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Ashley Miller Profile picture
Ashley Miller
@icmteaching
#zentensivist #FUSIC co-chair. ICS council member. Former BSE committee member & examiner. BJJ ⬛️⬛️🟥⬛️🥋. No politics, no pets, just #foamed #fluids #pocus
May 12 • 7 tweets • 2 min read
Thanks for some great comments on this thread. Some nuance and further explanation is needed here.
Being ill activates the symp NS. I’m sure you have all noticed being tachy and having a bounding pulse when you have flu or are hungover! CO goes up to meet ⬆️ metabolic demand. Sepsis of course is the same and can result in a ⬆️or ⬇️ cardiac output. The key factor is the balance between sepsis causing venoplegia (reducing Pms) and the sympathetic response trying to counter this (which increases Pms and HR).
May 10 • 6 tweets • 2 min read
#haemodynamics #hemodynamics myths.
Myth 1.
'Sepsis causes low SVR and high stroke volume/CO' This is a common misconception. Why? Because the moment a sick patient comes anywhere near a health care provider they get fluid boluses.
Oct 18, 2021 • 20 tweets • 8 min read
Post holiday season, @ICUltrasonica, @wilkinsonjonny & I are back to take you through the most most critical clinical questions on #haemodynamics that ultrasound can answer

We’re now on to question 3 of FUSIC HD

’Is the aorta abnormal?’

#FUSIC #echofirst #POCUS #FOAMus Aortic dissection is easily missed, carries a high mortality and should be on the differential of any patient with shock, abdo pain or chest pain. Contrary to popular belief the entire aorta can be imaged via transthoracic and abdominal ultrasound. Let’s start with some anatomy
Jun 30, 2021 • 25 tweets • 9 min read
We’ve seen how to measure VTI and stroke volume with #ultrasound
Our next #FUSIC haemodynamic question brought to you by @icultrasonica, @wilkinsonjonny and I is:

Q2. Does SV respond to fluid, vasopressors or inotropes?

#echofirst #POCUS #haemodynamics #foamed In Q1 we saw how to measure stroke volume (SV). Q2 helps us manage someone with an inappropriately low SV. Pressors, fluids and inotropes are all treatment options. If If used correctly, they will ↑SV. If not, they won’t, and they may even be harmful.
Oct 15, 2020 • 7 tweets • 4 min read
@iceman_ex @avkwong Really interesting study. Before I read it I assumed that 'physiological assessment' would be lots of fluid responsiveness assessment and then filling to an unresponsive (pathological) state. In fact a lot of ultrasound was used. And there was no difference in fluid administered @iceman_ex @avkwong So why did US not help? Echo doesn't tell you whether there is hypovolaemia or not. A hyperdynamic heart is a feature of low venous return which is more often from venoplegia than hypovolaemia. Echo cannot distinguish between these.
Apr 22, 2020 • 8 tweets • 2 min read
Let's talk about fluids in COVID. @iceman_ex @Wilkinsonjonny @ThinkingCC @load_dependent
1/8 Early in the outbreak it was commonly advised to aim for a -ve fluid balance
More recently a higher than expected occurrence of AKI and RRT has been observed prompting calls for a more liberal fluid strategy.
All these miss the point about the type of fluid being administered
2/8