Discover and read the best of Twitter Threads about #LUS
Most recents (6)
#AKIConsultSeries:馃懆w T2DM鉃★笍馃彞 for fever, dysuria and CVA tenderness. On arrival: 猬囷笍BP, 猬嗭笍Glucose, 猬嗭笍AGMA. Dx UTI + DKA. Tx: Abx + Insulin Pump + 4 L Crystalloid + NE
After resus, pt still oliguric, Cr 3.2. NE 0.7 ug/kg/min,馃confused, BP 85/62, HR 123, 2L O2. CRT 4 sec
1/12
After resus, pt still oliguric, Cr 3.2. NE 0.7 ug/kg/min,馃confused, BP 85/62, HR 123, 2L O2. CRT 4 sec
1/12
Given DKA, giving additional fluids is tempting. But before we do this, its easy to do a quick assessment of fluid tolerance #POCUS
#LUS shows some B-lines (bilat)
#IVC plethoric w no respiratory collapse
#VExUS shows very pulsatile portal vein 馃毃馃
2/12
#LUS shows some B-lines (bilat)
#IVC plethoric w no respiratory collapse
#VExUS shows very pulsatile portal vein 馃毃馃
2/12
Pulse pressure is low (23!): This suggest a low cardiac output state!
Also, there are signs of fluid intolerance!
#EchoFirst: Window is suboptimal, but we see a Hyper-dynamic LV w small cavity and a turbulent flow (green color). There was no systolic RV failure
3/12
Also, there are signs of fluid intolerance!
#EchoFirst: Window is suboptimal, but we see a Hyper-dynamic LV w small cavity and a turbulent flow (green color). There was no systolic RV failure
3/12
#AKIConsultSeries Middle-aged male 鉃★笍馃彞 for painful knee and fever. Now in shock 馃毃
馃搨Chart review: PMH EtOH Cirrhosis, right knee arthroplasty.
It is always a good practice review previous PACS images馃┗: Nodular liver, colateral vessels and prosthetic right knee
1/11
馃搨Chart review: PMH EtOH Cirrhosis, right knee arthroplasty.
It is always a good practice review previous PACS images馃┗: Nodular liver, colateral vessels and prosthetic right knee
1/11
On exam: BP 72/48, HR 82, O2Sat 95%.
CRT 7 sec, 馃somnolent, confused. No edema, no obvious ascites.
Warm, swollen and erythematous knee: Tap with obvious purulent fluid馃Й
Cr 2.8 mg/dl (baseline 0.5), K 6.7, Urine 馃敩: hyaline casts, some urothelial cells
2/11
CRT 7 sec, 馃somnolent, confused. No edema, no obvious ascites.
Warm, swollen and erythematous knee: Tap with obvious purulent fluid馃Й
Cr 2.8 mg/dl (baseline 0.5), K 6.7, Urine 馃敩: hyaline casts, some urothelial cells
2/11
Loos like hemodynamic AKI (AKA Pre-renal)
Usual causes in Cirrhosis:
馃敺Distributive: Septic, "Hepatorenal physiology" 馃敺Hypovolemic: Laxatives, vomiting, large volume paracentesis
馃敺Congestive: Porto-pulmonary HTN, Co-existing cardiomyopathy
3/11
Usual causes in Cirrhosis:
馃敺Distributive: Septic, "Hepatorenal physiology" 馃敺Hypovolemic: Laxatives, vomiting, large volume paracentesis
馃敺Congestive: Porto-pulmonary HTN, Co-existing cardiomyopathy
3/11
Read 10 tweets
#POCUS y #SoMe4MV en #PedsICU
馃攰en Ventilaci贸n Mec谩nica 馃珌
Abro hilo, iniciamos, y abiertos los comentarios:
馃攰en Ventilaci贸n Mec谩nica 馃珌
Abro hilo, iniciamos, y abiertos los comentarios:
Esta informaci贸n tuvimos el gusto de compartirla en el IV Curso Internacional de Medicina Intensiva Pedi谩trica dentro del XVI Congreso Internacional de Medicina Intensiva organizado por la @sopemi_org.
Gracias por la invitaci贸n. Ahora si, entremos en materia.
Gracias por la invitaci贸n. Ahora si, entremos en materia.
Los objetivos planteados en tres puntos:
Relacionar el Ultrasonido Pulmonar (LUS) y la Ventilaci贸n Mec谩nica (VM).
Conocer gu铆as y monitoreo que nos ofrece el POCUS en VM y mencionar elementos evaluables por LUS.
Relacionar el Ultrasonido Pulmonar (LUS) y la Ventilaci贸n Mec谩nica (VM).
Conocer gu铆as y monitoreo que nos ofrece el POCUS en VM y mencionar elementos evaluables por LUS.
AKI Consult: 馃懙 鉃★笍 ED with severe DKA. CT Abdomen and Chest to look for infectious trigger: negative. Tx with IV insulin and balanced crystalloid + 6 L with obvious improvement. Cr was 2.7
Remained oliguric, now in sudden shock with increasing NE dose (0.5 ucg/kg/min) 馃毃 1/12
Remained oliguric, now in sudden shock with increasing NE dose (0.5 ucg/kg/min) 馃毃 1/12
#POCUS Very hyper-dynamic馃珋 with increased contractility and no RV dysfunction.
馃攷 Look carefully at color of flow exiting the LV:
Aliasing (green color): This means ultrasound system is trying to image an event that is occurring faster than the sample rate
2/12
馃攷 Look carefully at color of flow exiting the LV:
Aliasing (green color): This means ultrasound system is trying to image an event that is occurring faster than the sample rate
2/12
This means flow is fast. But how fast? Choose the CW doppler setting and find out!
In this case acceleration was almost 6 m/s!
Flow acceleration occurs in the setting of obstruction (similar to putting your finger on the hose exit)
So what is causing the obstruction? 3/12
In this case acceleration was almost 6 m/s!
Flow acceleration occurs in the setting of obstruction (similar to putting your finger on the hose exit)
So what is causing the obstruction? 3/12
Pt w advanced liver cirrhosis. 馃彞 Comes w worsening ascites. No fever馃, no bleeding馃└. 馃 ok, no asterixis. BP 91/50. Labs馃搱: AKI (Cr 3.0 mg/dl), UNa 7 mEq/L, bland sediment. #POCUS 馃憠small cirrhotic liver with significant ascites. Paracentesis ruled out PBE. 馃搳Poll below馃憞 1/11
What would your initial treatment be? 2/11
Don't treat reflexively. A thorough physical exam 鈾ワ笍馃┖revealed a systolic murmur at left lower sternal border. Neck exam 馃憞
Sitting Down (90潞) /// Supine (45潞) 3/11
Sitting Down (90潞) /// Supine (45潞) 3/11
