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

Still melting in the sun? Watching England apparently playing football for once….need a break from all of this? Then read on and absorb the best POCUS, papers, resources and much more from the FOAMEd world! Buckle up!

News!

Jeremy Hunt stepped out of his role as UK health secretary…..

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Dave Lyness does ITU trials April 2018

Great works as ever from David here. Click to download from his site.

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Papers and Reviews!

More lumens equals better flow…no?!

Well…what do you think. This simple study looked at flow rate through all 3 lumens of a CVC line Vs cannulae..

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POCUS makes a difference…doesn’t it?

A nice paper here looking at an analysis of publications pertaining to POCUS and patient management. The table of inclusion studies makes for a nice snapshot into what has been done in a body system format. Does it make a difference then…to interventions and diagnoses; yes! But to outcome…read on?

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Here’s Dexmedetomidine again…this time in a paravertebral!

Adding this super drug into your paravertebral block pre-OLV, may decrease the incidence of severe post-op pulmonary complications.

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Beta blockers to COPD patients…no!?

This nice paper from Chest delineates it is possible to give beta blocker therapy to patients with COPD….with due caution!

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The evolution of IV fluid therapy

A fabulous paper on the subject well worth a read.

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Surely adrenaline is best after MI?

Maybe not. Take a look at this paper comparing the 2 drugs on evolution of CS after AMI. It’s a small RCT, but epi resulted in increased tachycardia, lactic acidosis & refractory shock vs norepi in CS. With SOAP II trial in the NEJM showing decreased mortality with norepi vs dopamine in CS, norepi is emerging as default pressor (but should be individualized based on hemodynamics).

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Propofol…the cure for cancer!?

A grandiose and rather daft statement I realise, but it appears our milky white friend could hold some keys to further cancer management. Intriguing stuff.

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Recruitment, PEEP titration…it all kills!??

We saw the results of the recent ART trial. Now this…..but, taken with a slight pinch of salt, it is still situation specific and we shouldn’t simply bin this as an option. Read on…

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TAPSE all the way?

This review looks at what most quote as their indices of choice for the assessment of RV function.

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Papworth do it again!

Another great selection of papers here.

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It’s good to be negative…well with fluids anyway!

Funnily enough, Papworth picked up on this one too. A great paper delineating that day 3 could be the sweet spot to deresuscitate on ITU.

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Watch your retinal scanning!

Excuse the tenuous link there. But retinal detachment can be diagnosed falsely in many patients.

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Survival of the fittest

Goes without saying really, but what is apparent in this case series of 210 patients brought into the ED with ongoing CPR, only 1.3% survived to go home. Is there a place for stopping before they get in….difficult one! It’s so difficult for our paramedics to make this call….they can’t!

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Late breaking trials from the American College of Cardiology Scientific Sessions

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Blogs!

TBL do starch!

A lovely piece written about this 2012 landmark trial which caused an almighty stir with the FDA ultimately! In critically ill adults with severe sepsis, does 6% hydroxyethyl starch (HES) compared to Ringer’s acetate reduce the incidence of death or end stage kidney failure?

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Adrenaline and more adrenaline for PEA…not necessarily!

You can see what pseudo-PEA looks like below in the POCUS section. But this is a fabulous blog, as ever, by the RebelEM crew on the subject. Key points below too.

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Dantrolene…you know, the one you can’t dilute!!

We see many hyperthermic states on the ICU. We administer therapies to patients to reduce the metabolic rate in attempts to  prevent rhabdo and death. But what’s the role of dantrolene in all of this? Is it the ultimate antidote? Sarah Shafer from Tox&Hound talks us through this drug…

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Bicarb gets you ROSC!?

Did we see a higher sustained ROSC rate when sodium bicarbonate was administered to acidotic patients after CA? Anand Swaminathan talks us through the results of this trial

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That LAD again!

ECG Corner give us a nice reminder of coronary artery territories and ECG changes. Here, a very proximal LAD occlusion.

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Tamponade and all you need to know!

A beautiful piece from EMDocs here on tamponade and the minutiae of what’s important.

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Basic ABG’s!

A lovely piece from David Kaufmann et al on basic ABG interpretation.

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Learn more about cardiac arrest and even better…get learners to absorb!

Brilliant stuff highlighted by CanadiEM on this. Teaching this stuff is great at the time, but then, once the course had been attended and candidates are released back into the wild, knowledge decays. So how can this be improved? For each topic, they provide suggestions for improving provider performance (with downloadable graphics to accompany them), that may ultimately optimize patient outcomes from cardiac arrest. See below!

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POCUS!

To start us off!

Are we scanning every patient, do we scan on the round, after, or all of the above. See the results of Segun’s survey and also take a look at the associated chain of replies.

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JKB takes the ultrasound everywhere!

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Can POCUS diagnose chest pain causality?

Thanks to US Gel for this.

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We are still behind on this!

I have been trying to push this with some of our locality med schools…it’s tough as there isn’t enough time for this in an already tight curriculum. But there should be, as US seems to be a future must requirement….

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More complete heart block and AV dissociation

Daniel Ambinder again here, also note the ECMO cannula in situ.

 

Look into the eyes….

Papilloedema and ONSD’s together give a great diagnostic yield.

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RV problems…after a hunt with POCUS!

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Reverse the flow

Nice clip from Andrew Liteplo demonstrating reverse hepatic vein flow post arrest.

Why 3rd degree block causes collapse!

Thanks to Stephan Achenbach for this.

Nasty old valve!

Thanks to Mark Lucey for these. An old AVR with an abscess and LA communication, nasty!

 True…or false?

Thanks to EMUSS for this demonstrating the difference between  true PEA and false!

POCUS for PE

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Not one to see on POCUS!

But you might, as part of your quick assessment during arrest. Thx to the POCUS Atlas for this image.

HIV and endocarditis

Thanks to Jorge Morales for this

Tamponade and Jordan Jumping!

Brilliant as ever from @ultrasoundjelly! Demonstrating RV dysfunction during tamponade conditions

Large Ascending Aortic Aneurysm

Thanks to Ivan Stankovic for this.

Naughty mitral valve!

Gonzalo Casasola shows us what can happen with late MV prolapse!

Ouch…it’s appendicitis!

Arizona Ultrasound point out this self diagnosed appendicitis!

RWMA’s

Erica Beatty runs us through this territorial tutorial!

 

 

Tweets and Pics!

Do you know much about ATN?!

I didn’t…until I read this wonderful chain from Tony Breu on Twitter. Click to take a look.

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Pre-op fasting…its a devil!

From EBPOM, surgery is diabetogenic!

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EPOCH – was there a difference?

So this trial was set up to see whether we could improve the peri-op care of surgical patients using a Q.I arm in a trial. The aims; to provide more reliable peri-operative care based on evidence based practice: the right interventions, for the right patients at the right time, every time and reduce 90 and 180 day mortality. Preliminary results were announced at EBPOM. So, not a great difference…does this mean that we do the right thing more often than not then. This negative trial is positive then? Longer LOS in the QI arm though!

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SNAP-2

Some more slides from EBPOM

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Post-op cognitive disorder!

It seems that giving a ‘good’, anaesthetic is all you need then?? More from ABPOM.

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Imagine this luxury!

From EBPOM…dedicated sonographers on the ICU….imagine!

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Infographs!

Dixie does 70 years ITU!

Lovely piece here from Aoife regarding all of the work Crit care units do for our patients!

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Acidosis and Alkalosis simplified!

Some great mnemonics also included!

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Treating MI…its a Marvel!

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Remember this…it’s a CXR!

Thanks to Sam Ghali for this image.

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Types of spinal cord injury

Thanks to Sekran Eroglu for this.

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AliEM cards does ARDS!

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The heat is too much

Strata5 takes us through heatstroke…fits with the weather we’ve been having!

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Handover in the MIST!

Amy Lynn points out a rather nice way of getting information from first responders to the ED receivers.

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Videos!

Pace it!

Franz Wiesbauer points out this great video on pacemakers.

Why are they bleeding?

A lovely video pointed out to us by Franz Wiesbauer on appropriate tests for the bleeding patient.

 

Resources!

Echo Guided Life Support

Take a look at this site. Talks you through how-to! You have to pay for the e-learning section, the course and the book. But worth a look.

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Watch that inferior epigastric artery!

A nice .pdf document here on the matter for you to download.

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Until next time!

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JW

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