Thread by @DrShukla14

#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?

Apical 4 chamber not possible (defib pads) but subxiphoid short axis shows thick RV wall - also not expected in acute PE

So decided not to jump the gun - and held lytic. More information comes as medical record available patient is known to have apical hypertrophic cardiomyopathy

#POCUS after ROSC - when apical 4 chamber could be obtained - RV does not seem to be dilated now!

Cardiac arrest from any etiology (including hypovolemia!) may cause dilated RV, shown in this animal experiment by Aagard et al doi.org/10.1097/CCM.00…

So #POCUS in cardiac arrest -
1. Primum non nocere - don't interrupt chest compressions
2. #POCUS is just a data point - don't give lytic if Pulmonary embolism does not "fit" the overall picture.

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