Tag Archives: LIVES2019

Trauma: which fluid? when?

Which fluids need to be administered in the trauma patient? when? In trauma patients, fluid resuscitation aims at restoring circulating volume to prevent cardiac arrest due to severe hypovolemia, and at achieving a satisfying level of mean arterial pressure to ensure adequate tissue perfusion, limiting coagulation disorders. Lot of potential secondary adverse effects could be associated to  fluid resuscitation, ie hemodilution, acidosis & coagulation disorders.

In this infographic,  the concepts of permissive hypotension and remote damage control resuscitation RDCR, and some notes on on crystalloids, colloids & blood products.  

graphics by Marta Velia Antonini @FOAMecmo

content based on the talk given by Sophie Hamada, ICU Hôpital Bicêtre University Paris Sud, Groupe Traumabase.EU during the Trauma & surgery session  of the EDIC I Refresher Course at #LIVES2019 Congress

 

Consolidation on Lung Ultrasound

The 7 principles of Lung Ultrasound in the Critically Ill LUCI and echographic diagnosis of lung consolidation in this LIVES2019 infographic!

1 – a simple equipment is the best

2 – thorax is a mingling of air (gas) and water (fluids)

3 – lung is the most voluminous organ: here some advices on where to apply the probe?

4 – all arises from pleural line

5 – LUCI is the science of artifacts

6 – Lung: is a vital organ

7 – Most life-threatening disorders reach the wall and and have usually extensive surface

Why and how looking for consolidation?? here the Blue protocol with its profiles and some notes on the Pink protocol. How to distinguish between translobar and non translobar consolidation? Do we have an obstructive atelectasis or it’s just compression? take a look…

graphics by Marta Velia Antonini @FOAMecmo

content based on Daniel Lichtenstein masterclass at #LIVES2019

 

Diagnosing pneumothorax and lung effusion on Lung Ultrasound

Here a couple of infographics on bedside lung ultrasound…                                                                  first one refers to diagnosing pneumothorax, with an introduction of basic definitions on lung ultrasound (ie pleural line, pleural sliding, A/B lines, lung pulse):

1  suspecting pneumothorax in the absence of lung sliding

2 signs which confirm or rule out PTX diagnosis

3 how to look for lung point

Second infographics relates to pleural effusion:

1 diagnosing effusion on 2D and M-mode lung ultrasound

2 localize effusion & define its expected nature

3 easily & quickly quantify pleural effusion to understand if it has to be evacuated

4 if drainage is needed, POCUS could assist or guide chest tube insertion, and support continuous monitoring of the effusion, to evaluate drain effectiveness.

At the end, some tips to choose the right probe for LU & some suggested readings, enjoy!

graphics by Marta Velia Antonini @FOAMecmo                                                                                    content based on Belaïd Bouhemad masterclass at #LIVES2019

Polytrauma management

Pitfalls in the trauma case management:

intubation 

hemorrhagic shock

thoraco-abdominal penetrating injuries

pelvic circumferential fractures

posterior dislocation of the hip

retro-orbital hematoma

older patients

Be careful to avoid common cognitive errors,  premature diagnosis, over-reliance upon early negative results, attributing abnormal findings to benign causes, early grading injury severity based on signs in young healthy adults, distractions due to focus on main/obvious injuries and on performing a critical procedure. Also consider lot of potential communications error, lack of situational awareness & errors in staffing or workload distribution.

PS do not forget analgesia & sedation!

infographic based on the talk given by Sharon Einav, Shaare Zedek Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel during the Trauma & surgery session  of the EDIC I Refresher Course at LIVES2019

graphics by M Velia Antonini @FOAMecmo