A patient with long-standing renal failure has a cardiac arrest on commencement of dialysis. You achieve ROSC, and do a focused echo. Here are the views you achieve.
Parasternal long axis... Apical 4-chamber

Thank you to everyone who commented and voted on this case - some great debates!

Before I go through assessment of fluid responsiveness in critical care, it's worth saying that it is one component of your overall assessment of the patient. Not to be taken in isolation. [1/12]

https://twitter.com/GoughCJ/status/1305899939281752066

One of the key principles here is that the positive pressure delivered into the thorax from the ventilator will affect the venous return to the right heart (with less returning during inspiration).

This leads to variation in IVC and LVOT VTI/V max values.
[2/12]

This is my first critical care echo case tweetorial. I will be discussing the assessment of potential fluid responsiveness in critical care. Case today, answers tomorrow.

Please do give me honest feedback so I can make these useful. The case is a post-op patient who is hypotensive. They have had some fluid resuscitation already. Do they need more filling? Do they need inotropes? Do they need vasopressors?

They are intubated and fully ventilated.

Here is the PLAX.

Consistency is helpful, but an arbitrary cut off is not.

Information from death certificates would be much more accurate, and reflect deaths caused, or contributed to, by Coronavirus.

Let me give 2 examples that the new rules would mislead...
[1/4]

https://twitter.com/BBCHughPym/status/1293586562786234371

1. A person has mild Covid infection and isolates at home for 10 days. They go back to work and are fine. A week later they are killed crossing the road.

This IS counted as a death from Coronavirus.
[2/4]

As lockdown restrictions are being lifted, it’s tempting to think that life can start to get back to normal. I think it’s key to understand how hospitals have changed to cope with COVID-19 and how rushing to normality is causing much apprehension for the many health workers [1/8] Even before the #COVIDー19 pandemic, ITUs were typically short staffed and running at almost full capacity.

This relied on all medical team members working incredibly hard together, along with goodwill overtime, to ensure safe staffing levels. [2/8]

Organ donation in the UK has now changed to an "Opt-out" system.

What does this mean for you and your family?

Bear with me, and I will briefly go through the changes, and how you can ensure you can communicate your wishes, even if it is too hard to talk to your family. [1/n] Death and dying are very hard subjects to talk about, and often make people feel uncomfortable. However, at some stage we will all die, and it’s worth thinking in advance what we would want at that point in our lives - and ideally communicating that to those close to us. [2/n]

With more people being offered testing for Coronavirus, daily updates on numbers tested, and potential news in the bid for an accurate antibody test, it’s a good time for an overview on testing. A thread. [1/n] There are two broad types of test:

1. Those looking for antigen (i.e. you currently have Covid)
2. Those looking for antibodies (i.e. your immune system has faced Covid recently). [2/n]

It’s time for an update on what it’s like in Intensive Care right now. Apparently we are past the peak, everything is alright…. Right??

Well, not so fast…

I’ll take you through the predictions, the changes we made, the reality and what the future may hold [1/n] The predictions were terrifying and depressing. Based on modelling from other countries, NHS England told us to prepare for 140-280 ventilated patients.

Is that a lot? Is it a little? We need some context…. [2/n]

With @BorisJohnson being admitted to #intensivecare, it’s a good time to reflect on what an admission to hospital with #COVID19 symptoms could mean for you.

This is based on my personal experiences as an Intensive Care Consultant, caring for many #COVID19 patients [1/n] If you need hospital, you are in the ~10% of people with more severe symptoms. You will likely be cared for in an acute ward, together with other patients with similar symptoms. You are likely to need additional oxygen, given either up your nose, or through a face mask. [2/n]

I am getting asked a lot what it’s like working in Intensive Care at the moment. I think the best way to answer is with an overview of a recent shift.

It’s all a bit unsettling. We need extra staff on so I’ve been moved from days on to nights. [1/n] We’ve moved handover to a bigger room in an attempt to try and stay a bit away from each other.

After handover it’s hard to differentiate the patients. They all have such similar stories...a few day history of cough and fevers. [2/n]

Now that I am recovering from Covid-19, I want to share my symptoms, and my experience, in case it is of help to anyone else. I've felt pretty rotten the last few days, but am finally improving.

I am only talking about my own experiences - as a patient, not a doctor. (1/n) I'll have a quick moan about testing, and then go through my symptoms.

Testing, testing, testing.
We must stop the ridiculous imbalance where politicians and sports stars can apparently get tested, but frontline health workers cannot. The criteria must be consistent. (2/n)