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Critical care echo lecture #4 @HarvardPulm @MGH_PCCM @PCCSM_BIDMC:
JUST THE RIGHT PRESSURE (i.e. assessing RVSP😀).
Key slides ⤵️ and brief pearls/takeaways 🧵... (1/8)
#Medtwitter #echofirst #PCCMTwitter
JUST THE RIGHT PRESSURE (i.e. assessing RVSP😀).
Key slides ⤵️ and brief pearls/takeaways 🧵... (1/8)
#Medtwitter #echofirst #PCCMTwitter
1⃣ Speak to your PH specialists about RVSP role and utility in PH diagnosis and management. That is not its role for the intensivist.
2⃣ Acutely, RVSP can help determine if there is a chronic component to elevated PA pressures (>60 usually not acute!), but does not rule out acute on chronic, nor pseudonormalization in severe RV failure
Cardiac Output by VTI!
Summary slides from our next lecture, broken into 5 steps⤵️
@MGH_PCCM @HarvardPulm @MGHHCICU
1⃣ Overview & approach - and why you care. CO adds significant detail and nuance to LV function assessment
#POCUS #Medtwitter #PCCMtwitter #echofirst
Summary slides from our next lecture, broken into 5 steps⤵️
@MGH_PCCM @HarvardPulm @MGHHCICU
1⃣ Overview & approach - and why you care. CO adds significant detail and nuance to LV function assessment
#POCUS #Medtwitter #PCCMtwitter #echofirst
2⃣ Optimize the PLAX for the LVOTd. Sometimes I find that too much "optimization" actually makes it harder. Just know your options and do what works with your patient.
3⃣ Understand Doppler physics. Specifically PWD for this one. Recognize how the angle of insonation AND the angle of flow relative to the probe, affects your measurements.
It's a PFO! A few words about this powerful echo window: The bicaval view 🧵 (1/8)
#POCUS #Medtwitter #echofirst #PCCMTwitter #ICUtwitter
#POCUS #Medtwitter #echofirst #PCCMTwitter #ICUtwitter
This window is attainable only via a transESOPHAGEAL echo (TEE).
Point-of-care TEE is used widely in SICUs worldwide, and MICUs outside the US. You can expect to see them increasingly in US MICUs over the next decade. (2/8)
Point-of-care TEE is used widely in SICUs worldwide, and MICUs outside the US. You can expect to see them increasingly in US MICUs over the next decade. (2/8)
By viewing the heart via the esophagus, windows are often much crisper than when fighting with rib shadows, edematous lungs, and often bandages/wounds (esp. in surgical patients) on the chest. (3/8)
Greatly enjoyed launching our @MGH_PCCM @HarvardPulm didactic critical care echo curriculum with LV Assessment - Beyond the Eyeball!
Assessing LV function isn't as simple as it sounds.
Take home messages for POCUS learners below ⤵️:
#POCUS #Echofirst #Medtwitter #PCCMTwitter
Assessing LV function isn't as simple as it sounds.
Take home messages for POCUS learners below ⤵️:
#POCUS #Echofirst #Medtwitter #PCCMTwitter
👀The oft-invoked 'eyeball' method is a deceptive oversimplification. You can't suddenly accurately assess LV function just because you're told to!
You need to train your eye to look at other quantifiable measures of LF function - even if you won't actually measure them. 🧐
You need to train your eye to look at other quantifiable measures of LF function - even if you won't actually measure them. 🧐
Sure - make your best guesstimate of EF. But also look at:
1⃣myocardial thickening
2⃣myocardial excursion
3⃣annular excursion/MAPSE
4⃣fractional shortening +/- fractional area change
5⃣EPSS
You don't have to actually measure these, but you can't 'see' them if you don't know them!
1⃣myocardial thickening
2⃣myocardial excursion
3⃣annular excursion/MAPSE
4⃣fractional shortening +/- fractional area change
5⃣EPSS
You don't have to actually measure these, but you can't 'see' them if you don't know them!
