Tom Fisher
@tomfisher.bsky.social
CT2 anaesthetics, critical care echo-head, NIHR academic clinical fellow @ Univ of Birmingham
#OMB Another consequence of the “no foreign research” federal rule is to pull US science further backwards, making more way for China's ascension as a research powerhouse and leading global collaborator. 🇺🇸🇨🇳🌐 How & why? NEW piece👇 www.bmj.com/content/393/...
🫀 Delighted to see the publication of our narrative review examining diastolic dysfunction in critical illness This is fascinating area of pathophysiology. Whether it represents an epiphenomenon or a treatable trait and its influence on long‑term outcomes is a key question for future work. 1/2
Very excited to post this preprint... making a species that doesn't hibernate do something a lot like it, AND showing it is cardioprotective. www.biorxiv.org/content/10.1...
Synthetic torpor in the rat recapitulates key features of natural torpor and is cardioprotective
During hibernation, animals enter torpor, a reversible physiological state typically characterised by reductions in core temperature, heart rate and oxygen consumption. Species that enter this hypothe...
biorxiv.org
I had the pleasure of teaching lung #pocus at a “train the trainers” course, with the ever excellent @avkwong.bsky.social and Cian McDermott as faculty Some reflections from the day: (1/n)
For all my ECG nerds friends: What to consider when you see one or more PVCs: medicusofhouston.com NEVER a tariff on MY classes! #ECGNerds #ECGSky #MedSky #CardioSky #Cardiology #YaleEM #EMedSky #nursesky #MedEd #EMSky #BlueSky #MedEducation #emimcc #EUSEM #ACEP #AAEM #ESEM #ASEM #ACEM
Delighted to share the Barts echo team’s latest article “Examining the Relationship Between Pulmonary Artery Acceleration Time and Pulmonary Artery Pressures in Patients with Ischemic Cardiogenic Shock” Free to read for 50 days on the following link www.sciencedirect.com/science/auth...
sciencedirect.com
Really nice article on TAPSE/TRVmax as a potential prognostic marker From the team at Nepean ICU, led by Emma Bowcock annalsofintensivecare.springeropen.com/articles/10....
The value of right ventricular to pulmonary arterial coupling in the critically ill: a National Echocardiography Database of Australia (NEDA) substudy - Annals of Intensive Care
Background Right ventricular (RV) function is tightly coupled to afterload, yet echocardiographic indices of RV function are frequently assessed in isolation. Normalizing RV function for afterload (RV...
annalsofintensivecare.springeropen.com
My pov : patients with good outcomes after OHCA associated with hanging...were probably not in OHCA...
Tom Fisher@tomfisher.bsky.social · 2y ago➖Those with OHCA rarely have good functional outcomes ➖Those without OHCA frequently have good outcomes ➖Associated C spine/vascular/airway injuries are uncommon in those who survive to hospital 🧵2/6
ICU Mini-Stories: Middle-age pt presented to ED at 8:00 am with cough/dyspnea/weakness x 2 weeks. Poor appetite/could walk only a few feet due to dyspnea/dizziness. Vitals: HBP 79/60, HR 80, afebrile, O2 sat 96% on 2 l/m. Physical exam: ill-appearing, dry mucous membranes. Labs:
🔬 Pleased to share our new scoping review on cardiac arrest after hanging- sadly not an uncommon cause of cardiac arrest which has previously lacked a good quality synthesis of evidence Link: authors.elsevier.com/a/1kXSi_6ryq... 🧵1/6
Significant
xkcd.com
Anaesthesia@anaesjournal.bsky.social · 2y agoTIVA vs sevoflurane - does it affect recurrence-free survival after hepatectomy? Findings: There was NO significant difference in one-year recurrence-free survival when comparing propofol-based TIVA with sevoflurane-based inhalational anaesthesia. #AnSky #MedSky #OncSky https://buff.ly/4gZGnDI
When following a left atrial pressure algorithm that uses 2.8m/s as a binary cutoff, do people give a bit of leeway if it's *almost* 2.8 with severe TR/wide vena contracta?
Does anyone know where I can find a manual/user guide for Phillips 5500CV or other similar Phillips device? Only get Phillips espresso machines when I Google for the manual and it's slow mastering the knobology incrementally just while scanning! #cardiosky #echofirst #echosky
Instructive case in my ongoing FUSIC HD journey- pt with dyspnoea, leg/groin/abdo swelling
Was somewhat surprised by moderate-severe AR (prev trivial) when looking to assess a prev moderately stenotic AV in a FUSIC HD training scan recently. FUSIC HD limits AV assessment to colour and dimensionless index. Is the DI still useful in these mixed valve disease cases? #echosky #cardiosky
People often talk about the time critical nature of sepsis. But it may surprise you to hear that the evidence to support “early” antibiotics actually isn't a settled debate. Why is that? The key question is “early in relation to what”? 🧵 1/n
A sad day for critical care - and what a phenomenal legacy he has left us. RIP Prof Gattinoni, a Giant ⚕️📟 www.esicm.org/obituary-luc...
Obituary: Luciano Gattinoni - ESICM
In Memory of Professor Luciano Gattinoni
esicm.org
If the LV of the patient with sepsis is «hyperdynamic» when on noradrenaline, then EF dropps and the LV looks poorly when vasopressin is added, but recovers to normal with dobutamine, you likely haven’t «uncovered hidden LV dysfunction» or septic cardiomyopathy. #emimcc #pocus #echofirst 1/
Why do so many (UK) favour a sternal cap refill rather than peripheral in adult patients? Many claim this is superior by way of anecdote and "their hands will be cold anyway" but I've never been able to find ANYTHING to support this (certainly no andromeda equivalent!) #emimcc
Acute Decompensated Valvular Disease in the Intensive Care Unit CCR Journal Watch criticalcarereviews.com/latest-evide... Get the latest critical care literature every weekend via the CCR Newsletter - subscribe at criticalcarereviews.com/newsletters/...
30ml/kg first-line for allcomers with sepsis (no nuance added in discussion beside implying CLOVERS & CLASSIC & sepsis pathophysiology support this) What could go wrong??!?
Critical Care Reviews@criticalcarereviews.com · 2y agoToday's Paper of the Day is state of the art of sepsis care for the emergency medicine clinician criticalcarereviews.com/latest-evide... Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2024
A thread 🧵 on trials I think have changed or will change ICU practice (at least my own). #emimcc
1w cough and increasing dyspnea. Upon pickup by paramedics sat70%, hypotensive. ⬆️CRP/WBC. Pneumonia/septic shock assumed, abx and bolus fluids initiated, intubated in the ER. Hypotensive despite high dose pressor, #Echo follows #FOAMed #FOAMcc
Rant #5 Please don't tell me what the PaO2 is... Less experienced critical care staff members are frequently exercised by arterial blood gas PaO2 readings. What is the SpO2 I genially ask? In our target range? Well that's fine then. Staff member shifting uneasily, "but the PaO2..." Here we go...
Ben Morton@benmorton.bsky.social · 2y agoOver the years I've developed a number of "rants" (aka teaching) that seem to resonate with trainees on #ICUsky ward round. This pedogogical style might make educationalists wince but keeps me and (crucially) trainees, interested Interested in any counter rants, refined rants or rant affirmation
Basic FICE training scan in a stable post-op elderly patient with no cardiac hx other than systolic murmur & pre-op echo demonstrating SAM of the MV, pending workup. Have always thought it must be amyloid? #cardiosky #emimcc #pocus
Talking of Bier, @orthopodreg.bsky.social the story of how he developed spinal anaesthesia is pretty wild A story of cocaine, cigars, and German army helmets. #AnSky #MedSky #HistoryMedSky
a baby rhino is playing with snow in a zoo enclosure .
Alt: a baby rhino is playing with snow in a zoo enclosure .
media.tenor.com