There are many reasons for a raised lactate. Identify the cause and then you will know if you need to do anything about it. Hint - it's usually not IV fluids. Lactate-CCNDownload
Lactate
Fluid guideline for critical care patients
Fluid-guideline-ICU-CCN-1Download
Hypernatraemia
Hypernatraemia is an independent predictor of mortality. DOI: 10.1093/ndt/gfm831. It is completely avoidable. This downloadable 1 page guide outlines causes, diagnosis and treatment. Hypernatraemia-guidelineDownload
Hyponatraemia
Hyponatraemia can be confusing to diagnose and treat. Here it is all on 1 page! Hyponatraemia-guideline-3Download
Best of #FOAMed #FOAMcc #POCUS #echofirst finds – May (2)
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... Continue Reading →
Best ED #FOAMed #FOAMcc #FOAMem #POCUS – December (1)
So here we are with some of the grabs from around and about in the world of EM. Another to follow soon. Infograph of Note.. This one is in the repository, but a great reminder of how to spot that impending occlusion as it could be happening. Twit Choice! Mutton Jeff! Here is... Continue Reading →
iFAD 2017 – #IFAD2017 #FOAMed #FOAMcc #POCUS possibly the best meeting in the world!
What was it about?! The aim of this sixth edition meeting is to review recent advances in fluid management, and hemodynamic and organ function monitoring in the critical care setting in a comprehensive manner for intensivists, anaesthesiologists and emergency physicians as well as interested internists and surgeons. However the meeting will deal with any broad... Continue Reading →
Fluid Therapy Part 2 – Fluids Beyond Resuscitation! #FOAMed #FOAMcc #POCUS
Before we go any further with this post, please do join us for this amazing meeting: Programme Register here Submit your Abstract here Abstract It is imperative to acknowledge that there are four main indications for fluid therapy. The United Kingdom’s National Institute for Health and Care Excellence (NICE) recently provided a complete set... Continue Reading →
Best of #FOAMed #FOAMcc #POCUS – June (2)
Here is the podcast discussion this post. Click the pic and listen along as you read! A sift of FOAMed FOAMcc and POCUS gems. Enjoy! Papers and Stuff! A great article worth looking through, outlining the utilisation of ultrasound in critical care. 10 points why it is a highly useful diagnostic aid to the critical... Continue Reading →
Best of #FOAMed #FOAMcc #POCUS – June (1)
Here's another for you! Lot's going on as ever...and this is always very hard to put together without getting too carried away! Podcast 3 from the Two Jonnys coming your way this Thursday too...looking forward to that. Thanks also to Rob MacSweeny, as ever, for his hard work trawling about and putting together the always... Continue Reading →
Best of #FOAMed #FOAMcc #POCUS
Here is my latest trawl of what I considered to be the best of FOAMed at the moment. This is certainly not exhaustive...you can end up like a child in a sweetshop otherwise! The podcast discussion I had with Jonathan Downham can now be heard by clicking the pic below. This is episode 2 of... Continue Reading →
48hrs of #FOAMed finds! #FOAMcc #POCUS
Sorry for the lapse! I just wanted to promote what I see as one of the best forthcoming meetings in Antwerp (November 2017). The International Fluid Academy meeting! This 3 day meeting promises to fill your eager brains with masses of the latest evidence, key pearls and key discussion points from a wealth of high-end... Continue Reading →
Magnesium; the cure for all arrhythmias? #FOAMed #FOAMcc
We look at it daily on routine ICU bloods, it is used to help various acute conditions, it is always checked in the setting of cardiac arrhythmia....it burns with a glowing flame! We seem to obsess with keeping it’s serum level at the higher end of normal....is the fuss justified? It is true that hypomagnesaemia predisposes... Continue Reading →
This Week’s Best #FOAMed #FOAMcc #POCUS (March 13-19)
Another really busy week with various meetings going on around the world. This is a selection offering you an insight into what has been going on out there recently, and do remember that many of the Twitter shots contain clickable links! Lots of POCUS, as well as lots of new papers and reviews from Critical... Continue Reading →
The Week’s Best #FOAMed #FOAMcc #POCUS (20-25 Feb 2017)
A bad week on ICU! Pericardial tamponades, many of the sickest patients I have seen for quite some time, tight aortic valves and a lot of POCUS!!! So..a lot going on this week, but I have been trawling and hope this gives you an idea of what's been going on? Make sure the kids are... Continue Reading →
The week’s best #FOAMed #FOAMcc finds (3 – Jan 17)
Loads to get through here...so if you're looking at this in theatre (ensuring your patient is safe as No. 1 priority, obviously), you are probably doing it during a long case. To the rest of you, grab a large coffee and relax as you read. Lots of the screenshots may also have links, so do... Continue Reading →
ENVOL study – is there a marker for positive fluid balance? #FOAMed
WHATS IT ABOUT? The maintenance of optimal blood volume without the development of a positive fluid balance is something we are all striving to achieve for our critically ill patients. Sick patients become 'leaky' and we continue to fill them with fluids, chasing a worsening situation as they seem hypovolaemic. They get: Large... Continue Reading →
Volume Overload: Prevalence, Risk Factors, and Functional Outcome in Survivors of Septic Shock #FOAMed
A study carried out in an academic county hospital in the US examined the associations between volume overload on ICU discharge, mobility limitation and discharge to a healthcare facility amongst survivors of septic shock. Septic shock is commonplace in critical care and indeed, its incidence is on the increase. With this however, we are seeing... Continue Reading →
Albumin…should we dig it, or ditch it?
Intro I am always asked by vigilant ITU trainees of all grades, 'should we give some albumin here; what do you think?'. In answer, my response is normally...no, it has no mortality benefit at all. But am I being harsh? Physiology for dummies! So albumin: Maintains the oncotic pressure (+ plasma volume) in blood vessels... Continue Reading →
Is the literature inconclusive about the harm from HES? We think….Yes!
A recent editorial discusses the thorny issue of fluid resuscitation. Notably, there is still no consensus about the major aspects of fluid resuscitation. It's the usual rigmarole we face....no clarity about when to start and stop fluids, how to guide them or even how much to give. The bulk of the research has been focused on comparing... Continue Reading →
