1/ We want to improve haemodynamic management and fluid stewardship at my place (Honvédkórház ICU, Budapest, Hungary).
See examples of study metrials below and please tear them apart as we want to improve them further.
The first one was made to avoid reflex fluids in oliguria.
The rest of the pages are about haemodynamic profiling.
3/ Notes
- The target population is an ICU doc with a few years of experience with variable US skills.
- implementation will be with hands-on training
- This is an excerpt from a 12-page long document but did not have the time to translate all
4/ - excuse my translation and spelling please
- many things are very much local, e.g. we use lots of PiCCO but no Swans, most of our patients are trauma/burns/postsurgical with some medical
- NA stands for norepinephrine in ug/kg/min
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The point I would like to put out to debate complemented by a case is regarding the resolution of POCUS in some clinical scenarios detecting fluid overload.
2/ Basically, if your IVC is dilated, already -> VEXUS 1
For VEXUS 3, it seems to me, you need to have a significant cardiac abnormality and/or kidney injury (often to the point requiring RRT).
3/ And many septic pts with normalish hearts hover around VEXUS 1-2, not really differentiating the mildly overloaded from +10-15ls.
It is very well possible that I have conceptual problems or technical errors, which I am happy to learn about :)
Pseudomonads produce pyocyanin and pyoverdine that give it greenish colour on agar. Hence the name "aeruginosa" meaning "copper rust". Frank Pseudomonas pus can also look greenish for the same reason.
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