Neville

@aribindi @ross_prager High dose adrenaline causes alpha effects and vasoconstriction. Learned this from the Paris Team that routinely limits their administration to 3 x 1mg boluses. My anecdotal experience resonates with this.

@docvlok @ross_prager Wait what? Why would inotropes affect cannulation?

You are crashing a patient onto ECMO to save their life. Here are my tips to support the cannulation if you aren't the one cannulating. Reply with anything I missed here (or you do differently) 👇 (these are good principles for most resus procedures) 1. Think ahead! 2. Check current lines - where are your meds infusing and where are the cannulas going. Many times you need to place another central line to allow the groin/neck to be accessed. 3. Optimize coagulopathy (within reason). A unit of platelets? Some fibrinogen or FFP? 4. Anticipate bleeding. Cross match blood. If VA ecmo I often have a couple of units at he bedside. 5. For VV-ECMO if the SpO2 is really bad, over hand bagging (or ventilating) them to optimize the sats. The 30min of overbagging while cannulation is happening can cause a ton of injurious lung ventilation. Consider tolerating lower sats temporarily (e.g. 85%) 6. Optimize the room (or setting more generally). 1) Procedure tables 2) extra equipment out 3) ultrasound machines (2 of them) in the room and plugged in 4) TEE probe in patient ready to go (if available) 7. Check and document distal pulses BEFORE cannulation carefully (especially VA) 8. if VA-ECMO place a right radial/brachial arterial line to monitor for north-south syndrome. Not all of these need to be done pre-cannulation, and what exactly is done varies based on urgency (e.g. ECPR vs. more gradual VV-ECMO start) but these are things to think about peri-cannulation. Photo credit to JEMS and the SAMU team in Paris.

Monoclonal antibodies are not named as "mabs" anymore👇 Suffixes/stems As the previous INN nomenclature scheme for monoclonal antibodies (mAb), this new INN mAb nomenclature scheme is used for all substances that contain an immunoglobulin variable domain that binds to a defined target, and that is composed of only immunoglobulin-derived pharmacologically active components. The suffix is preceded by an infix that indicates the target class. However, in contrast to the previous INN mAb nomenclature scheme, the new INN mAb nomenclature scheme divides the substances that contain an immunoglobulin variable domain into four groups, there being three groups for monospecific immunoglobulins and one for bi- and multi-specific immunoglobulins, independent of their type, shape and form. --- Group 1 -tug for unmodified immunoglobulins Monospecific full length and Fc unmodified[1] immunoglobulins of any class. Molecules which might occur as such in the immune system. Including: IgG, IgA, IgM, IgD, IgE only allelic variants Glycoengineering without mutation C-terminal lysine deletion without any other mutation in the Fc region --- Group 2 -bart for antibody artificial Monospecific full length immunoglobulins with engineered constant domains (CH1/2/3). Monospecific full length immunoglobulins that contain any point mutation introduced by engineering for any reason anywhere (hinge, new glycan attachment site, mixed allelic variants which would not occur in nature, altered complement binding, altered FcRn binding, altered Fc-gamma receptor binding, etc.) e.g. IGHG4 with S>P mutation, stabilized IgA --- Group 3 -mig for multi-immunoglobulin Bi- and multi-specific immunoglobulins regardless of the format, type or shape (full length, full length plus, fragments) --- Group 4 -ment for fragment All monospecific domains, fragments of any kind, derived from an immunoglobulin variable domain (all monospecific constructs that do not contain an Fc domain)

SWAAC ELSO 💥CALL FOR ABSTRACTS - Deadline approaching

@swaac_elso Registration link?

Highlights from Qatar simulation course Next course on 16-20 November

@WCGHWEMS - join our Annual EMS Research Day. Your participation and engaging conversation is the fuel required during our pursuit for clinical excellence

Register for the #SUEM25 symposium and take advantage of the early bird special, featuring abstract, poster presentations, trauma, ethics sessions and much more! Deadline for early bird is 31 January and deadline for abstracts is 14 February Register at: buff.ly/4axU6iI

⚠️ Bleomycin & anaesthesia⚠️ Do you know what precautions are required in patients who have been exposed to bleomycin? Exposure to high FiO2 at any time post-bleomycin exposure may trigger life-threatening pneumonitis. @DrSusannahP #AnSky #MedSky #OncSky buff.ly/42enyI9

Have you heard about the script that saves you time and money? Grab an exclusive discount for the most intelligent script in SA.Redeem your 50% discount today on a web browser at info.emguidance.com/script-prescri… Use the referral code below upon checkout: VLOK142

@Clint_EM @colljsaunders @UCTHealthSci So well derserved!!! Excellent stuff!!!

Thrilled to congratulate Colleen Saunders on her well-deserved ad hominem promotion to Associate Professor! Her dedication to research, education, and advancing emergency care is an inspiration to us all. Here's to continued success and innovation! @colljsaunders @UCTHealthSci

My approach to detecting pneumothorax using POCUS. @CritCareTime

Early 40s male with chest pain and collapse, looks horrible, SBP 80, lactate 7. Previous large PE with pulmonary hypertension on echo 2 months ago, discharged on apixaban POCUS on arrival shows:

🔍 Mastering the Complexities of Ischemic Stroke: A Comprehensive Diagnostic Approach When faced with an ischemic stroke or TIA, it’s crucial to accurately identify the underlying cause to tailor the most effective treatment. This flowchart breaks down the essential steps in differentiating between cryptogenic stroke and its subtypes: ESUS (Embolic Stroke of Undetermined Source) and Lacunar Stroke. Key Insights: 1.🔎 Lacunar Stroke Diagnosis: •The ARCADIA criteria guide us in diagnosing lacunar strokes. Look for subcortical infarcts within the distribution of small penetrating arteries, with lesions less than 1.5 cm on CT or T2-MRI, or less than 2.0 cm on DWI MRI. •Always consider the presence of atrial cardiopathy or systemic embolism, as this can significantly influence the management strategy. 2.🩺 ESUS Pathway: •For ESUS, after thorough cardiac monitoring, the absence of atrial fibrillation directs us to investigate other potential sources, including carotid web, complex aortic plaque, non-stenotic carotid plaque, PFO, or occult cancer. •Treatment options vary: from antiplatelet agents and statins to PFO closure or anticoagulation therapy—each tailored to the identified source. 3.💓 Atrial Cardiopathy: •Pay attention to specific markers like PTFV1, NT-proBNP levels, and left atrial diameter index to diagnose atrial cardiopathy. •In cases without atrial fibrillation, start with antiplatelet agents and keep an eye on the upcoming results from the ARCADIA & ATTICUS trials to refine your approach. Teaching Point: This structured approach ensures that we’re not just treating the stroke, but addressing its root cause. By applying these diagnostic criteria, we can better prevent recurrent strokes and optimize patient outcomes. #StrokeAwareness #Neurology #Cardiology #IschemicStroke #ESUS #LacunarStroke #AtrialCardiopathy #StrokePrevention #CriticalCare #HealthcareInnovation

As part of the upcoming FCEM Part II examination, I have collected some useful research in this collection using Read by QxMD: FCEM II (South Africa) read.qxmd.com/shared-collect… Open to collaboration and contribution #SouthAfricanEmergencyCare #EMSSA

What an incredible publication! Pain is such a universal human experience but continues so poorly understood and managed. This book has a huge impact. Well done @JoParkRoss and @RomyParker1

Such a great initiative by National Department of Health! This promises to be a fantastic session with the extra-ordinary, inspiring and marvelous @cunningham_char

@teachplaygrub @slahri7 This dr really has incredible way of teaching complicated neuroanatomy and neuroradiology.

Have MULTIPLE questions about MULTIPLE sclerosis? Having trouble seeing neuromyelitis optica? In a fog about MOG? Here’s the cheat sheet you NEED to distinguish the demyelinating diseases! Demyelinating diseases predominantly involve the optic nerves, brain, & spine. The three main chronic demyelinating diseases are Multiple sclerosis (most common), neuromyelitis optica (NMO), & myelin oligodendrocyte glycoprotein (MOG) antibody associated disease or MOGAD Each has its own features in the optic nerve, brain, & spine. Here’s how to remember them! ▶️MS 🔸Optic nerve: --MS only has 2 letters, so MS involvement of the optic nerve tends to be short segment 🔸Brain: --Letter M makes the shape of the perivascular distribution of lesions along the ventricles (Dawson’s fingers) --Letter S makes the shape of the subcortical U fiber involvement 🔸Spine: --MS is only 2 letters, so lesions are usually less than 2 vertebral bodies in length ▶️NMO 🔸Optic nerve: --NMO is a longer abbreviation, three letters, so longer involvement --NMO can stand for Near My Occiput. Occiput is posterior, so more posterior nerve involvement 🔸Brain: --NMO can stand for Near My Ocean. What is your brain’s ocean? The ventricles. NMO lesions are all periventricular 🔸Spine: --NMO is 3 letters, so lesions usually more than 3 vertebral bodies in length ▶️MOGAD 🔸Optic Nerve: --Remember MO’ GAD-olinium. So things that cause more regions of enhancement. MOGAD lesions are commonly bilateral & long segment & enhancement can extend perineural 🔸Brain: --Remember LO’ GAD. MOGAD typically involves the lower areas of the brain 🔸Spine: --Remember MO’ PLAID. MOGAD can give a plaid-like H shape in the cord from predominantly gray matter involvement Hopefully, this cheat sheet will help you remember how to distinguish the demyelinating diseases! It ain’t lyin’ about diseases of myelin!

July series for new #ICU #Nephrology fellows: Cardiac #POCUS parameters in the assessment of pulmonary hypertension #echofirst #FOAMed #Nephpearls Click 'ALT' for abbreviations Courtesy: 2022 ESC/ERS pulm HTN Guidelines

As resuscitationists keep searching for the holy grail of volume status and fluid responsiveness, we have trekked into the world of echocardiography. This paper adds some nunchuck skills to our bow-staff skills. 🎩 tip to the authors. eddyjoemd.com/foamed/

@AirborneCovid @Gas_Air_CCdoc Cause usually a traumatic hemopneumothorax doesn’t spontaneously resolve…

How many trauma chest tubes do you think the average South African trained doctor has placed by the time they are done with their second year of working?