Discover and read the best of Twitter Threads about #ivc

Most recents (10)

Tamilian from India may have migrated to Australia Satellite photograph of the rock carved legend reveals.
#Archaeology #Thread

Other set of ancient symbols discovered along the eastern coastline of Australia and Antarctica are very similar to early #Sumerian and #IVC characters

Src: William James Veall, (Copyright WJV 2017)

Yet another Rock-strewn debris with a pattern of rocks seemingly set in the form of an ancient legend embedded into the seashore. Exposed size 50 meters in length x 25 meters

Read 4 tweets
#AKIConsultSeries:👨w T2DM➡️🏥 for fever, dysuria and CVA tenderness. On arrival: ⬇️BP, ⬆️Glucose, ⬆️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,🧠confused, BP 85/62, HR 123, 2L O2. CRT 4 sec

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 🚨🤔

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

Read 12 tweets
“The Athens of South India” - 'Madurai' c.500 bce
Megasthenese, Strabo 25BC, Pliny 75 AD Ptolemy 130AD mention of Madurai.

#Keeladi an excavation site in this small #Thread
#Archaeology Image
#Keeladi was an industrial area of #madurai dated back around 580 BCE determined from the excavated Artefacts…

#Archaeology ImageImage

The Keeladi residents used to burry their deads in North South direction…
#Keeladi were experts in Structural #Engineering. They had Plumbing System, Draining system, Water storage system
#Archaeology… ImageImageImageImage
Read 9 tweets
#AKIConsultSeries Middle-aged male ➡️🏥 for painful knee and fever. Now in shock 🚨

📂Chart review: PMH EtOH Cirrhosis, right knee arthroplasty.

It is always a good practice review previous PACS images🩻: Nodular liver, colateral vessels and prosthetic right knee

On exam: BP 72/48, HR 82, O2Sat 95%.
CRT 7 sec, 🧠somnolent, confused. No edema, no obvious ascites.

Warm, swollen and erythematous knee: Tap with obvious purulent fluid🧫

Cr 2.8 mg/dl (baseline 0.5), K 6.7, Urine 🔬: hyaline casts, some urothelial cells

Loos like hemodynamic AKI (AKA Pre-renal)

Usual causes in Cirrhosis:

🔷Distributive: Septic, "Hepatorenal physiology" 🔷Hypovolemic: Laxatives, vomiting, large volume paracentesis
🔷Congestive: Porto-pulmonary HTN, Co-existing cardiomyopathy

Read 11 tweets
Patient with flank pain, hematuria and significant leg edema


Lung Ultrasound #LUS 2/10
#IVC long axis 3/10
Read 10 tweets
#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
En nuestros #SabadosdePOCUS tuvimos a @ACRP901 con el tema:

"Los Secretos Ecográficos de la Vena Cava Inferior (#VCI/#IVC)"

¿Quieres enterarte de alguna puntos claves?

Abrimos hilo... 🧵 #POCUS
Un punto clave del Dr. @ACRP901: "Los niños no son adultos pequeños"
La VCI sigue siendo esquiva.
Es #Fundamental conocer la fisiología y anatomía al tocar este tema.
Y recuerda: los secretos se encontrarán en la #Fisiología más que en la ecografía per se.
La #VCI se encuentra inmersa en varios protocolos y en las modificaciones de cada uno de estos dependiendo el contexto del paciente (#FOCUS, #RUSH, #EFAST).

Se habían utilizado a la #VCI regularmente para medir el estado de volemia y una posible respuesta (o no) a fluidos.
Read 25 tweets
Kicking off multidisciplinary Research Consensus Panel (RCP) to finally investigate the ❓: what is the optimal medical therapy (OMT) following venous recan? Follow #VenousRCP throughout the day to learn more and contribute! #SIRFoundation @SIRRFS @SIR_ECS @JVIRmedia
🔴 Pathophysiology of venous thromboembolism #VTE
🟠Venous recanalization & stenting
🟡The mystery of medical therapy following recanalization
🟢Patency & outcome measures
🔵Economics & cost-effectiveness of treatment
🟣Future directions
🔴 ✅#VTE affects ~100 of every 100,000 people yearly in the US
✅Incidence of VTE ⬆️⬆️ exponentially with age, especially after 40
#Endovascular recan is a common tx; post-tx algorithms vary widely
✅More #epidemiology info @CircAHA
Read 24 tweets
🧵 AKI and #COVID19

68 yo ♂️ PMH obesity, HTN, CAD w stent, OSA, T2DM
➡️ ED w SOB + fever 39.9°C. Poor oral intake

RR 40, Sat 94% Room Air, BP 157/74 HR 124. Alert. Bibasilar crackles

Labs: Cr 1.3 (baseline 0.8), WBC 10, K 5.4, HCO3 17, CK 184. UA and CXR👇 (case from @NEJM)
How would you manage this AKI initially? What is the likely cause of AKI in patients with #COVID19? (this last question discussed in thread 🧵)
No easy answer except to say that FENa is very unlikely to be useful. It is not unreasonable to try fluids for AKI in the setting of perceived hypovolemia. However, this gets complicated when the potential for worsening ARDS exists. I'll try to tackle the answers one by one 💪
Read 17 tweets
**Nuances of IVC assessment**

So I was asked by @msiuba and @NephroP to talk about about the various nuances of IVC assessment in mechanically ventilated patients. I thought I'd go over some basic concepts for both spontaneously breathing and vented patients

Concept 1:
The core mechanism of respirophasic alterations of IVC diameter is its relationship with (actual, not transmural) CVP.
⬇️CVP -->⬆️venous return -->⬇️pressure within the IVC --> tendency to collapse (& vice versa).

Concept 2:
The IVC pressure-diameter relationship
Since ΔIVC pressure is related to changes in CVP (concept 1), a direct relationship between CVP and IVC diameter exists (image)

Note that as the IVC dilates, its compliance reduces (stiffens). Hence, any further increase in IVC pressure doesn't increase its diameter.
Read 11 tweets

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