ʇɟıɥsI̍CͨMͫpɐɹɐd ≆ Dr Justin Kirk-Bayley
@PARADicmSHIFT
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UK somnificator, INTJ lefty & inamorato of #POCUS, #FOAMed, #FOAMcc & #FOAMus Turning ICU upside down one ultrasound scan at a time. @ICS_updates Council member
Caring critically in Surrey
Joined March 2009
If intensive care is about attention to detail, then here’s an easy win. Ensure everything IV is as concentrated as it can be for the route given. Use dextrose as a diluent if you can. Aim for admission weight to be restored unless you are addressing nutritional deficit….
💧Fluid creep accounts for more fluid than resuscitation in ICU. But nobody prescribes it — and most don’t even notice it. The truth?.🧨 Most ICU patients don’t need routine maintenance fluids. Here’s what’s really going on 👇🧵
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Surely a feeling felt by many critical care outreach teams. The need to do something, yet kicking the can down the road. Also the strong desire to accelerate the pressor dose reduction by any means possible when they are in ITU. Inappropriate use of IV fluids for patients is
💉 “Give a fluid challenge — see if we can get the norad down.”. We’ve all heard it. Boluses are often given just to reduce vasopressor doses. Why?.• Fear that pressors are harmful.• Pressure to keep patients off ICU.But topping up to drop the norad might not be the best move…
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When patients get hyponatraemia often the response is to order a lot of tests. Thinking about the underlying cause, and realising it’s not just about the sodium might help unnecessary blood draws. A great Tweetorial and a flow diagram to guide your thinking from @Turningthe_Tide—.
🧵Why does low protein intake cause hyponatraemia?. Most people find this confusing. But the underlying physiology is beautifully simple. Let’s walk through it 👇. #Hyponatraemia #FluidBalance #MedTwitter #FOAMed
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How did we get to the success of the #FUSIC programme in the UK?.@DrJenStep taking us through the great journey from early meetings of #POCUS minds through to spreading work internationally with @ICS_updates and @SICMSG at #SOA25. (Whose hairy wrist is that?! 😆)
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Some of the @Turningthe_Tide team at @ICS_updates #SOA2025 delivering a tour de force of macro and micro circulation physiology, but also a reminder of how not to cause unintentional harm to critically unwell patients by not carefully managing fluid therapy.
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RT @jennyldb: Great session in Critical Care Tales @ICS_updates #SOA25 on changing 2 multi-use giving sets for IV medications - saves money….
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Hearing @Krockdoc talk about how bad we all are at managing electrolytes and giving unnecessary IV fluids to the frail elderly at @ICS_updates #SOA25 shows us that @Turningthe_Tide has so much work to do to fix this!
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At @ICS_updates #SOA25? Love #POCUS or want to learn more? Come and hear from @DrJenStep how we got to a world-class accreditation programme with #FUSIC in the UK, and enjoy a competitive showcase of great examples of when #POCUS saved the day.
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RT @Wilkinsonjonny: First inaugural ICS Cast done with the fantastic Yunus Dudhuwala. What a gentleman and amazing orator. We can’t wait….
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RT @ICS_updates: We’re wrapping up the Pre-Congress workshops with brilliant insights from @cardiacACCP and @DrJenStep . Thank you to ever….
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RT @ICS_updates: This #SOA25, join us for our Wednesday night party at Albert's Schloss in Birmingham on 2 July. Have a drink and a danc….
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RT @Turningthe_Tide: 🧵1/.Hypovolaemia is the most overdiagnosed concept in medicine. We say it reflexively — especially in sepsis. But here….
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RT @Wilkinsonjonny: The wait is over. it’s the start of something new! 👏. The @ICS_updates ICS Cast begins … and where better to kick it al….
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RT @Turningthe_Tide: 🫁 What happened to ARDS?. 20 years ago ARDS was everywhere. Now we rarely see it. We didn't cure it. We just stopped….
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What’s going on at this year’s ICS State of the Art meeting?.A lot of ultrasound, that’s what!. Look at this video to see what the #FUSIC team have put together. From beginner to advanced or just curious, dive in!. #SOA25 @ICS_updates
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You've seen this hundreds of times, let's talk about what it means for intensive care!
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You've heard of the Clinical Frailty Score….Come and hear from its inventor, Prof Ken Rockwood. I'll be privileged to question him, and experts on prehabilitation, laparotomy outcomes, and peri-operative medicine at #SOA25.@profsandyjack @ICS_updates
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RT @Wilkinsonjonny: Come and see @Jennythatcanbl1 and I demo live on every nerve block you need to know to help your patients on ITU!. Tues….
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Why is the threshold for pressors for hypotension set so high?.Why do we insist on giving excess IV fluid & just cause problems later on?.Hearing @icmteaching and @ross_prager talk about this at the @ICS_updates #SOA25 is going to be great. And keep your eye on @Turningthe_Tide!.
The very 1st line of a recent @BJAJournals states:.'In early critical illness, intravascular volume depletion secondary to capillary leak is common & requires aggressive fluid resuscitation to improve cardiac output & tissue perfusion'.Why are we still propagating these myths? 🧵.
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