Discover and read the best of Twitter Threads about #POCUS

Most recents (24)

2/9 Being a fibroelastic sac the pericardium covers & protects the #heart

In constrictive pericarditis:
1️⃣healing of acute pericarditis
2️⃣granulation tissue
3️⃣obliteration of pericardial cavity
4️⃣loss of pericardial elasticity
5️⃣restriction in ventricular filling

#CardioTwitter
3/9
Correspondingly #cardiacimaging with #cardiacMRI in T1 mapping shows ⬆️ extracellular volume in myocardium, suggestive of global myocardial fibrosis, as shown by doi.org/10.1016%2Fj.jc… 10.1016/j.jccase.2018.06.001
Read 9 tweets
#POCUS #MedTwitter #Nephpearls
Many #VExUS enthusiasts asked for a #tweetorial on image acquisition pearls. Did one b4 but time for an updated one 🧵

#1 Let's start with basics
Color Doppler identifies the flow + tells the direction (blue is away & red towards the probe [BART])
#2 👆BART holds good unless u invert the scale.
👇Pulsed wave Doppler (PWD) depicts blood flow at a certain point (sample volume) - we analyze the pattern of flow + velocity using this mode.
Above-the-baseline = flow towards the probe (like red on color)
Below = away (like blue)
#3
While performing any Doppler study, it's important to keep in mind that the angle between US beam & blood flow determines the accuracy of velocity displayed. Parallel = best, perpendicular = worst
As #VExUS does not rely on absolute velocities, its OK not to have perfect angle
Read 28 tweets
Another Pt with HFrEF < 20%, and AKI on GDMT and 40 mg Lasix BID on PE he has Bil LE 2+ edema, no respiratory distress. Would you just increase his Lasix or work on improving his LV contractility, afterload with keeping the same preload control?
Read 13 tweets
#POCUS #VExUS consult for #hyponatremia. Elderly pt with h/o mitral valve replacement. On Bumetanide, UNa ~70 mmol/L, Uosm ~250🧵
Trace edema, JVD +, feels OK
Calling hemodynamic friends @khaycock2 @ThinkingCC @ArgaizR @msiuba @IM_Crit_ @MDBeni @siddharth_dugar Educate us!
1/ IVC
2/ 👆Consistent with elevated right atrial pressure.
👇Hepatic vein #VExUS
D-only pattern (rhythm: ventricular paced)
3/ Portal vein #VExUS
Doesn't look bad
Read 12 tweets
#POCUS #echofirst quiz:
In this PLAX view, what structure does the arrow indicate? + what's abnormal about it (if any)?
Clinical: 71y pt with fever/cough, initially thought to be pneumonia, later developed chest pain. BP 134/83 Pulse 106
Will post the answer/source tonight
#MedEd
Tweet 1/3
Answer:
Dilated coronary sinus with a mobile echogenicity (vegetation/infective endocarditis in this case)
Full case: 🔗ncbi.nlm.nih.gov/pmc/articles/P…
From #POCUS standpoint, 2 main causes: persistent left superior vena cava & pulmonary HTN. This pt had the former.
2/3
Normally on PLAX view, coronary sinus is barely visible. But when dilated, it can be confused with descending aorta (esp. by users who never encountered this scenario)
Read 4 tweets
3/ A little out of the realm of this thread, #Impella and other mechanical circulatory support are part of a larger strategy to treat cardiogenic shock. Check out the @SCAI classification system below for more information

ImageImage
4/ Impellas are placed via femoral or axillary artery, into the aorta, & across the aortic valve. There is an inlet on the LV side and an outlet on the aortic side. There are a number of different Impellas, each of which have different flow rates, lumen size, and access needs. 👇 Image
5/ However, the structural design Impellas is grossly similar. The tip of the catheter has a flexible pigtail, intended to prevent mechanical injury of the ventricle (absent on the larger LD and 5.5 models). Important- look at the flow rate, up to 5 LPM with the 5.5! 🤯 Image
Read 8 tweets
El número mágico de la terapia intensiva, es como los signos de la masonería, el 65!
Se empieza a romper un poco la regla de PRIMERO LO CARGAMOS DE VOLUMEN Y DESPUÉS SI…

Al parecer va mejor iniciar un manejo en conjunto de volumen y vasopresores y así evitar la sobrecarga del paciente.

Lindo lugar para el #VeXuS
Read 20 tweets
Top 10 #POCUS Papers of 2021
These aren't necessarily the best papers from last year, but they were papers that caught our interest
#VanPOCUS22 @VancouverPOCUS
Read 11 tweets
Inspired by a prev post lets do a thread on G.l. Sonography we'll cover peds where GI ultrasound shines and adults🧵 First up gut signature which is an sono term that corresponds to the layers of bowel from inner to outer: mucosa, submucosa, muscularis propria, and serosa
Lets look at normal bowel first differentiating between the small and large intestine is not hard. Large intestine has huastra and can often be osbcured by fecal matter and gas small bowel lacks haustra and is usually very peristaltic.
Peristalsis
Read 33 tweets
1/4 #POCUS EM case: M/50, anginal pain since 2 hours. ECG: lateral STEMI. Decision for fibrinolytic therapy (non-PCI site)
2/4 #POCUS appearance of lateral hypokinesia on Short Axis LV:
3/4 #POCUS appearance of lateral wall hypokinesia on Apical 4 Chamber -
Read 5 tweets
One of my favorite topics in #POCUS - various effusions seen from different sonographic windows.
Here is a thread 🧵with labeled images for those interested.
1. PLAX view - pericardial effusion - anterior to descending aorta ⚫️below LA), wedge shaped
#MedEd #IMPOCUS #Nephpearls
2/ PSAX papillary muscle view
LV is think as many of my patients have #CKD and LVH (as well as mitral annular calcification seen on PLAX view above)
#Nephrology #POCUS
3/ Apical 4-chamber view
Sometimes, effusions may be missed due to inadequate visualization of ventricular free wall/lung interference. Always pay attention to the RA area
#POCUS
Read 22 tweets
Looks like #POCUS ologists are in a mood to revive old #VExUS posts and tweetorials today.
Let me re-share the VExUS flash card(s) 🧵
1. VExUS grading live card
#MedEd #IMPOCUS
Hepatic vein #VExUS #POCUS
Portal vein #VExUS #POCUS
Read 5 tweets
@Rajiv_Sinanan @ThinkingCC 1/ Real reason(s) based on my conversations with people from different backgrounds:
Private practice: "#POCUS sounds interesting but I ain't got time for that. Will consider if I get compensated"
Academia: (not generalizing but most places)
Emphasis is on funded research
@Rajiv_Sinanan @ThinkingCC 2/ Clinical faculty are hired for clinical duties, outreach dialysis etc., which is fair but the problem is educational endeavors are rarely rewarded/provided with protected time. Faculty who want to be #POCUS champions must first learn it (either from institutional experts or
@Rajiv_Sinanan @ThinkingCC 3/ external courses), then integrate into curriculum, take care of administrative stuff/image archiving, prepare didactic material etc., which consume a lot of time and effort. Without dedicated protected time, its almost impossible to continue the initial enthusiasm.
Read 8 tweets
1/n #POCUS case - F/28. Left wrist pain since 2 weeks, severe since 48 h -> ED visit. Unable to grip due to painful thumb movements. Tender over lateral radial styloid area, Finkelstein test +. Dx: De Quervain tendinopathy.
2/n Comparison with normal - * marks fluid pockets around thickened tendons APL and EPB.
3/3 Gratifying relief after injection (levobupivacaine+triamcinolone), discharged with primary care followup.
Read 4 tweets
RUSH Protokoll im Schockraum hat einfach Sinn.

#POCUS #ZNAAKW #einfachMedizin
Die kurze Videosequenz zeigt ein schlagendes #Herz im #Ultraschall. Die Untersuchung wurde unter Notfallbedingungen im #Schockraum durchgeführt & diente der orientierenden Suche nach der Ursache eines schweren (Kreislauf-)Schocks, mit dem die Person durch den Rettungsdienst

2/x
in die Klinik transportiert wurde.
Die Herzspitze ist oben im Bild, die Herzbasis ist unten. Das Herz steht sozusagen auf dem Kopf. Zudem ist es auf dem Monitor spiegelverkehrt dargestellt. Die linke Herzseite ist also rechts im Monitor und umgekehrt.
3/x
Read 14 tweets
It's #ResusciTuesday and today we discuss about the use of point-of-care ultrasound (POCUS) during Cardiopulmonary Resuscitation with @NatasaSpr
#ResusciTuesday #ResusTwitter #ERC #RESUS22 #FOAMed #POCUS
@NatasaSpr POCUS has been adopted by many physicians over the past decades and has been integrated in CA algorithms for the detection and treatment of reversible causes such as pneumothorax and cardiac tamponade. Many different protocols have been proposed. (Anesthesiology 2021;135:508–519) Image
@NatasaSpr Pearls and Pitfalls
❌Right Ventricular dilation during CA: In isolation should not be used to diagnose massive PE. It is observed minutes after CA as blood shifts from systemic circulation to the right heart, probably as a result of hypovolaemia, hyperkalaemia and arrhythmia.
Read 13 tweets
1/n #POCUS case - Pneumothorax. M/20, abrupt left pleuritic chest pain. Absent breath sound left side, hyper-resonant percussion. Absent Pleural sliding on #POCUS . No lung point found, consistent with clinical impression of large pneumothorax.
2/n Normal pleural sliding on #POCUS right anterior thorax
3/n therefore CXR was not a surprise -
Read 7 tweets
Thread 1/n #POCUS as a mystery solving tool. M/50, SYNCOPE. Seemed benign orthostatic, and I was upset a Head CT was done. Was expecting it normal, but surprise - reported as left parietal WATERSHED territory infarct. MRI later shows infarct better -
2/n Re-examined carefully, and indeed patient had a homonymous right inferior quadrant-anopia. But WHY does he have watershed infarct unilaterally, from what is a global hypo-perfusion event? Left carotid looks ok...
3/n left carotid doppler -
Read 6 tweets
Thread 1/n #POCUS case - (?) COVID - cured by metoprolol. Acute dyspnea with cough, referral as ? COVID-19 with CXR. Sinus rhythm 120/min, RR 40/min, Sats 68% RA, 93% with O2 15 lpm by NRBM.
2/n #POCUS all lung zones show B-lines as expected, but minimal left pleural effusion which is NOT common with COVID-19.
3/n Scanning the heart -
Read 6 tweets
Calling all #POCUS fans, and #criticalcare 💓 afficionados! Asking if we have the right tools to identify RV dysfunction (RVD) in ICU?? We took an unbiased view (paper link at end of a long thread 🧵)....
The RV is not regular and so dysfunction can sometimes be found in one measure but not another - the crooked RV demands more than one guard to be caught playing up! 🇺🇲🇨🇦🇪🇺 consensus cardiology guidelines suggest looking at FAC and TAPSE to define RV systolic dysfunction:
In ICU tho pts are dissimilar to those cardiology sees. Acute pathology with RVD has been variably defined. Acute PE is a useful start; though systolic dysfncn is a prognostic TTE marker RV dilatation and septal behaviour is better recognised. Notably⬆️Troponin --> ⬆️risk too
Read 18 tweets
1/7: POCUS Pearl!: Calculating EF Using Simpson's Biplane Method (without math!!) - A Tweetorial: @PennUltrasound @3jeffkramer @Novaleda @cruhlmoore @runawaycar09 @williamhui @Rpourmir @nilan_schnure
2/x: Start with obtaining 2 views above: Apical 4 chamber and Apical 2 chamber. To obtain Apical 2 chamber rotate your probe 90 degrees from A4C view while keeping LV in center (probe marker away from patient or toward ceiling in this case) *Note: My view is too cephalad for A4C
3/x: Try to make sure you are getting a true apical view in each case to most accurately depict chamber size. Apex wall will be thinnest compared to rest of LV and most elongated (base to apex) if you are truly apical.
Read 9 tweets
Thread: 1/3 Clinically anterior glenohumeral dislocation, confirmed by #POCUS within 5 min of arrival
2/3 Pain 10/10 to 0/10 within 5 min of interscalene block
3/3 X-ray was required for followup purposes. Patient walked to x-ray comfortably, and reduced in x-ray suite painlessly and effortlessly. ED LoS 40 min.
Read 4 tweets
Small thread 🧵illustrating #POCUS based hemodynamic assessment. Relatively a classic case of pulmonary HTN and right heart failure but would like to get some insights from the experts.

1/ Parasternal long axis (PSAX) showing D-sign
#VExUS #MedEd #Nephpearls #IMPOCUS
2/ Parasternal long axis (PLAX) view demonstrating RV dilatation.
One of the three musketeers is big. Don't know what I'm talking about? Here is a brief reminder: 🔗nephropocus.com/2021/07/12/the…
(Mobile thing in the RVOT is PA catheter; M-mode quiz from this morning is actually this)
3/ Apical 4-chamber view #POCUS
Note how RV is dilated - bigger than LV and forming the cardiac apex.
Inter-atrial septum is bowing to the left indicating high right atrial pressure (not unexpected).
Read 21 tweets

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