Discover and read the best of Twitter Threads about #ultrasound

Most recents (24)

A. Demoule: How to assess respiratory muscles strength? #ISICEM23
❌ EMG and p0.1 - they measure drive!
❌ Clinical Examination? - limb muscles ≠ diaphragm strength
- Patient on MV (Pressure Support):
✅ diaphragm ultrasound (TFdi)
✅ measure Pocc (occlusion pressure)
How to perform? #Diaphragm #Ultrasound #ICISEM23
❌ You cannot use if the patient doesn’t trigger the MV
➡️ Intercostal view
➡️ Linear probe
➡️ 8-9 IC space
➡️ Mid axillary line
➡️ 2D then M-Mode
✔️Diaphragm Thickening Fraction: TFdi
✔️ Weaning failure if TFdi < 29%
❗️A low TFdi or Pocc predicts diaphragm weakness!

If patient is fully cooperative, try Maximum Inspiratory Pressure (high value excludes muscle weakness).

Read 3 tweets
Public service announcement 🧵 about #PCOS & #ultrasound

1 - Ultrasound should NOT be used for the diagnosis of PCOS in those <8 years after menarche, due to the high incidence of multi-follicular ovaries in this life stage

*FYI PCOM = polycystic ovarian morphology Image
2 - Using endovaginal ultrasound transducers w/ a frequency bandwidth that includes 8 MHz, the
threshold for PCOM on either ovary, a follicle number per ovary of = or > 20 and/or an ovarian volume
= or > 10 ml on either ovary, ensuring no corpora lutea, cysts or dominant follicle
3 - The threshold for PCOM should be revised regularly with advancing ultrasound technology, and age-specific cut-off values for PCOM should be defined.
Read 9 tweets
Guideline summary for #ED docs on early pregnancy loss/miscarriage:…
10% of all #pregnancies end in #miscarriage, though the rate approaches 80% by maternal age 45yrs.
Half of early pregnancy loss (AKA miscarriages) are due to chromosomal abnormalities. 🧵
Crown-rump length (CRL) 7mm or greater and no heartbeat. Mean sac diameter (MSD) 25mm and no embryo.
Each one is an #ultrasound feature diagnostic of early pregnancy loss.
80% of patients with early pregnancy loss can be safely managed with an expectant management (watch and wait) approach.
Relatively few miscarriages will require ED care; most of these will involve significant and symptomatic haemorrhage or infection.
Read 15 tweets
♂ 50 y. With pulsatile femoral mass. history of femoral puncture 💉.

#vasculardoppler #ultrasound #MedEd #FOAMed #POCUS #radiology @ButterflyNetInc
3/4 Ying-yang , or pepsi sign described in both true and false aneurysms.

On Doppler ultrasound, the yin-yang sign indicates bidirectional flow due to the swirling of blood within the true or false aneurysm.… Image
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
Providing basic life support is a core skill for all healthcare staff

#basiclifesupport #bls #FOAMresus #resuscitation
Read 13 tweets
1a) Welcome to a new #accredited #tweetorial on the management of aFXa-DOAC-associated #hemorrhage and specifically the role of coag laboratory testing in these challenging cases.
1b) Our expert author is #pharmacist Craig Beavers, PharmD @beaverspharmd CV Clinical Pharmacy Specialist @UK_COP, and Immediate Past Chair of the @ACCinTouch #ACCCVT Section
2) This 🆓program is accredited for 0.5h CE/#CME for #physicians #physicianassociates #nurses #nurespractitioners #pharmacists and is supported by a grant from AstraZeneca. See statement of accreditation and faculty disclosures at
Read 37 tweets
ACEP acaba de sacar estas tarjetas súper útiles para apoyarse en la realización del #pocus cardiaco. Aquí se las dejo! Que les sean de mucha utilidad #ultrasound #criticalcare #emergency #education #FOAMed #medicine
Ahí las tienen… que las disfruten !
Read 3 tweets
This is obvious for a lot of people but still:

If EIP1559's goal was just to take advantage of the high gas fees to burn a lot of ETH, they would have just increased the gas limit to lower fees but still burn way more ETH through the increased volume from the induced demand.
e.g. The market is okay with paying 50 gwei when there's a supply of 15 million gas per block.

If we 10x gas supply, fees should go down to 5 gwei.

But there's a lot of people willing to pay those lower fees so the increased volume would bring them back up to maybe 15-20 gwei.
A low gas limit actually hinders protocol revenue

50 gwei/gas × 15m gas/block = 0.75 ETH burned per block – net +1.25 ETH/block, still inflationary supply.☹️

15 gwei/gas × 150m gas/block = 2.25 ETH burned per block – #ultrasound money deflationary at -0.25 ETH/block! 🦇🔊
Read 5 tweets
New FREE paper in which we compare #hamstring fascicle behavior and muscle forces between the Nordic hamstring exercise, Roman chair and deadlift…

More info, images & videos in thread ⬇️

@kenneth_meijer @BeBiomech @SamVanRossom @NMS_UM @HumanMoveSci_UM
@kenneth_meijer @BeBiomech @SamVanRossom @NMS_UM @HumanMoveSci_UM Low strength and short fascicles are risk factors for hamstring injuries. These risk factors can be modified using many different exercises.

However, which exercise is most effective to specifically modify selected risk factors?
We sought to answer this question in this study by comparing the single-leg deadlift (DL; left) Nordic hamstring curl (NHC; middle), and single-leg roman chair hold (RCH; right). Image
Read 11 tweets
Today's #POCUS lecture by @mtabbut about the FAST exam in Hemodynamically Pediatric Blunt Abdominal Trauma. #MetroEUS
Aggregate sensitivity of FAST for all intra-abdominal injuries is low. Specificity is high. Remember though, the FAST was designed to look for FF, not all injuries. So if the injury is not associated with FF, the FAST will likely not see it.
So what can we do to increase the sensitivity of the FAST? Serial exams and adjunctive labs.
Read 6 tweets
Ecografía pulmonar 🫁. Guía fácil y práctica de como utilizarla. ABRO HILO
#POCUS #CardioEd #echofirst #ENARM #medicaleducation #ultrasound #MedEd #Cardiology Image
Es curioso porque clásicamente se decía que la ecografía pulmonar no era posible. Harrison afirmaba que " los ultrasonidos (US) se disipan rápidamente en el aire por lo que carecen de utilidad en la evaluación del parénquima pulmonar" ¿Qué ha cambiado? Image
Daniel Lichtenstein, un intensivista francés, redescubrió la ecografía pulmonar. Es cierto que los US no se transmiten bien por el aire, pero Lichtensein descubrió que pequeñas alteraciones en la relación aire-agua a nivel pulmonar formaban artefactos ecográficos característicos. Image
Read 25 tweets
3/ Clot is in a constant state of evolution. #Fibrin—> #Collagen.
Unfortunately many patients present in the subacute or late phase of #clot development which hinders many of our treatment approaches.
7️⃣days- 20% collagen

1️⃣5️⃣ days- 50% collagen

2️⃣1️⃣days- 80% (!!) collagen
Read 39 tweets
We’ve seen how to measure VTI and stroke volume with #ultrasound
Our next #FUSIC haemodynamic question brought to you by @icultrasonica, @wilkinsonjonny and I is:

Q2. Does SV respond to fluid, vasopressors or inotropes?

#echofirst #POCUS #haemodynamics #foamed
In Q1 we saw how to measure stroke volume (SV). Q2 helps us manage someone with an inappropriately low SV. Pressors, fluids and inotropes are all treatment options. If If used correctly, they will ↑SV. If not, they won’t, and they may even be harmful.
Measuring VTI before and after each of these interventions will therefore easily show you if they have worked. But can we predict which one is likely to work before we give drugs or a drop of fluid? 1st, let’s go back to some physiology.
Read 25 tweets
What are the key clinical questions about haemodynamics that ultrasound can answer?

@icmteaching, @wilkinsonjonny and I are going to take you through the 10 most important…

starting with...

Q1. Is stroke volume abnormal?

#FUSIC #echofirst #POCUS #ultrasound #haemodynamics
Despite shock being such an important diagnosis, intensive care clinicians are rubbish at detecting a low or high cardiac output (CO) clinically.

Sensitivity of detecting cardiac index (CI) < 2 clinically in this study was 0!…
From an apical 5- or 3-chamber view we can use PW Doppler to assess the velocity time integral (VTI) in the LVOT to determine blood flow.

Essentially, LVOT VTI is the average distance travelled by ejected blood during one contraction...

It is also known as stroke distance.
Read 12 tweets
Patient with epig pain and multiple ED visits with neg CT and non-specific labs - but persistent pain. What do you do? GI cocktail + famotidine and discharge? How about a little #POCUS first. #FOAMed #FOAMus #Ultrasound #MedTwitter @mtabbut @laurarbrownmd @RJonesSonoEM
And the transverse view. What do you think now? Poll below in thread. #Whatsthedx #EmergencyMedicine @DianeGramer @SLWerner_EM @ClaridgeJeffrey @vanessapho @ladha_prerna
What do you think?
Read 9 tweets
Thrilled to share our latest work out today in @NeuroCellPress using functional #ultrasound (fUS) neuroimaging to decode movement from single trials in non-human primates 🐒 - a new benchmark for fUS & a precursor to closed-loop #BCI.…

#tweetprint 🧵 1/n
Congrats to all co-authors @DMarescaLab, @VasileiosChris2, @MisterGriggz, @CharlieDemene,

dream-team collaborators @TanterM, @CharlieDemene (@INSERM @PhysMedParis, @ESPCI_Paris),

& PIs/ #neuroscience luminaries Richard Andersen & @mikhailshapiro (@Caltech, @CaltechN) 2/n
Background: Brain-machine interfaces (BMI) are powerful devices for restoring function to people living with paralysis. Already, our patients control external devices like computers and robotic limbs with incredible fidelity. 3/n
Read 14 tweets

Patient with left flank pain, pelvic pain, hematuria and gonadal varices

Your only imaging modality is vascular U/S....Lets find out!

A Mohan #Tweetorial

#RPVI #cardiotwitter #irad #vascular @HadyLichaaMD @t_intheleadcoat @TheNarulaSeries
2/ What’s going on here?? First name your structures #RPVI

SMA- superior mesenteric artery
AO- Descending Aorta
Lt renal VN- left renal vein

@CHICKVIR @Jonathan_PaulMD @iRadRock @keithppereira @Vascupedia_com @DrYanLiu
3/ Save this- transverse slice at the level of the renals! So much anatomy in such a confined space

#RPVI #cardiotwitter #IRAD #Vascular #foamed #cardioed #cardiology #ultrasound #pocus
Read 11 tweets
Did you adequately numb the peritoneum for your paracentesis?

If it looks like this then yes! Yes, you did. Congratulations. Your patient thanks you (and may ask for you by name next time!)

#ultrasound #irad #MedTwitter #MedEd #POCUS
For any intra abdominal needle passage, pain crossing the skin and peritoneum (sometimes muscles too) are worst. The 25G lido needle isn't too bad, but if you try to pass a 5 French without good local anesthesia, they're going to feel it.
Paracentesis is a great procedure for learning US/needle skills. Make sure you 👀your needle tip OVERLYING the deepest, echogenic, anterior abdominal wall layer and numb, numb, numb. If that layer pushes away from you, chase it with your needle!
Read 6 tweets
In the run up to #RAUK21 -5-6th May 2021 ,& to introduce some of the many publications of our Bruce Scott Lecturer @EMARIANOMD - I thought I’d start tweeting 10 of his papers to get you inspired about #RegionalAnaesthesia #RegionalAnesthesia - I’ll add them all to this thread...
In the first of 10 of @EMARIANOMD‘s papers, lets start by looking at this one on Continuous interscalene brachial plexus block via an ultrasound-guided Posterior approach #RAUK21 #MarianoTopTen 1/10……
The second of 10 of @EMARIANOMD’s papers is on #PedAnes! This paper is on the Feasibility of ultrasound-guided peripheral nerve block catheters for pain control on pediatric medical missions in developing countries. #RAUK21 #MarianoTopTen 2/10…
Read 9 tweets
Desde el grupo de @ecosemes y @EcosemesA queremos demostrar la gran importancia que tiene el abordaje de SARS-CoV-2 desde el punto de vista ecográfico con 3 casos clínicos. La importancia de #POCUS ¡Abrimos hilo! 👇🧵
1) Mujer 66 años. Tos persistente de 7 días. Fiebre el primer día. Acude por astenia hace 2 días. Satura al 96% con 16 rpm. ¿Te ayudaría la ecografía para sospechar altamente de COVID y planificar tu manejo?
¿O quizás esperamos mejor a la PCR-COVID? Esta paciente tiene 7 días desde el inicio de los síntomas; no sería candidata al test de antígeno rápido.
Read 11 tweets
Not only do we diagnose complex nerve conditions we also treat them!

We diagnosed pudendal neuropathy using #MR #Neurography and then ablate the nerve using #CT ImageImage
We also use #MR #Neurography for planning #CT guided nerve injections ImageImage
Not just #MR and #CT, we routinely do complex (and simple) procedures using #ultrasound, like this #barbotage we performed for a young patient who had immediate pain relief. ImageImage
Read 4 tweets
3 things you should know about cancer of the womb

1️⃣ 1 in 90 women have a life-time risk of having it

2️⃣ It often manifests with vaginal bleeding, especially after menopause

3️⃣ You can take steps to prevent it.

A thread 🧵

{Retweet for awareness!} Image
What increased your risk of having cancer if the womb?

- Obesity
- Late menopause (after 52 years)
- High estrogen levels
- Nuliparous (not giving birth)
- Diabetes
- Drugs e.g. tamoxifen, tibolone
- Family history of womb cancer esp in your mother, sister or daughter.
Once a womb cancer is suspected, two common tests can be done to confirm it;

- Trans-vaginal #ultrasound scan: the walls of the uterus might be more than 4mm thick

- Womb tissue can be taken out (#biopsy) for histology: highly definitive if done using hysteroscopy
Read 6 tweets
1/ Hey #IDFellows, here is a new #IDTwitter Tweetorial: 24F w/1 wk hx pharyngitis + 1d cough & SOB. VS T 39.3C, RR 23, SpO2 92%, HR 112. Exam with tonsillar swelling & erythema; L neck pain and swelling on palpation. CXR w/peripheral nodular opacities. Best empiric abx?
2/ Lemierre’s syndrome = #eponym for suppurative thrombophlebitis of the jugular vein. Often preceded by pharyngitis +/- neck swelling. Commonly associated with pulmonary septic emboli. Check these #NEJM Clinical Images:
3/ Most common organisms include Fusobacterium necrophorum >>> other fusobacterium > anaerobic streptococci. Fusobacterium necrophorum, an anaerobic gram-negative rod, seems to be distinctively adept at causing septic thrombophlebitis.
Read 11 tweets

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