It has certainly been a year of great #FOAMed for Critical Care and Anaesthetics...
In this short round-up of the Propofological year - we look at 10 topics of the year as well as projects I've been involved in, infographics we've created, podcasts, YouTube channel, #IFAD2017 and perhaps talk about some of what's to come in 2018.
1. SEPSIS 3.000000 - is still here...! Seems to be at every conference I attend!
2. POCUS - a fan favourite in the community. More people picking up the probe this year! A great deal of excellent resources popping up all over the place. Critical Care Northampton have excellent resources for POCUS-mad practitioners!
3. Fluid Management (less seems to be more?) - #IFAD2017 hammered home the need to REALLY think about fluid prescriptions in the critically ill. They highlighted sepsis is primarily a condition of vasoplegia where patients may also require fluid... it's not solely a problem of hypovolaemia. This probably ties in with our own experiences with IV fluids where there is, in many conditions, a resus phase, plateau and de-resuscitation phase. Such is the scale of the problem we came together and developed a protocol for fluid prescription focusing on the four D's... IV FLUID PROTOCOL
4. Renal Issues - bicarb/NAC protection is a bit of a myth when it comes to IV contrast. We may not have been blown away by the outcome of the PRESERVE trial, but it certainly helped to confirm suspicions.
5. A fascinating sepsis trial in Zambia increase focus onto current sepsis management in developing countries. Not generally applicable to developed countries population, but still enormous amount of food for thought and a lot of interesting data. Many patients were HIV positive, and the inotrope used was dopamine (cheap and widely available). Lots of questions remain to be answered (and asked) about why this protocol performed so badly vs standard care.
6. Presentation skills at conferences still leave a lot to be desired. At nearly every conference, I could imagine Mr Ross Fisher's despairing face, wailing at the presenter for reading out endless slides of boring data. A key piece of advice would be that people do not come for you to read them your data, they come to hear your opinion on your data. Provide articles in advance, provide data in advance and deliver a TALK to your audience. More about P3 presentation skills here by Ross Fisher...
7. Opioid alternative regimes are still interesting a vast number of practitioners out there. I published a list of alternatives with Dr. Sergey Motov in 2016, which vent viral at this year's @Core_EM via Dr. Anand Swaminathan. You can see it here along with the 'concept' here. Perhaps one of the things I would like to mention about this piece of work is that they are SUGGESTIONS for opioid alternatives. We would hate to be labelled as zealots when it comes to an anti-opioid stance - it would be foolish not to recognise the important role of opioids as an analgesic - particularly when I use them in anaesthetics every day! But it would be equally foolish to approach all pain-types with opioids. There is an evidence base that Dr Motov has ploughed into and referenced for this resource, and it does require an update in 2018 (given new evidence about diazepam in back pain etc.) - which will be coming up in January! There is also plenty of room for multi-modal analgesia within many specialties.
8. A little more about #IFAD2017. Many thanks to the wonderful Prof. Manu Malbrain for inviting me to form part of the core faculty at IFAD this year. He is an inspirational man and a phenomenal host, who really understands the power of social media in intensive care medicine. Unapologetic of his technological stance when it comes to a fairly traditional conference, he has revolutionised this event and made more than 24 million impressions via Twitter, world-wide as well as boosting real-term participation of the conference by up to 1000 extra via webinars and online interaction. The material that was curated by the social media team is still being used at this moment by people across Twitter and the internet. I look forward to joining him again for the next event.
9. Born out of the IFAD social media team was a group of us who wanted to move forward together in critical care #FOAMed and develop a new and exciting project which will bring us a new and exciting style of critical care conference in the UK.... more on this in 2018.
10. Discussions ebb and flow in Twitterland, some of them more tiresome that others. A desire to move on from discussions over DL vs VL and Sux vs Roc is growing and hopefully will continue to flourish into 2018. Having spoken about this in some of our podcasts, I think a good proverb may be, for many, many, many aspects of medicine; "There are many ways to skin a cat". Often, it's good to disagree - but - sometimes it's better to just move on and discuss something else... at least for a while.
Below are some great resources to highlight some of the efforts that have dominated my own year in educational material:
Infographs on Cardiac Arrest, Opioid Alternatives, Rib Fracture Management and IV Fluid Constituents were amongst the popular of 2017 for Propofology followers. You can see a full list of the infograms here.
The Propofology/QuickMedic YouTube channel continues to grow with free content. Check out one of our first videos in 2017 here... many more on the channel!
The summary that I have made of the top #FOAMed trials for ICU is available in infogram form, here.
www.CriticalCareNorthampton.com by Dr. Jonny Wilkinson continues to provide excellent blog posts, trawling the net for excellent critical care articles and projects. We have collaborated extensively this year with #IFAD2017 and in other projects to bring some excellent material to the fore. We hope you have enjoyed this as much as we have. Jonny has my particular thanks this year as being a wonderful contributor to Propofology projects as well as getting us involved in as many different aspects of #FOAMed as practically possible. Check out some of our stuff:
IV FLUID PROTOCOL
STOP BEFORE YOU BLOCK
#IFAD2017 QUOTES & GRAPHICS
#ICSSOA2017 QUOTES AND GRAPHICS
TheBottomLine from the Wessex Deanery created a brilliant review of their top ten trials from 2017. I collated them in an infographic here, but check them out for yourself!
CriticalCareReviews.com has its latest meeting in JANUARY of 2018! Lots of #FOAMed content to come from that. You can see all the old content from 2017 (still extremely relevant) here.
Propofology will continue to be a site of resource curation and promote social media in medical education to all levels of practitioners, in all corners of the world.
Have a wonderful new year everyone. Be kind to each other. Thanks so much for everyone's support of the Propofological endeavours throughout 2017... there will be many more in 2018.
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