Discover and read the best of Twitter Threads about #pocus

Most recents (11)

Yes, it's terrible that interns only spend 12% of their time with patients. However, this isn't an entirely new phenomenon, and computers aren't totally to blame. How little time interns spend with patients has been observed since at least 1959 1/

sciencedaily.com/releases/2013/…
in 1961, Payson et al published in @NEJM a time study of 2 interns, conducted in 1959.

Their conclusion: "The finding that concerned us most was the small amount of time spent with patients." 2/

www-nejm-org.ezproxy.med.nyu.edu/doi/full/10.10…
Intern B in the @nejm study didn't have a computer, but he also wasn't spending too much time directly with patients. 3/
Read 9 tweets
A new #echofirst #POCUS #medthread CASE!

55 yo woman with hx of metastatic lung CA, known malignant pleural/pericardial effusions presents as a transfer in shock with associated encephalopathy. HR 120s-130s (sinus), cool extremities, MAP 65 on 8-10 mcg/min norepi. O2 4L NC.
What are you going to do based on the above image?
The LV cavity appeared small/underfilled to you in the first image, not sure why, but you elect to bolus IV fluids while you complete your exam. You move to the A4C view and notice this:
Read 9 tweets
Assessment of Fluid Overload and Hypervolemia (1/8)

Clinical assessment and signs for #FO are aspecific and unreliable:
-pitting edema
-ascites
-positive fluid balance
-orthopnea
-hepatojugular reflux
-...

Preparing for #smacc #ISICEM19 #IFAD2019 #WCACS2019
Assessment of Fluid Overload and Hypervolemia (2/8)

Biochemical Assessment for #FO is aspecific and unreliable:
-Hypoalbuminemia
-Hypoproteinemia
-low COP
-low osmolality
-...

Preparing for #smacc #ISICEM19 #IFAD2019 #WCACS2019
Assessment of Fluid Overload (FO) and Hypervolemia (3/8)

Radiological and #POCUS imaging and signs for #FO are aspecific and unreliable:
- Absence of #IVCC
- Kerley-B lines
- Lung ultrasound B-lines
- Pleural effusions

Preparing for #smacc #ISICEM19 #IFAD2019 #WCACS2019
Read 7 tweets
This is the bedside Echo of a critically ill young lady who presented to the ER in shock

[thread]
Those bright, whip-like structures emanating off the tricuspid valve are infective vegetations. They look similar to blood clots-in-transit except that instead of free floating you can see that they are tethered down.

[2/x]
The Right Ventricle (RV) should normally be about half the size of the Left Ventricle (LV). But here the RV is more than double the size of this underfilled LV!

Why would a patient with endocarditis also have right heart strain?

[3/x]
Read 11 tweets
#POCUS in cardiac arrest - keep probe on prior to pulse check pause - avoid delays searching for window - to minimize duration - and record a 3 sec loop which can be analyzed later. (thread)
(continued) this is what image looked like at pulse check - Dilated RV with septum bowing towards LV - should we give fibrinolytic for possible pulmonary embolism?
#POCUS is just a data point - in overall clinical context - additional data - this was a out of hospital VF arrest. With PE - we would expect a PEA arrest. Moreover, no risk factor for PE - and in fact, patient is on long term warfarin for AF - a "negative risk factor" for VTE?
Read 9 tweets
#POCUS in a gentleman with LUQ tenderness after blunt abdominal trauma 1 week ago. What is seen caudal to the spleen?
Perisplenic hematoma was suspected - and CT was performed
This is a normal anatomical variant of elongated left liver lobe - so called "Beaver tail liver"
Read 5 tweets
[THREAD] Our tips on small bore chest tube placement for pleural effusion! Performed by a resident @BostonCityEM supervised by fellows @BUPulmonary. We'd love your input! Not a comprehensive guide. Made with written patient authorization. #meded #FOAMcc #pulmcc
For new large unilateral effusions such as this, we place a chest tube if fluid pH <7.2, glucose <60. Without fluid studies, we place a tube empirically if effusion is large, loculated, infected, or likely to reaccumulate- except CHF/fluid overload.
First step: ultrasound. We position the probe with marker to the head, as lateral as possible. Intercostals tend to sag as you move towards the midline, so you could hit them when going above the rib. Lateral access is safest.
Read 24 tweets
Good morning everyone! For my first session of day 2, I’ve decided to come and learn all about vasculitis in the ICU - being presented by Marlies Ostermann from @GSTT_ICU #lives2018
Marlies starts with a couple of case histories:

Middle aged women, presenting with undifferentiated pulmonary and renal failure, raised inflammatory markers, Nonspecific chest X-ray changes...

But which one has vasculitis? #lives2018
The answers are surprising...

(And it looks like you should #POCUS everyone with suspected vasculitis 😁😜) #lives2018
Read 22 tweets
Now debating “endpoints of fluid resuscitation” featuring @Manu_Malbrain and @PrXaMonnet #lives2018

Up first: Manu!

Follow him @Fluid_Academy and check his work annalsofintensivecare.springeropen.com/articles/10.11…
Magder Shelton: cardiac output is the key component of determining fluid requirements. Stop once CO adequate ncbi.nlm.nih.gov/pubmed/2054368… #lives2018
Read 19 tweets
Male/37. Fever 39 with cough and runny nose. Wheezy, HR 124, RR 30, sat 88% on air. Comments? ( the "season" has started! ) #POCUS
pubs.rsna.org/doi/full/10.11…
"Figure 8: Transverse thin-section CT scan at the level of the bronchus intermedius in a patient with influenza A virus shows ill-defined centrilobular nodules (arrows). Peripheral subpleural consolidation in the apical segment of left lower lobe"
Absence of consolidation (“hepatization” with air bronchograms) with #POCUS showing sub pleural consolidation supports diagnosis of viral pneumonia
Read 4 tweets
Curious about how #POCUS is taught? This #Tweetorial is for U
#Preview for #ASEchoJC 🔜9/4 8pm EST

Point-of-Care Cardiac Ultrasound POCUS: State-of-the-Art in Medical School Education bit.ly/2wxD4PZ by @amerjohri

#POCUS not 🐇🎩, not short #TTE
2/ Current #goals #Cardiac #POCUS #MedEd

(1) introduce concepts of ultrasound- common imaging views, correlate with anatomy, & physical examination skills

(2) develop scanning techniques➡️ basic competence

(3) recognize & differentiate b/w normal anatomy & basic pathology
3/ When Do We Start? Prerequisite knowledge for #POCUS teaching

"priming effect" of preclinical education

Big machine 1st over handheld Martinez et al bit.ly/2wzCcJB @UMMC

Start 1st year @Hoppmann et al bit.ly/2Q4ECsO @UofSCSOM
Read 10 tweets

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