First up for tweet-ucation on this final day of live #CHEST2021 is “The Wave of the Future: Beyond the Ultrasound Basics"! 1/
Dr. Orlando Garner (@ogarnerccm) will discuss "Brain Drain: Neuro-Ultrasound for the non-Neurointensivist." #CHEST2021 2/
Transcranial US anatomy and probe positioning. #CHEST2021 3/
You can assess midline shift. #CHEST2021 4/
Increased ICP will be seen as MCA decreased diastolic flow and a sharp upstroke initially, or even diastolic flow reversal in the setting of cerebral arrest. #CHEST2021 5/
Find the MCA anterior to the thalamus in the circle of willis. #CHEST2021 6/
You can estimate the ICP using the pulsatility index. #CHEST2021 7/
You can also use US to evaluate for vasospasm. #CHEST2021 8/
Measure the optic nerve sheath (bilaterally enlarged in increased ICP). Unilateral enlargement should change your differential (things like optic neuritis). #CHEST2021 9/
ONSD pitfalls #CHEST2021 10/
Take home points! #CHEST2021 11/
Dr. Ali Omranian will discuss "From the Neck Down: Upper Airway Ultrasonography and Confirmation of Tube and Line Placement." #CHEST2021 12/
(SLIDE)
You can use US to evaluate a tracheal intubation #CHEST2021 13/
Normal longitudinal view of upper airway #CHEST2021 14/
The linear probe gives the best view of the airway. #CHEST2021 15/
Anterior structures of the neck #CHEST2021 16/
Algorithm for US evaluation after intubation. #CHEST2021 17/
Caveats #CHEST2021 18/
US for intubation confirmation has been studied. #CHEST2021 19/
Philippe Rola (@ThinkingCC) will discuss "Avoiding the Michelin Men: How to Approach Venous Congestion". #CHEST2021 20/
Asking the IVC whether a patient is fluid responsive is a beginner's question. #CHEST2021 21/
This study looked at the VExUS score for grading venous congestion. #CHEST2021 22/
Possible future fluid management philosophies to consider. #CHEST2021 23/
Dr. Alfredo Jardino will discuss "Waves of Breathlessness: POCUS for Ventilator Liberation." #CHEST2021 24/
Non-POCUS vent weaning protocols #CHEST2021 25/
POCUS weaning protocols #CHEST2021 26/
42% of weaning failures are related to the heart with decreased LV function after removed of positive pressure. #CHEST2021 27/
Start with an eyeball test of the LVEF. #CHEST2021 28/
The EPSS is 100% sensitive for predicting severe systolic dysfunction. #CHEST2021 29/
Can estimate filling pressures using E/A and E/e' ratios. #CHEST2021 30/
You can assess your cardiac output . #CHEST2021 31/
Lung POCUS can also be helpful, #CHEST2021 32/
B-lines can help identify pulmonary edema even with a normal CXR. #CHEST2021 33/
Hepatization of the lung can reflect de-recruited lung. #CHEST2021 34/
You can evaluate whether there is a pleural effusion. #CHEST2021 35/
Lung US score #CHEST2021 36/
The diaphragm makes 80% of the inspiratory effort. You can evaluate thickness fraction and diaphragmatic excursion. #CHEST2021 37/
Diaphragmatic thickness fraction can be measured during inspiration and exhalation. #CHEST2021 38/
Diaphragmatic excursion can also be evaluated. #CHEST2021 39/39
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