Integrated ultrasound approach to Fluid Responsiveness……Canadian Style. #FOAMED

Remember the funny talking French Canadians who brought you EGLS recently?

Well, they’re back.

They think we’ve been a bit narrow in our discussion of the IVC for fluid responsiveness.  They think we could get a little more sophisticated with our sound waves than looking at the IVC in isolation……and we think they’re right.
Fair warning:  The first several minutes of this talk are physiology heavy, but it’s great stuff and totally worth it if you can make yourself focus on the details.  It matters!!  
And just so you know, we met them in person at the World Congress of Ultrasound in Medical Education last week and they were great guys!  Of course, we didn’t understand a word they said, but we nodded our heads and smiled for hours as we talked to them.
Lastly, if you’ve got a #FOAMED idea, go apply for the #FOAMED Innovation Scholarship.  Or if you want to support the Scholarship and get your learn on at the same time, then buy the iBooks.

See you at the Castle! versions:
Introduction to Bedside Ultrasound Volume 2 (available very soon)

4 comments… add one

  • Reza

    October 22, 2013, 1:58 pm

    Hi, I’m looking for an interesting topic to start a research project. The key terms for the topic are:
    Bedside Ultrasound, Emergency Medicine.
    Could any body help me?

  • Kish

    November 3, 2013, 1:29 pm

    One of the best presentations on an approach to volume resuscitation I have seen.
    Great work guys!

  • TDimaginaryBFF

    November 27, 2013, 7:59 am

    Great stuff conceptualizing the guyton curves. The big picture approach to all this fluid resuscitation stuff is off the hook and the ideas that drive it are pretty exciting, I feel like I have x-ray vision. I am going to look through the archives, but what I am trying to find are doppler techniques. I feel like I have X-ray eyes, excited learning all this stuff, but in those grey area patients, doppler techniques may be the saving grace. Many of the non-invasive ways to assess volume responsiveness = do X, y, or Z and then measure CO via doppler. Can I measure LVOT…..? Sure. Can I doppler the aortic jet? Ummmm…… The carotid flow……maybe not so much. Any directions to some resources would be great.

    Also, after reading the papers, I really not seeing how people are just raising the legs and seeing a increase in MAP and saying oh they must be volume responsive (I understand that MAP = CO x SV) without having really any standardization or other measurable endpoints. How long do you hold them up for, how long does the MAP stay increased (if they are volume responsive I take it that the MAP increases until you lower the legs). Is it just nonsense.

    Anyway, great work.

    • PB

      December 30, 2013, 10:23 pm

      A physiological approach but not a real everyday practice. Look IVC in extense anterior AMI…LVEF is reduced, B lineas are present, pseudonormal transmitral pattern is seen…but right ventricular function is good and IVC is collapsing more than 50 % and normal in diameter. Is really a fluid responder? the fluid response law says that a patient is volume responsive when BOTH ventricles are in the steep part of Starling curve…so IVC alone is not enough…maybe is better to see the entire echo movie. And is important not to forgot that pulse pressure variation (with strict conditions= tidal volume more than 8 ml/kg; regular sinus rythm, no espontaneous ventilatory efforts) more than13 %) have one condition that result in false positive= cor pulmonale. Again, it is important to see all movie…with a good and sometimes complete echocardiogram and of course, integrate thoracic ultrasound and B profile.


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