Category Archives: critical care

To drain a pleural effusion found on POCUS?

Suggested indications:

If underlying lung is recruitable (ref?)

Inverted diaphragm 

Specific indications e.g. Surgical, BTS guidelines 

Stalled wean + large effusion. If max distance between diaphragm measures >5cm then almost certainly >800ml and drainge will improve situation (ref?)
High RSB index

Overall nil definitive evidence, so take a pragmatic approach.

From CUSIC day @ICSSeminars

Addressing end-of-life issues

Interesting article from an unusual source…

http://www.wsj.com/articles/how-doctors-can-approach-end-of-life-conversations-1443407564?utm_campaign=tw&utm_source=hs_email&utm_medium=email&utm_content=22582817&_hsenc=p2ANqtz-99-SORgwu2Pwzk8E2Tdha-TkKJapbHJ1kJ9RE6YZwLAsmoIyEQsYNktncDtKdFbZRwwm9Ls1VbBoXZ7tYZ71-9Irwp7IQEL9qumMvytkGFQ1tEQ-8&_hsmi=22582817

Take home messages:

Explore patients values

What is important to them?

Quality vs length

What have they learnt about death and dying from previous experiences with family/friends

What does a good day (or good death?) look like to them