Tom Fisher
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tomfisher.bsky.social
Tom Fisher
@tomfisher.bsky.social
610 followers 220 following 85 posts
CT1 anaesthetics, critical care echo-head
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Tom Fisher @tomfisher.bsky.social · Feb 1
🔬 Pleased to share our new scoping review on cardiac arrest after hanging- sadly not an uncommon cause of cardiac arrest which has previously lacked a good quality synthesis of evidence

Link: authors.elsevier.com/a/1kXSi_6ryq...

🧵1/6
Screenshot of an abstract for cardiac arrest after hanging: a scoping review Abstract Background Hanging is a common cause of suicide and asphyxial cardiac arrest. There are few data to inform the treatment of cardiac arrest after hanging. We designed a scoping review to describe evidence relating to interventions and outcomes in patients with and without cardiac arrest after hanging. Methods Medline, Embase and Cochrane were searched from inception to 05/12/2024. Titles and abstracts were screened, and duplicates were removed. Articles were eligible for inclusion if they studied non-judicial hanging in adults or children, included cardiac arrest patients and provided functional or survival outcomes. Results The search retrieved 855 articles. One hundred and nineteen references underwent full-text review. Forty-five studies were included in the review. Studies were mainly from high-income countries and were all observational. There was variation in the terminology for hanging and in the outcomes reported. Survival with favourable functional outcome was rare in patients with cardiac arrest after hanging but was very common in patients without cardiac arrest. Cervical spine, airway and vascular injuries were rare. No studies identified interventions that were associated with improved survival following return of spontaneous circulation. Conclusion There are few data to inform treatment of patients with cardiac arrest after hanging. The available data suggest that cardiac arrest is a critical determinant of poor outcome following hanging. Further research should uniformly report outcomes of patients with cardiac arrest after hanging based on the Utstein template.
Reposted by Tom Fisher
mike-ambler.bsky.social
Very excited to post this preprint... making a species that doesn't hibernate do something a lot like it, AND showing it is cardioprotective.
www.biorxiv.org/content/10.1...
Synthetic torpor in the rat recapitulates key features of natural torpor and is cardioprotective
During hibernation, animals enter torpor, a reversible physiological state typically characterised by reductions in core temperature, heart rate and oxygen consumption. Species that enter this hypothe...
www.biorxiv.org
March 19, 2025 at 12:55 PM
Reposted by Tom Fisher
drfreeze.bsky.social
I had the pleasure of teaching lung #pocus at a “train the trainers” course, with the ever excellent @avkwong.bsky.social and Cian McDermott as faculty

Some reflections from the day:

(1/n)
February 27, 2025 at 9:45 AM
Reposted by Tom Fisher
ecgprof.bsky.social
For all my ECG nerds friends:

What to consider when you see one or more PVCs:

medicusofhouston.com

NEVER a tariff on MY classes!

#ECGNerds #ECGSky #MedSky #CardioSky #Cardiology #YaleEM #EMedSky #nursesky #MedEd #EMSky #BlueSky #MedEducation #emimcc #EUSEM #ACEP #AAEM #ESEM #ASEM #ACEM
"A Few Words About Premature Ventricular Complexes (PVC)" - Page 1 Come join us in Halifax, Nova Scotia April 21 - 24, 2025 for a TARIFF-FREE great time in The Masterclass in Advanced Electrocardiography! Earn AMA PRA Category 1 Credit and benefit from the only live, in-person interactive course in advanced ECG interpretation! "A Few Words About Premature Ventricular Complexes (PVC)" - Page 2 Come join us in Halifax, Nova Scotia April 21 - 24, 2025 for a TARIFF-FREE great time in The Masterclass in Advanced Electrocardiography! Earn AMA PRA Category 1 Credit and benefit from the only live, in-person interactive course in advanced ECG interpretation! "A Few Words About Premature Ventricular Complexes (PVC)" - Page 3 Come join us in Halifax, Nova Scotia April 21 - 24, 2025 for a TARIFF-FREE great time in The Masterclass in Advanced Electrocardiography! Earn AMA PRA Category 1 Credit and benefit from the only live, in-person interactive course in advanced ECG interpretation! "A Few Words About Premature Ventricular Complexes (PVC)" - Page 4 Come join us in Halifax, Nova Scotia April 21 - 24, 2025 for a TARIFF-FREE great time in The Masterclass in Advanced Electrocardiography! Earn AMA PRA Category 1 Credit and benefit from the only live, in-person interactive course in advanced ECG interpretation!
February 14, 2025 at 10:43 PM
Reposted by Tom Fisher
drfreeze.bsky.social
Delighted to share the Barts echo team’s latest article

“Examining the Relationship Between Pulmonary Artery Acceleration Time and Pulmonary Artery Pressures in Patients with Ischemic Cardiogenic Shock”

Free to read for 50 days on the following link

www.sciencedirect.com/science/auth...
www.sciencedirect.com
February 8, 2025 at 2:16 PM
Reposted by Tom Fisher
drfreeze.bsky.social
Really nice article on TAPSE/TRVmax as a potential prognostic marker

From the team at Nepean ICU, led by Emma Bowcock

annalsofintensivecare.springeropen.com/articles/10....
The value of right ventricular to pulmonary arterial coupling in the critically ill: a National Echocardiography Database of Australia (NEDA) substudy - Annals of Intensive Care
Background Right ventricular (RV) function is tightly coupled to afterload, yet echocardiographic indices of RV function are frequently assessed in isolation. Normalizing RV function for afterload (RV...
annalsofintensivecare.springeropen.com
February 6, 2025 at 10:55 AM
Reposted by Tom Fisher
damienbarraudmd.bsky.social
My pov : patients with good outcomes after OHCA associated with hanging...were probably not in OHCA...
tomfisher.bsky.social Tom Fisher @tomfisher.bsky.social · Feb 1
➖Those with OHCA rarely have good functional outcomes
➖Those without OHCA frequently have good outcomes
➖Associated C spine/vascular/airway injuries are uncommon in those who survive to hospital

🧵2/6
Bubble plot of rates of favourable functional outcomes in hanging categorised by cardiac arrest status, demonstrating very poor outcomes in patients who experienced OHCA compared to those who did not
February 2, 2025 at 6:22 AM
Reposted by Tom Fisher
imcrit.bsky.social
ICU Mini-Stories:

Middle-age pt presented to ED at 8:00 am with cough/dyspnea/weakness x 2 weeks. Poor appetite/could walk only a few feet due to dyspnea/dizziness. Vitals: HBP 79/60, HR 80, afebrile, O2 sat 96% on 2 l/m. Physical exam: ill-appearing, dry mucous membranes. Labs:
February 1, 2025 at 10:20 PM
tomfisher.bsky.social
🔬 Pleased to share our new scoping review on cardiac arrest after hanging- sadly not an uncommon cause of cardiac arrest which has previously lacked a good quality synthesis of evidence

Link: authors.elsevier.com/a/1kXSi_6ryq...

🧵1/6
Screenshot of an abstract for cardiac arrest after hanging: a scoping review Abstract Background Hanging is a common cause of suicide and asphyxial cardiac arrest. There are few data to inform the treatment of cardiac arrest after hanging. We designed a scoping review to describe evidence relating to interventions and outcomes in patients with and without cardiac arrest after hanging. Methods Medline, Embase and Cochrane were searched from inception to 05/12/2024. Titles and abstracts were screened, and duplicates were removed. Articles were eligible for inclusion if they studied non-judicial hanging in adults or children, included cardiac arrest patients and provided functional or survival outcomes. Results The search retrieved 855 articles. One hundred and nineteen references underwent full-text review. Forty-five studies were included in the review. Studies were mainly from high-income countries and were all observational. There was variation in the terminology for hanging and in the outcomes reported. Survival with favourable functional outcome was rare in patients with cardiac arrest after hanging but was very common in patients without cardiac arrest. Cervical spine, airway and vascular injuries were rare. No studies identified interventions that were associated with improved survival following return of spontaneous circulation. Conclusion There are few data to inform treatment of patients with cardiac arrest after hanging. The available data suggest that cardiac arrest is a critical determinant of poor outcome following hanging. Further research should uniformly report outcomes of patients with cardiac arrest after hanging based on the Utstein template.
February 1, 2025 at 1:21 PM
Reposted by Tom Fisher
icmtim.bsky.social
If a picture’s worth 1000 words then this cine loop’s a damn novella dedicated to the pathogenesis of hepatic hydrothorax 😍

#EMIMCC #pocus
January 22, 2025 at 7:45 PM
Reposted by Tom Fisher
doced.bsky.social
xkcd.com/882/
January 16, 2025 at 11:04 PM
tomfisher.bsky.social
When following a left atrial pressure algorithm that uses 2.8m/s as a binary cutoff, do people give a bit of leeway if it's *almost* 2.8 with severe TR/wide vena contracta?
January 2, 2025 at 10:19 PM
tomfisher.bsky.social
Does anyone know where I can find a manual/user guide for Phillips 5500CV or other similar Phillips device? Only get Phillips espresso machines when I Google for the manual and it's slow mastering the knobology incrementally just while scanning!

#cardiosky #echofirst
#echosky
December 31, 2024 at 1:34 PM
tomfisher.bsky.social
Instructive case in my ongoing FUSIC HD journey- pt with dyspnoea, leg/groin/abdo swelling
December 24, 2024 at 9:41 AM
tomfisher.bsky.social
Was somewhat surprised by moderate-severe AR (prev trivial) when looking to assess a prev moderately stenotic AV in a FUSIC HD training scan recently. FUSIC HD limits AV assessment to colour and dimensionless index.

Is the DI still useful in these mixed valve disease cases?

#echosky #cardiosky
December 6, 2024 at 12:18 AM
Reposted by Tom Fisher
benmillette.bsky.social
There's not enough #POCUSky so let's get the ball rolling. What is the similarity between the following two thoracic ultrasounds?
Clip 1:

#emimcc #medsky
December 3, 2024 at 12:11 PM
Reposted by Tom Fisher
doced.bsky.social
People often talk about the time critical nature of sepsis. But it may surprise you to hear that the evidence to support “early” antibiotics actually isn't a settled debate. Why is that? The key question is “early in relation to what”? 🧵 1/n
December 3, 2024 at 9:38 AM
Reposted by Tom Fisher
whistlingdixie.bsky.social
A sad day for critical care - and what a phenomenal legacy he has left us.

RIP Prof Gattinoni, a Giant ⚕️📟

www.esicm.org/obituary-luc...
Obituary: Luciano Gattinoni - ESICM
In Memory of Professor Luciano Gattinoni
www.esicm.org
December 2, 2024 at 5:02 PM
Reposted by Tom Fisher
load-dependent.bsky.social
If the LV of the patient with sepsis is «hyperdynamic» when on noradrenaline, then EF dropps and the LV looks poorly when vasopressin is added, but recovers to normal with dobutamine, you likely haven’t «uncovered hidden LV dysfunction» or septic cardiomyopathy. #emimcc #pocus #echofirst 1/
November 30, 2024 at 9:57 AM
tomfisher.bsky.social
Why do so many (UK) favour a sternal cap refill rather than peripheral in adult patients?

Many claim this is superior by way of anecdote and "their hands will be cold anyway" but I've never been able to find ANYTHING to support this (certainly no andromeda equivalent!)

#emimcc
November 29, 2024 at 5:21 PM
Reposted by Tom Fisher
criticalcarereviews.com
Acute Decompensated Valvular Disease in the Intensive Care Unit

CCR Journal Watch
criticalcarereviews.com/latest-evide...

Get the latest critical care literature every weekend via the CCR Newsletter - subscribe at criticalcarereviews.com/newsletters/...
November 28, 2024 at 7:43 PM
tomfisher.bsky.social
30ml/kg first-line for allcomers with sepsis (no nuance added in discussion beside implying CLOVERS & CLASSIC & sepsis pathophysiology support this)

What could go wrong??!?
criticalcarereviews.com Critical Care Reviews @criticalcarereviews.com · Nov 28
Today's Paper of the Day is state of the art of sepsis care for the emergency medicine clinician
criticalcarereviews.com/latest-evide...

Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2024
November 28, 2024 at 9:23 AM
Reposted by Tom Fisher
dilipj1.bsky.social
A thread 🧵 on trials I think have changed or will change ICU practice (at least my own). #emimcc
drmattthomas1.bsky.social Matt Thomas @drmattthomas1.bsky.social · Nov 25
At the back of Revision Notes In Intensive Care Medicine there is a list of 59 key papers relating to intensive care medicine published between 1998 and 2015 (the book was published in 2016).
I'd like to keep my revision up to date. Are there any equivalent lists of key papers from 2016 to now?
November 27, 2024 at 5:16 AM
Reposted by Tom Fisher
load-dependent.bsky.social
1w cough and increasing dyspnea. Upon pickup by paramedics sat70%, hypotensive. ⬆️CRP/WBC. Pneumonia/septic shock assumed, abx and bolus fluids initiated, intubated in the ER. Hypotensive despite high dose pressor, #Echo follows #FOAMed #FOAMcc
November 3, 2024 at 10:45 PM
Reposted by Tom Fisher
katiewiskar.bsky.social
1/
Back to the basics today: let's talk about common pitfalls in obtaining cardiac #POCUS images ❤️

Here are some very common image acquisition errors in basic views, as well as the simple moves to correct them ✅

🧵

#emimcc #POCUSky #echosky #MedSky
November 26, 2024 at 5:51 PM