Pulmonary Embolism

This month’s questions: In patients with pulmonary embolism and evidence of right ventricular failure as a result of acute pulmonary artery hypertension: 1. How is the decision made as to whether to thrombolysis is appropriate? 2. When should surgical or mechanical thrombectomy be considered? 3. Is there a role for inotropes and if so, what is … More Pulmonary Embolism

Line management

This month’s questions: 1. What determines whether we anticoagulate our patients with line related thromboses? And when is the optimum time for line removal? 2. Should we be placing midlines instead of peripheral cannulas when the need arises for non-cvc related access in our ICU patients ? This month’s paper: Essential reading in the  form of https://www.nejm.org/doi/full/10.1056/NEJMoa1714919 , or is … More Line management

December 2018 Journal Club

Hi Everyone This months paper can be found here : https://www.ncbi.nlm.nih.gov/pubmed/26963326. Enjoy! “Hi Everyone Hope you enjoyed the paper! I thought I’d end the year on a philosophical note by raising the concept of the fragility index (this is summarised beautifully here (https://lifeinthefastlane.com/ccc/fragility-index/)) but if you don’t fancy clicking there; in essence it’s a tool … More December 2018 Journal Club

Status epilepticus

1. What are the essential investigations for a patient presenting with refractory status epilepticus? 2. Once traditional treatments (propofol, benzodiazepine infusion, and barbiturates) have been exhausted what should be our next line therapies? 2. Where should these patient’s be managed and what is the minimum monitoring standard?   This month’s paper is a fantastic article from the NEJM from this year, … More Status epilepticus

October 2018 Journal Club

Hi Everyone Have a look at this month’s paper here https://eur03.safelinks.protection.outlook.com/?url=https%3A%2F%2Fjournals.lww.com%2Fshockjournal%2Ffulltext%2F2013%2F12000%2FRadial_to_Femoral_Arterial_Blood_Pressure.13.aspx%23R11-13&data=02%7C01%7C%7C7229646d25464736f0f008d638eb2985%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C636758979987318298&sdata=N5oE9oVKkCGZIMh8cG%2Ba0l2oEqCISF1q5ChccLYBfPc%3D&reserved=0 It’s food for thought….. Cheers Rob “Hi everyone Hope you all enjoyed the paper! I appreciate that this isn’t a very “academic” topic but it’s something that has always interested me, namely how reliable / robust are the numbers that we aspire to normalise? … More October 2018 Journal Club

QOTM – BP management in sepsis

This month’s questions: 1. In patients on escalating doses of vasopressors (and/or inotropes) should we routinely be inserting a femoral arterial line to correlate with radial arterial pressures, and if so and they differ which pressure do we target? Is anyone doing this already 2. Is there ever any benefit in using inotropes as part of the management of septic shock? Do they do more harm … More QOTM – BP management in sepsis