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#POCUS con USPed Latinoamérica🌎

En #SabadosdePOCUS Roberth González Cardiólogo Pediatra de 🇵🇪 nos habló de #Ecocardiografía en el Paciente #Critico en #Pediatria.

¿Quieres saber un poco de qué trato?

Abrimos 🧵 👩‍⚕️👨‍⚕️
Comentarios iniciales #PedsICU:

No vemos internamente la interacción cardiopulmonar. El #POCUS ha cambiado eso.
Dicha interacción regularmente había sido estudiada por separado.
La integración ❤️-🫁Pulmón debe ser siempre en contexto.

🔄🔃
Algo que le sirvió mucho al Dr. Roberth: la #Fisiología, su funcionamiento.

Ojo, este dato se ha mencionado mucho en nuestras sesiones. El #POCUS en verdad te ayuda a mejorar tus conocimientos básicos, cuando ves lo que tanto estudiaste.
Read 21 tweets
1/ pt presents with sudden onset CP at home. Takes Tylenol and goes back to sleep. Wakes up in the AM with mild CP. Goes to outside hospital with near res of pain. Trop 5 on arrival. No EKG changes. Diag cath 🔽

@HadyLichaaMD @agtruesdell @RajTayalMD @rajivxgulati @DrAmirKaki
3/ I decided to place on G2B3a and ship to me. Plans for #PCI 12-24 hours after Aggrastat marinate. Patient continues to have mild CP controlled with nitro. #EKG stable. This is image next morning.

@BotPci @yourheartdoc1 @alaa_gabi @doconmoney @AkhilGulati @Pooh_Velagapudi
Read 4 tweets
Non-COVID teaching: Can you identify this unusual cause of chronic cough? (Hint: always carefully look at tubes and lines on #CXR and axis on #EKG) #medtwitter #FOAMed #FOAMrad ImageImage
So let’s jump into this #FOAMed case. On the CXR we’ve got a couple interesting things:
* the PICC line appears to terminate on the wrong (e.g. left) side (white arrow)
* the aortic knob is on the wrong (e.g. right) side (grey arrow)
* it’s hard to identify the cardiac silhouette ImageImage
Some of these findings are easy to miss. To avoid missing things, it’s really important to have a systematic approach to reading a CXR. Here’s a good one:
➡️mededportal.org/doi/10.15766/m…
Read 11 tweets
Abro hilo.
Evitemos malentendidos:
Epidemiología ≠ Infectología ≠ Microbiología.
Epidemiología es el estudio del comportamiento de las enfermedades en la POBLACIÓN. Aplica para TODAS (ej. Epidemiología del #cancer)
Primero necesitas tener diagnóstico objetivo de la enfermedad.
Usaré el ejemplo de #cancer:
Si tienes un tumor acudes con un especialista quirúrgico que DECIDIRÁ el abordaje DIAGNÓSTICO, una vez que tenga los resultados que confirmen si es #cancer o no, decidirá el tratamiento. Y eso se repite una y otra vez...
Con esos datos los epidemiólogos hacen lo suyo para poder realizar intervenciones POBLACIONALES, no individuales.
¿Han visto que sea el epidemiólogo el que le autorice una biopsa al #cirujano o una tinción especial al #patólogo?
Read 5 tweets
1/x
If you have difficulty interpreting an ECG, I will explain the basic method that I use, and I am sure it will help you. It's called the basic "method of Dr. Roig". Here we go..
2/x
R-ate
The first step is to calculate the HR.
Total QRS x 6 = HR.
If HR > 100 bpm = Tachycardia.
If HR < 60 bpm = Bradycardia.
3/x
O-bserve the rhythm
The second step is to observe the rhythm.
If R-R interval is equal = Regular rhythm.
If R-R interval varies = Irregular rhythm.
If P wave is upright in lead II = Sinus rhythm.
Read 8 tweets
Ok my first crack at this. Tell me what’s going on with this #EKG. 27 yro male, no PMH comes to ER with “weakness”. What to do. #ICUIRL
cc: @EM_RESUS @MDaware @jlitell @cardiojaydoc02 @HeartOTXHeartMD @VenkBellamkonda @ogi_gajic
I added a retweet w/comment with some more pertinent information.
Ok..more data. Initial troponin is 1.6 and and the patient tells you he may have done some partying. Which drug are you concerned about?
Read 4 tweets
It's #12leadthursday-- time to test those #cardio skills! Look out for answers tonight so you don't miss a beat ☺️ #FOAMed #cardiotwitter
Read 6 tweets
What is the underlying rhythm? See reply for the answer @amalmattu @MasriAhmadMD @MusaSharkawi @jelevenson @ @mbelshazly #FOAMed #EKG Image
@amalmattu @MasriAhmadMD @MusaSharkawi @jelevenson @mbelshazly A cursory glance may fool one to think this is atrial flutter. On closer inspection clear preceding p-waves are seen. This gentleman has Parkinson's disease and the undulating baseline coincides with his resting tremor frequency. Image
@amalmattu @MasriAhmadMD @MusaSharkawi @jelevenson @mbelshazly I have seen this almost a dozen times already. I shall dub this Electrical Parkinsonism.
Read 3 tweets

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