The NYC Tracks with Jon-Emile: Paracentesis and Volume Status. #FOAMed, #FOAMcc, #FOAMus

So I was in NYC last week and met up with my buddy Jon-Emile Kenny, (@heart_lung), intensivist-physiologist extraordinaire, and we recorded a few discussions on practical matters.

I always love to debunk myths and avoid dogmatic guesswork, and, more often than not, Jon, with his encyclopedic knowledge of the physiology literature, but more importantly a cutting edge understanding of it, can back up my vague ideas and empirically derived ideas, so that the next time someone asks me why this is so, I can have a semi-enlightened answer!

So here is the first, where we discuss the common question about the need (or not) of intravascular volume repletion during or following large volume paracentesis. Yes, there are some formulas out there as to how much albumin or crystalloid one should give, due to the worry of subsequent hypovolemia. Note how those formulas use no data about your patient’s volume status at the time of paracentesis, so as far as I’m concerned, they have no value whatsoever in an era where we can assess this. Yes, ultrasound is the base as far as I’m concerned.

Here we go:

Please share your thoughts!

cheers

 

Philippe

Bedside Ultrasound Picture Quiz #6 – #FOAMed, #FOAMcc

So your intubated patient has developed abdominal distension and residuals are 250. You scan the LUQ:

 

Screen Shot 2013-10-28 at 11.32.45 PM

 

 

what do you see?  what should you do?

scroll below…

 

 

 

 

 

 

 

 

 

 

 

 

dilated stomach2

 

You have gastric distension with at least a liter of fluid in there.   Put in an OG, hold feeds, assess the rest of the abdomen to r/o bowel obstruction, consider motility agents and look for a reason behind the ileus or obstruction.

 

 

Philippe

Bedside Ultrasound Clip Quiz 2 – #FOAMed, #FOAMcc

64 yr old woman POD#3 Rt heimcolectomy with fever and abdominal pain.

Right costal longitudinal scan. What do you see?

 

 

 

 

 

 

 

 

A complex echogenic sliver of ascites over the liver…now what do you do? Here’s what I did…

 

…and it showed fecaloid material. Turned out to be anostomotic leak.  Didn’t have to push much for surgery.

 

Philippe