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𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊 Profile picture
@PulmCrit
Jan 27, 2020 • 5 tweets • 6 min read • Read on X
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RV resuscitation! screen for RV failure with POCUS (and records if you have em) #thepeoplesventricle #StoweEM20 by @mattroginski ImageImageImage
incorrect probe rotation can cause RV size to be underestimated! Matt’s own echo has great TAPSE #humblebrag #StoweEM20 by @mattroginski ImageImage
badness:
D sign on short axis
RV dilation in subcostal
#StoweEM20 by @mattroginski ImageImage
signs of severe badness: with bubble injection:
- bubbles take forever to clear (CO is aweful, blood isnt going anywhere)
- right to left shunt
#StoweEM20 by @mattroginski Image
- juditious volume management
- early pressor
- arrhythmia tx
- avoid intubation if possible
#StoweEM20 by @mattroginski ImageImageImageImage

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More from @PulmCrit

𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊 Profile picture
Oct 26
Critical interactions for the critical care cardiologist: An anthology of the tortured pharmacist's department

- @TaniaAhuja at #critcarecards24 Image
@TaniaAhuja who should get AV nodal blockers?

Diltiazem is contraindicated in shock.

**If you don't know the EF, may avoid.**

Diltiazem and riveroxiban may interact as well.

- @TaniaAhuja at #critcarecards24 Image
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@TaniaAhuja diltiazem plus riveroxiban interaction may increase bleeding

- @TaniaAhuja at #critcarecards24 Image
Read 6 tweets
𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊 Profile picture
Oct 26
Low slow and trying to crash

CCB & Bbl intoxication.

Getting things done is tough! A really sick CCB/BBl intoxication challenges this.

- @emcrit at #critcarecards24 Image
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@emcrit Start with calcium, although it probably don't do a ton. May follow this with a calcium infusion if there is sufficient IV access.

- @emcrit at #critcarecards24 Image
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@emcrit Intubate early before hemodynamics truly fall apart.

- @emcrit at #critcarecards24 Image
Read 9 tweets
𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊 Profile picture
Oct 25
Why do I deviate from ACLS?

- @mdonnino at #critcarecards24 Image
@mdonnino Do you resume CPR after shock? Yeap.

In 2005 the algorithm changed from stacked shocks to a single shock followed by waiting for 2 minutes to see what is going on.

No solid evidence that this was the correct approach.

- @mdonnino at #critcarecards24 Image
@mdonnino Years after implementation: the new approach actually seemed to cause worse outcomes (not statistically significant)

- @mdonnino at #critcarecards24 Image
Read 4 tweets
𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊 Profile picture
Oct 25
More on RV failure:

Acute RVMI: loading can be helpful because we want to raise the RV pressure higher than the PA pressure to cause blood to flow downhill.

- @Chrisotpher Barnett at #critcarecards24 Image
Image
Chronic pulmonary artery hypertension: RV is *chronically* adapted

Volume loading may help push patients into the RV death spiral.

- Chrisotpher Barnett at #critcarecards24 Image
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In chronic RV dysfunction, function may often be optimized by fluid removal.

this may additionally avoid systemic congestion!

- @ChrisBarnettMD at #critcarecards24 Image
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Read 6 tweets
𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊 Profile picture
Oct 25
1st talk: RV dysfunction by @Sam_Brusca at #critcarecards24

RV contracts in multiple mechanisms.

LV contraction indirectly contributes 40% of the stroke volume of the RV! Image
Image
- RV-PA coupling may fail with RV dilation, but this is difficult to assess at the bedside

- @Sam_Brusca at #critcarecards24 Image
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PAPI as a marker of RV-PA coupling!

cutoff may depend on context

RV MI: unconditioned PAPI decouples at <1

PAH: PAPI cutoff for worse outcomes may be higher Image
Read 7 tweets
𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊 Profile picture
Dec 17, 2023
how to place a consult: you MUST understand the five stages of consultant grief.

once you can understand this painful and natural process, requesting consults will make a LOT more sense

buckle up, it can be a little rough…

🧵 1/6…
stage 1: denial

- You dont need a consult.
- You called the wrong service.
- 18 years old? consult pediatrics
- I’m not actually on call now
- Everything’s fine, just walk it off…
stage 2: anger

- you should have consulted us earlier/later
- you should have checked this test before calling us
- you’re a terrible doctor/student/human being
Read 6 tweets

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