Discover and read the best of Twitter Threads about #pocus

Most recents (24)

Super easy explain of physiologic Hepatic Pulsed Wave Doppler waveform.

🧵1/
#doppler #radiology #pocus #vexus #hemodinamics #butterflyiq @ButterflyNetInc @hepocus
2/
After appropriate technique to get PWD of suprahepatic Veins.
Look for the 4 classic waves of the tetraphasic spectrum of the hepatic veins (a,S,v,D).
3/

Most of the flow in the hepatic veins is hepatofugal (towards heart).
Read 11 tweets
After yesterday's #POCUS quiz, it's time to reshare these cardiac tamponade infographics.
Courtesy of @ACEP_EUS
🔗acep.org/emultrasound/s…
Set of 3
See 🧵for the rest
#Nephpearls #MedEd #FOAMcc
Pulsus paradoxus #echofirst
Hepatic vein waveform changes
#POCUS #VExUS
Read 5 tweets
A 58-year-old woman with no known comorbidities presents with progressive fatigue and shortness of breath x several months. Noted to have bilateral pedal edema; BNP 2,473 pg/mL.
#echofirst 👇❓
Answer and 🔗 to source in thread.
#POCUS #MedEd #FOAMcc
Left atrial myxoma -> pulmonary hypertension (RVSP 93 mmHg) -> RV dysfunction (Note obvious RV enlargement ☝️
cvcasejournal.com/article/S2468-…
PLAX (same case)
Read 4 tweets
Another set of cardiac #POCUS #anatomy illustrations. 🧵
#Nephpearls #FOAMed
Source: sciencedirect.com/science/articl…
1⃣ Parasternal long axis
2⃣ Parasternal short axis aortic valve level
#POCUS
3⃣ Apical 4-chamber view #POCUS
Read 7 tweets
ICU stories (a brief one): One hour before the end of the am shift, u walk around in the ICU to make sure thinks look OK before u type your sign-out note. You spot the resp therapist & the nurse bagging the pt in Rm 306. From the hallway, u see the monitor: HR 160, RR/45, Sat 70%
This is a 30 yo pt w hx of a catastrophic brain bleed, s/p trach & PEG, admitted 2 wks ago w MDR Klebsiella UTI. Doing well, on trach mask 28%, until the episode of acute/unexpected desaturation
When u examine the pt, s/he is in extremis (accessory muscle use-tachycardic-tachypneic-diaphoretic). BP: 105/55. You grab the stethoscope that the resp therapist wears around his neck & you hear breath sounds in both sides (pt is skinny...)
Read 24 tweets
#POCUS image of the day:
Fox tail sign - left pleural effusion visualized from the apical cardiac window.
#MedEd #FOAMcc #FOAMed
#anatomy correlation
Read 3 tweets
Young ♀️ w CKD on HD, seen in Cardiorenal clinic

Pt had torrential tricuspid regurgitation due to CVC induced leaflet perforation ➡️ She underwent tricuspid valve replacement surgery 🫀🔪

However, 1 month after discharge she is still using a wheelchair 🤔

1/12🧵
#POCUS above shows plethroic, non-collapsible IVC and Hepatic Veins

Did surgery work?

Is there residual tricuspid regurgitation?

#Echofist (PLAx RV view + A4ch) color Doppler lets us see there is no or minimal TR

Prosthetic valve seems to be working

2/12
But there is still venous congestion. In fact congestion is significant, take a look at portal vein Doppler 👇

Pulsatility Fraction = 40%, this means there is significant venous congestion. Why?

Is this just volume overload? Should we probe a lower dry weight?

3/12
Read 13 tweets
#MedEd image of the day. What's wrong with the 🫀?
Clinical: A woman in 40s with h/o severe mitral stenosis secondary to rheumatic heart disease & Afib presented with worsening dyspnea, orthopnea, & chest pain x 7 months
See thread for #echofirst images and source/answer.
#POCUS Image
Apical 4-chamber view showing severe right atrial enlargement and annular dilatation of the tricuspid valve during systole.
Severe TR as expected.
Read 5 tweets
🚑 Anmeldung vom Rettungsdienst:
Sturz aus 18m in einen schmalen Schacht, komplizierte Rettung. Männlich, ca 50 Jahre.
A intubiert
C instabil
Wir bieten das grosse Team auf, verteilen die Aufgaben und wärmen 4 FFP. 4 EC sind im Schockraumkühlschrank.
Nachmeldung: Eintreffen in 3 Min, Patient unter Reanimation.
Eure nächste Vorbereitung?
TDrains und REBOA sind bereits vorbereitet (weil als C-instabil angemeldet). Konkret also Stechtisch, Sono und 7 Fr Schleuse - der teure Katheter bleibt zu, bis die Schleuse liegt.
Zudem machen wir jetzt das Thorakotomiesieb auf - bei uns immer primär nur linkslateral.
Read 12 tweets
ICU stories: 70 yo pt without medical hx but tobacco use (2 ppd x 40 y) was admitted w shortness of breath a wk ago. CXR/chest CT without PE/infiltrate. Was in afib/RVR on admission; placed on heparin & dilt/b-blocker (w some hypotension). Remained dyspneic, at times restless,
“requiring” multiple sedatives, & eventually was brought to the ICU. Intubated for "resp distress" & mental status changes. "Formal" echo, the day of ICU transfer, showed “LVEF 20% w global LV dysfunction”. On the vent 50% - peep 10. BP 110-130/60-70. Lactate < 2.0
Cards follow for "well compensated heart failure". A look w POCUS upon ICU admission:
Read 20 tweets
#POCUS puzzle 🧩of the day. Can you put together the pieces and arrive at an unifying diagnosis? Go through the thread 🧵below.
Context: #dialysis patient, physical examination #FOAMed #Nephrology #MedEd

Image No. 1 👇
Color #POCUS
Transverse #POCUS , IVC trace down
Read 8 tweets
Entendiendo la Congestión en insuficiencia cardíaca
Hilo 🧵
Taponamiento renal = más allá del entendimiento del síndrome CARDIORRENAL

Incremento de la presión venosa renal

Compresión de la vasculatura renal y de los tubulos renales
Caída de la filtración por aumento de la presión en la cápsula de Bowman
Incremento de la presión intraabdominal
Todo esto lleva a taponamiento renal !
Evolución de una teoría prerrenal a una Venorrenal
A continuación manejaremos la congestión
Read 7 tweets
Ambulatory Hemodialysis Unit Rounds:

Called to see a patient with hypotension: BP 76/40,🧠 OK, CRT 5 seconds

1st step ➡️🛑Ultrafiltration + 300 ml bolus. BP 90/60

Pt is a middle aged ♂️ w ESRD and T2DM

1/9 🧵
Now 3 kg above Dry Weight.

UF Volume so far: Only 600 ml

🔎📁 Previos HD sessions with no hypotensive episodes

1 week with URI symptoms, 2 days with dyspnea on exertion

On exam: No leg edema, Clear 🫁, JVP hard to assess (hx of multiple CVCs and central vein stenosis)

2/9
#POCUS:

Pericardial Effusion, Normal LV function, looks like there is some RV colapse

Plethoric IVC, Portal Pulsatility 39%.

A-Pattern on LUS, Small bilateral pleural effusions

🚨⬇️BP + Collapsing RV + Venous Congestion (IVC + Portal Pulsatility) suggests Tamponade!

3/9
Read 9 tweets
How do you examine the lower extremity venous system when you look for deep vein thrombosis? What points do you check with the probe? Do you use Doppler? What are the recommended protocols? The Society of Radiologists in Ultrasound recommends a complete duplex ultrasound:
👆 The black rectangles represent the extent of the compression US. The gray rectangles are the sites of Doppler.
2-CUS (2-points compression US) includes compression of the femoral veins 1-2 cm above & below the saphenofemoral junction & the popliteal veins
up to the calf veins
ECUS (extended compression US), includes compression US from the common femoral vein through the popliteal vein up to the calf veins confluence

CCUS (complete compression US), includes compression US from the common femoral vein to the ankle
Read 9 tweets
Reason # 67543 why #pocus is important: sometimes mild symptoms are a sign of impending disaster.

41 year old thin athletic male presented to the hospital with a few weeks of mild shortness of breath with exertion.

BP 170/70, HR 100. CXR with cardiomegaly, tortuous aorta.
Bedside #pocus exam shown below:
Most glaring is the size of the aorta. It is clearly larger than the left atrium. Also notable is the anterior leaflet of the mitral valve isn’t opening much.
Read 9 tweets
#POCUS quiz
You are performing physical examination in a patient with suspected fluid overload (plethoric IVC).
Parasternal short axis view demonstrates D-sign. But what's in the RV?
Apical view in thread.
#Nephrology #MedEd #FOAMcc
🔗 to source will be posted in a few hours.
Apical #POCUS
As our friends said, it's prominent moderator band in a patient with RV hypertrophy + prominent trabeculae.
Source article 🔗cvcasejournal.com/action/showPdf…
Read 4 tweets
ICU stories (a boring one…): If you work in a general ICU of a community hospital in United States, one of the common admissions you will get is the unfortunate resident of a nursing home or rehabilitation center that lives there for several decades & at some point becomes
febrile/“altered” & is sent to the ED for “evaluation”. The course is so predictable that we usually consider these admissions “boring”. This is the case of a middle-aged pt w cerebral palsy/mental retardation/seizures (on valproic)/PEG-chronic Foley in place who was sent to
the ED for fever+hypotension+tachycadia. Labs: WBC 15k, lactate 4.0. UA -as usually- suggestive of UTI (WBC>50, +bacteria, +nitrite, +esterase). CXR “clear” & pt w sat 99% on room air. Received ivf, Abx (pip/tazo + vanco) but due to persistent ⬇️BP, norepinephrine gtt was ordered
Read 25 tweets
First session post lunch - reseach and #POCUS.

And Prof Atkinson of SHOC-ED - a landmark #POCUS trial

pubmed.ncbi.nlm.nih.gov/29866583/

#WINFOCUS22
A summary from @WICSBottomLine #SHOCED
Does Point-of-Care Ultrasonography Improve Clinical Outcomes in Emergency Department Patients With Undifferentiated Hypotension?

thebottomline.org.uk/summaries/em/s…
#WINFOCUS22
@WICSBottomLine Do combined ultrasound and electrocardiogram-rhythm findings predict survival in emergency department cardiac arrest patients? The Second Sonography in Hypotension and Cardiac Arrest in the Emergency Department (SHoC-ED2) study

pubmed.ncbi.nlm.nih.gov/31566175/
#WINFOCUS22 #EACEM22
Read 4 tweets
Teleproctoring - mentoring with @POCUSClub

#WINFOCUS22
A very poignant question - with so much online learning/recordings/presentations, do we invest in the TIME and tech for these? Or do we just try to replicate the face-to-face version?

lighting, mics, etc

#WINFOCUS22
Your mobile phone probably has a better camera than your intergrated laptop #WINFOCUS22
Read 7 tweets
AI and ultrasound - @arntfield
Are you AI bilingual? I am definitely not.

ping @teddyhla @AriErcole @drPaulElbers @tomlincr

#WINFOCUS22 #EACEM22
A recurring theme for this session is could machines do it better?

#WINFOCUS22
Read 6 tweets
Are you a #juniordoctor or #medstudent?

Here's 10 great FREE modules to help get you started on the wards!

#meded #medschool #tipsfornewdocs #juniordocs #FOAMed #medtwitter #medstudenttwitter #juniordoctors #medstudents
Occasionally you'll need to perform sterile procedures. Make sure you prepare the best you can

osler.app.link/CztXIRjyntb
Providing basic life support is a core skill for all healthcare staff

osler.app.link/u4fe8uqyntb

#basiclifesupport #bls #FOAMresus #resuscitation
Read 13 tweets
It's December, already. The time of the year when I am trying to spend every last cent of the annual allowance given to us for continuing medical education (CME) by our employer. In essence, this is money that we have worked for and, since it won't carry over to next year, I hate
leaving it on the table. The problem is that if you buy a conference or a study course now, you have to watch everything - and submit proof of attendance/completion - before the end of the year. So, it's a very busy month dedicated to studying/reviewing educational material!
For example, I just finished watching the last one of the 93 lectures from The Hospitalist & Resuscitationist 2022 conference #HR2022. If you are an intensivist/internist/family medicine/EM physician, I have no doubt that u will find several pearls to bring back to your practice
Read 5 tweets
TOP 🔟 ECHOCARDIOGRAPHY CASES ➡️ November 2022 (personal opinion) #medtwitter #pocus #echofirst #cardioed #cardiotwitter #medicaleducation #ENARM #FOAMed
⬇️🧵
10. Subaortic membrane in the outflow tract of LV @Irina67790690
9. Septal rupture complicating acute myocardial infarction @CyntiaMachain
Read 12 tweets

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