Discover and read the best of Twitter Threads about #FOAMus

Most recents (20)

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
Asc aorta:
Visualised from PLAX view with depth ⬇️ & probe tilted to focus on the root. Tilting superiorly, or moving up a rib space, may help. Examine the AV and look for a dissection flap. Measure the diameter 3-4cm from the AV. The root can also be seen from A5C & A3C views
Read 20 tweets
Patient with epig pain and multiple ED visits with neg CT and non-specific labs - but persistent pain. What do you do? GI cocktail + famotidine and discharge? How about a little #POCUS first. #FOAMed #FOAMus #Ultrasound #MedTwitter @mtabbut @laurarbrownmd @RJonesSonoEM
And the transverse view. What do you think now? Poll below in thread. #Whatsthedx #EmergencyMedicine @DianeGramer @SLWerner_EM @ClaridgeJeffrey @vanessapho @ladha_prerna
What do you think?
Read 9 tweets
So, remember C3,4,5 keeps you alive?!

Yes, today’s Tweetorial from @icmteaching, @ICUltrasonica and myself is all about the diaphragm!

It’s a pretty vital muscle, and a muscle often forgotten. It’s no wonder why, when it’s weak, your patients won’t liberate from the ventilator! Image
So, does #POCUS have a role in assessing it. Of course it does!🤷‍♂️😂

We use 3 probe positions:

1) Mid axillary/RUQ point - marker 12 O’clock
2) Mid clavicular/Subcostal - marker 12 O’clock
3) Mid clavicular/subcostal - marker 3 O’clock
Here’s MidAx/RUQ position:

The lung curtain does get in the way here, so run M-mode low down to catch the diaphragm.

We use the vital organ (liver or spleen) as our scan window and discriminator between chest cavity and abdominal cavity👍
Read 14 tweets
Today it’s Lung #POCUS for you!

It is:

Easy to perform
Negates irradiation or transport elsewhere!

#FOAMed #POCUS #FOAMcc #foamus @icmteaching @ICUltrasonica

Where do we scan then?? Linear/curvilinear or phased probe positions shown👍👇
We don’t tend to use linear for the basal sections, as you need depth for the PLAPS points. To see the pleura clearly, minimise depth and drop gain down, you get a real concept of sliding on the screen.

Here are the normal views for you @GEHealthcare
Now; the Pneumothorax!

Pleural slide disappears as the parietal and visceral pleura separate. So, a static washing line is seen between the rib pillars 👇. The more you see, the more you recognise. Decompress IF your patient is compromised. It’s more sensitive than CXR!
Read 23 tweets
So; there are often debates regarding ultrasound probe manoeuvres 🤷‍♂️

Here we go with a graphical Tweetorial, courtesy of myself, @ICUltrasonica and @icmteaching

Hope this helps (you may see these soon in a forthcoming book btw😉

#FOAMed #POCUS #FOAMcc #echofirst 1/7


Here we slide the probe along a slug trail of gel, quite crudely, across a wide area of the body. This is often used to ‘window shop’, for structures we can’t see at first. When they snap into view, we can fine-tune movements 👍 Also allows view of larger organs.


Classic example here is when we get an apical view of the heart. At first, the heart may not be in line with the scan field. We can ‘swing’ it into view, so it appears more square on the screen. Makes parallel measurements more accurate and things less off-axis🤷‍♂️
Read 9 tweets
Goal and benefit of POCUS is to rapidly narrow the differential diagnosis through asking and answering defined clinical questions.
POCUS will narrow the differential more rapidly
Read 18 tweets
Patient with hx ESRD on dialysis and multiple previous central catheters. Needs central line. #POCUS as shown. Go ahead and place the line? Poll in thread. #FOAMed #FOAMus #MedTwitter #EmergencyMedicine @mtabbut @RJonesSonoEM @SLWerner_EM @NephroP @siddharth_dugar
Place the line here?
Answer: This patient with chronic thrombus at the shown location. Best to look for a different location.
Read 4 tweets
70 y/o👴🏼. 40 PY🚬 / 🍻

⤵️ 10 kg, ⤴️ cough + behavioral change

➖ R perihilar 🫁 mass

➖➕ Mediastinic & hilar ipsilat LAD

🧠 CT
➖ R cerebellar contrast enhanced lesion, suspected MET

🔰Broncogenic carcinoma

🗣👨‍⚕️👨‍👩‍👦‍👦Palliative care 🔜☠️


[1/3 🎞]
[2/3 🎞]
Read 4 tweets
Known distal UVJ stone. Has new rt flank pain. Mild hydro but what else? #POCUS #IMPOCUS #FOAMed #FOAMus #MedEd #MedTwitter @ACEP_EUS @SeeWithSound @PhilipsPOCUS @IMPOCUSFocus @medpedshosp @NephroP @jminardi21 @HeyDrNik @TomJelic @cianmcdermott @MH_EMultrasound @thepocusatlas
Area of increased echogenicity of parenchyma seen in upper pole. @Manoj_Wickram @tomkehrl @MH_EMultrasound @MetroHealth_EM @Casscln @ria_dancel @cm_lopresti @DRsonosRD
Also has trace perinephric fluid seen (arrow)
Read 17 tweets
50y🧔🏻HTN. Hx of Episodic sweating & palpitations.

🏥 < 12h SOB + diaphoresis
BP 220/120. HR 125. SpO2 80% CRT >5

#POCUS bilat B lines + RUQ mass

Tx: NIV + CI 💉 1° 🆙NTG + 2° Labetalol* 🔜 Stable

Emergent 🏝🛩 to tertiary center (4k km)

🔰Pheochromocytoma ⁉️


Medical 🛩 team decides ETI for transfer (questionable, considering ✅ response to NIV & 💉)

🏙 🏥 Plasma free metanephrines (++) confirm Dx.

Anesthesia: “To unstable to operate, wait..”

Finally: ☠️⚰️waiting for a more appropriate time..



Labetalol is ❌ recommend for Tx ⚠️
Weak α blocker effect, non selective B ⛔️(1:5, α: β). Could make worse the HTN and precipitate hemodynamic collapse.

Drug of choice in crisis are IV α ⛔️(not available in 🇨🇱 ), or nitropussiate (not available in my 🏥).
Read 4 tweets
Thread: Ultrasound for CVC placement - more than just follow the needle tip and confirm the wire.

There are many potential uses of ultrasound during CVC placement, shown here. Not all are essential.

Lung sliding on ipsilateral side - for a comparison to post-procedure
-use linear probe
-apical and lateral/anterior
Check vessel
-confirm compressibility
-understand axis of vessel
-check prox and distal for stenoses
-optimize depth and gain (this image may be undergained)
Read 25 tweets
Differentiating portal venous gas from pneumobilia on ultrasound. See thread. #POCUS #FOAMus #FOAMed #IMPOCUS #MedEd #MedTwitter #ultrasound @ACEP_EUS @USIGcleveland @MetroHealth_EM @aedrake65
Case 1. Liver TRV sweep. Which is present? Answer poll.
Case 1. Which is present?
Read 9 tweets
Pt-Bilat LE pain/swelling 5 days.Prior hx of unprovoked DVT/PE years ago but off meds due to insurance. See thread. POCUS DVT #POCUS #IMPOCUS #FOAMed #FOAMus #MedEd #FOAMcc @ACEP_EUS @medpedshosp @cianmcdermott @jminardi21 @grepmeded @siddharth_dugar @msiuba @NephroP @SonoStache
What POCUS DVT protocol to use? 2-point or 3-point or extended? With or without Doppler? Meta-analysis showed good performance of 2 and 3 point POCUS but need to understand POCUS compression limitations if only compression used:…
Adhikari and colleague article showed 6.3% false neg rate due to prox isolated DVT with 2-point compression. Limitations of POCUS prox compression DVT exam go beyond just missing isolated/focal DVT.
Read 9 tweets
Patient with RUQ abdominal pain. Difficulty finding GB. Pt denies history of prior abdominal surgery and no scars seen. See thread. #POCUS #IMPOCUS #FOAMed #FOAMus #MedEd #MedStudentTwitter @medpedshosp @NephroP @grepmeded @cianmcdermott @ACEP_EUS @PhilipsPOCUS
GB Sag and TRV sweeps. GB not seen. No surgical clips seen. Contracted GB, agenesis of GB, ectopic location of GB, prior removal (and patient forgot--it does happen)?
On Sag image, don't confuse bowel contents with GB filled with sludge
Read 6 tweets
Short image tweetorial on thoracic ultrasound findings in pneumonia. #POCUS #IMPOCUS #FOAMed #FOAMus #Medtwitter #Meded #COVID19 @medpedshosp @cianmcdermott @msiuba @siddharth_dugar @grepmeded @NephroP @emresidents
Normal lung ultrasound. A-profile with thin pleural line with lung sliding. Linear transducer used.
Irregular pleural line with patchy B-lines. Seen in viral (including COVID19) and bacterial pneumonia. This patient had mycoplasma pneumonia. Linear probe used.
Read 11 tweets
Anyone that took the #EmergencyMedicine ITE last week knows that we got approximately 220 out of 225 questions on LVADs, and I’m pretty sure I got 85% of those questions wrong. So here’s a #tweetorial on LVADs

#FOAMed #CardioTwitter

LVAD Basics

🔺They dont have pulses‼️due to linear flow device
🔺How to assess perfusion? Mental status, cap refill, warm extremities
🔺Auscultate (more on that later)
🔺Pulse Ox can be unreliable due to lack of pulsatility➡️get ABG if poor waveform
🔺Do bedside echo early

Blood pressure with LVADs

✅MAP goal: 65-80mmHg
🔺Measure BP using manual cuff and doppler (95% accurate) as opposed to standard automated BP cuff (~50% accurate)
🔺Put in A-line if critically ill for continuous BP monitoring


Read 13 tweets
You're going to place a central line on a hypotensive patient. 💉

You got this 💪🏽

You put the ultrasound probe on their IJ to take a look 😷👀

And you see this👇🏾



@POCUS_Society @UBemSono @EM_RESUS @MaimoUltrasound @EMUGs_ @SAEMAEUS @sinaiemus
🌊 Turbulent Flow 🌊

Some of the many but not all causes include:
♦️Thrombi, Clots & Hypercoaguable States
♦️Vessel Stenosis & PVD (often from Atherosclerosis)
♦️Disorders affecting viscosity (PCV, Waldenstrom, etc)
♦️Sickle Cell

#FOAMed @UltrasoundMD @jeff_sono @grepmeded
In this patient, a clot further down the IJ prevented the CVC from being placed.😕

Use caution before attempting CVC placement in patients w/this much turbulent flow & consider some underlying causes!

#FOAMed @PittIMPOCUS @TempleEMUS @ultrasoundREL @ultrasoundpod @ACEP_EUS
Read 3 tweets
#POCUS appearance of acute epididymitis with funiculitis (inflamed spermatic cord)
Comparison of normal and abnormal epididymis Image
Testes appear symmetrical in echotexture Image
Read 5 tweets
Curious about how #POCUS is taught? This #Tweetorial is for U
#Preview for #ASEchoJC 🔜9/4 8pm EST

Point-of-Care Cardiac Ultrasound POCUS: State-of-the-Art in Medical School Education by @amerjohri

#POCUS not 🐇🎩, not short #TTE
2/ Current #goals #Cardiac #POCUS #MedEd

(1) introduce concepts of ultrasound- common imaging views, correlate with anatomy, & physical examination skills

(2) develop scanning techniques➡️ basic competence

(3) recognize & differentiate b/w normal anatomy & basic pathology
3/ When Do We Start? Prerequisite knowledge for #POCUS teaching

"priming effect" of preclinical education

Big machine 1st over handheld Martinez et al @UMMC

Start 1st year @Hoppmann et al @UofSCSOM
Read 10 tweets

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