rob MacSweeney.

What would you do?

Here is a fabulous ethical dilemma and one we face a lot on the ITU. Do you escalate or not? Do you place a DNACPR or not. Thanks to David Anderson for the pointer here. Look at the poll result below on it too. Were you in the ‘no’, camp??

Bicarb…inappropriate administration!

Have you seen or heard of people giving bicarb to acidotic patients, without careful consideration of causality? Perhaps I have, which is why this paper adds fuel to the fire for the call ‘AGAINST’! Unless the situation is appropriate….I had to add that.

E-FAST is possible in 4 hours!

This paper from Turkey explains how they gave instruction to med students on EFAST, and 4 hours seemed to permit some semblance of competency….read on…

Blogs!

How dare you wear nail varnish!

You can’t have nail varnish on as a patient…they can’t read your sats! Wrong….

St Emlyn’s bring us trauma updates!

There’s the infographic below too.

Bicarb on ICU!?

TBL take us through the paper we mention above. Another corker! In critically ill patients with severe metabolic acidaemia (pH ≤7⋅20), does the infusion of sodium bicarbonate, compared with no infusion, to reach and maintain a targeted pH of 7⋅30 decrease the primary composite outcome of mortality by day 28 or the presence of at least one organ failure at day 7?

Special K…the EMDocs way!

A nice article on the usage of Ketamine in sedation. It’s not JUST there to ‘knock out’ your patient!

Splash the O2 over every patient…do we care; not one IOTA!

TBL take us through the IOTA trial looking at whether liberal Vs conservative O2 strategies in patients with sepsis, critical illness, stroke, trauma, myocardial infarction, cardiac arrest and those who had emergency surgery increased hospital mortality.

Pain in the polytrauma patient….simplified

Thanks to PainandPSA.org for this.

POCUS!

Something not right here?!

Look at these mitral valves, then look at what a little colour can do.

…then colour!

Check out this fabulous blog piece on the pitfalls of pneumothorax detection

Great title here for this piece, showing us that finding that lung point can be very tricky. Also the best side to side images of chest scans I have seen in ages.

Lung sliding is observed in the 2nd ICS, a lung point is seen in the 3rd ICS and lung sliding is absent in the 4th and 5th spaces.

All about the trees!

Cian McDermott finds this brilliant image / infographic for us helping stage degrees of hydronephrosis.

The aortic valve says ‘Namaste’!

If it can do this…it’;s most likely to be normal!

Large or largest?!

Look at this LA from Parham Eshtehardi!

The chaps at @ultrasoundpod show us a bit of Mal-scanning!

You would think longitudinal scanning would be best to visualise a vessel…watch it for AAA!

POCUS this week!

Balint Botz takes us through some of his finds this week….nice compendium!

Water makes the sound go round!

Brill…add water into the cuff to make tubing clearer!

AMI in the making?!

POCUS…I don’t need exams!

Thanks to Adrian Wong for this one. This has been a big debate of late. If you have attended courses, scanned and sat an exam, does that make you any better at POCUS than someone who maybe hasn’t done an exam therefore doesn’t have a ‘qualification’, to use ultrasound? We think time spent with patients, scanning, adhering to good governance, buddying up with like ultrasound enthusiasts and escalating up the expertise ladder to specialists is the way. Exams are sometimes not worth the paper they are certified on when it comes to patient care…

What’s the point of pre-hospital US?

Thanks to @UwashEM for this

More on that diaphragm!

Here is a helpful video on assessment too (turn your volume down as the teacher is LOUD!)

Rock it, slide it, sweep it….Bop it!

Sounds like something relating to that annoying kids game! But, there is still debate even around the correct description of probe movement! See this great vid from UTS Aus on the subject.

Thanks to Janelle Bludorn for this table on it too.

Serratus Anterior block!

ASD from Christian Fox

The subclavian shrug!

A dodgy dance you’d do at a wedding disco! Great to help get access to the vein on SCV US.

The LV that’s crying out!

When PA pressure causes the LV to shriek out for help! Thanks to HeartToProve for this!

Check this out for recruitment!!

Thanks to Robert Arnfield for this cracking view on US of why a good recruitment manoeuvre can really help our patients!

Lovely lung point!

Thanks to TrEMATUS for this one…brilliant demonstration.

Look at the IVC

FAST in 4 minutes….

Check out all of the Radiology Nation playlists while you’re there.

Check out this case; puts it all together!

ECG, Cath lab and TEE findings all bundled together to better patient management.

Good old TEE!

Want to move POCUS on a bit?

Here is a great paper on some of the more advanced POCUS modalities you can start to practise to help your patients as your confidence builds. Thanks to Cian MacDermott for the pointer here.