Dr Nick Mani, MSc FRCEM

My Quality Improvement Project on Emergency Department PoCUS governance and administration been accepted for publication by @BMUS_Ultrasound @SAGE_Publishing 🙏🏾 So much blood, sweat and tears. All worth it. @RCollEM @EMTAcommittee very keen to see an improvement nationally

Doc 1: I did #POCUS. EF is great. I’m done! Doc 2: Wait… do you want to comment on the LV wall thickness? Could it have implications for fluid therapy? (e.g. associated diastolic dysfunction, SAM depending on the clinical context). What about cardiology referral for further imaging or genetic testing? #Nephpearls #FOAMed

@amit_pawa @Anaes_Journal Its all about technique...

Wow! I am not sure I agree with the paranormal comparison here in this opinion piece by some very respected authors. As we are learning, there is some nuance to performing this block correctly, and it still fulfils many criteria that make it a plan A block. Interesting 🤔

New in EMJ - free open access: Endovascular resuscitation: an expert practice review A practical overview of REBOA, SAAP and ECPR for emergency physicians managing the sickest patients in shock or cardiac arrest. Please read / comment / share DOI: 10.1136/emermed-2025-215376

🚨 HOT OFF THE PRESS! 🚨 New guidance from the American Society of Echocardiography @ASE360 for Cardiac Ultrasound Artifacts 🫀📡 ➡️bit.ly/4tKDSvf 👉 A must-read for everyone in #EchoFirst! 🔍 What is an artifact? ➡️ An imaging feature that does NOT reflect true anatomy/pathology ➡️ Common, expected, and rooted in ultrasound physics ⚙️ 💡 Why this matters ⚠️ Artifacts can mimic disease → misdiagnosis → inappropriate management ⚠️ Present across ALL modalities: • 2D 🖥️ • Spectral Doppler 📈 • Color Doppler • 3D echo 🧊 📘 What this guideline delivers ✅ Standardized, structured approach to artifacts ✅ Clear explanation of: • Appearance 👁️ • Mechanism ⚙️ • Clinical impact 🏥 • Real-world cases 🧾 • Mitigation strategies 🛠️ 🧠 Also covers 🔹 “Artifact-like” phenomena 🔹 Interference from external devices & equipment 📡 🎯 Key takeaway 👉 Artifacts are inevitable—but misinterpretation is not 👉 Mastering them = safer, smarter echo practice 👩‍⚕️👨‍⚕️ Who should read this? ➡️ Sonographers ➡️ Cardiologists ➡️ Trainees ➡️ Anyone interpreting cardiac ultrasound 📢 Elevate your imaging game. Recognize. Understand. Mitigate. #CardioX #Cardiotwitter @JournalASEcho #ACCFIT

@Anaes_Journal The other aspect with the RCT (Ref 2) to note is, the injecrion is performed at T3. For any thorax indication, I have been told T5-7. So, I am not all all convienced the technique used in the RCT was the correct approach, which could jabe lead then led to the observation made.

@Anaes_Journal This approach is now recognised more and more is the incorrect technique as it only blocks dorsal rami. However if aimed at the tip of the TP (as I see it all the time), it works like magic (proxy to PVB indeed without going into the danger zone) as shown below

It was once thought that N-rays could explain paranormal phenomena such as telepathy or mind reading. Are there parallels between the popularity and enthusiasm of erector spinae blocks plane today and that of N-rays in the past? #anaesthesia #MedTwitter doi.org/10.1111/anae.7…

• Serratus Anterior and Erector Spinae Plane Blocks for rib fractures • Popliteal Sciatic Nerve Block for ankle fracture manipulation Just two of our live sessions daily, on our booth. Don’t miss these fantastic sessions happening live on our stand (6).

🫀 Hemodynamics is not blood pressure... actually, It never was. ⚠️ The biggest mistake in perioperative & critical care: 👉 Treating numbers instead of physiology 📊 What we were taught ✔️ BP ✔️ HR ✔️ SpO₂ 🔥 What actually matters 👉 Flow + oxygen delivery + tissue perfusion 🧠 Core concept 👉 Blood pressure ≠ perfusion You can have: ▪️ Normal BP → low cardiac output ▪️ High BP → poor microcirculation ▪️ Stable vitals → ongoing hypoxia 💡 Why? Because: 👉 BP = CO × SVR Same pressure → completely different physiology 🧬 The real pillars of hemodynamics ✔️ Cardiac output ✔️ Stroke volume ✔️ Preload / afterload / contractility ✔️ Oxygen delivery (DO₂) ⚠️ Critical insight 👉 Oxygen delivery = CO × arterial O₂ content Not: ❌ BP ❌ SpO₂ alone 🔥 This is where advanced monitoring changes everything 👉 From static → dynamic 👉 From guess → prediction 🧠 Dynamic parameters outperform static ones ✔️ SVV ✔️ PPV ✔️ PVI 👉 Predict fluid responsiveness 👉 Avoid fluid overload 💥 Reality check Only ~50% of unstable patients respond to fluids 👉 The rest get harm 🫀 Next level thinking 👉 Ventriculo-arterial coupling 👉 Cardiac power output 👉 Tissue perfusion markers 🚨 Final message Stop asking: ❌ “What is the blood pressure?” Start asking: 👉 “Is the patient perfusing?” 🧠 Because in critical care: 👉 Flow saves organs Pressure just looks good on the monitor 📚 Demir et al., Aydın et al. Turkish Journal of Anaesthesiology & Reanimation, 2025 DOI: 10.4274/TJAR.2025.251926 DOI: 10.4274/TJAR.2025.251925

Join me @POCUSUK and @BBraunUSA at the RCEM Annual Conference 2026 at the ICC, Birmingham (Stand 31)! 📍 Don't miss the live scanning on key hip and chest blocks—including PENG Block, FICB, SAPB, and ESPB. 🗓️ When: 28th & 29th April, 3:30 PM - 4:00 PM

Classic image of the day! #POCUS #FOAMed #Nephpearls

Stop press: sterile gowns are no longer mandatory for spinal anaesthesia. I’m so proud to have been part of this process trying to simplify our practice, making us more efficient, more sustainable without increasing risk to our patients. …-publications.onlinelibrary.wiley.com/doi/10.1111/an…

Congratulations to this weeks short clip challange winner Tanner Course! Q1: A 62-year-old man with a history of diabetes, cardiac amyloidosis, and early onset dementia presents with new-onset shortness of breath. You perform a POCUS exam in the PLAX view. What descriptors could be applied to the left ventricular myocardium? A1: Granular ; Echodense and Hypertrophic. All the above for the quiz pulmonarypocus.com/short-clip-exp…

@SonositeEurope @POCUSUK

Counting down to this year’s @Royal College of Emergency Medicine conference. We’re excited to have a live scanning schedule happening daily at our booth led by Dr. Nick Mani. Don’t miss these insightful sessions on our stand! @EveryOneNoOne1

linkedin.com/posts/royal-co… @POCUSUK Join us for the workshop at RCEM pre-conference workshop 👇🏽

Read the full paper in @TheLancet: doi.org/10.1016/S0140-…

The CRAFFT study is out....BOOOM! Check out CRAFFTstudy.org to read all about it. Thank you to everyone who made this possible - children, parents , research nurses, physiotherapists, the fab trials team and my colleagues - the ED doctors and surgeons. 🙏

What is considered a high-value basic ultrasound-guided regional anaesthetic technique? #anaesthesia #regionalanaesthesia #regionalanesthesia #pain #MedTwitter doi.org/10.1111/anae.7…