Thread by @Pocus101

Stop KILLING Your Patients with Fluid! Learn how to avoid Fluid Overload with Venous Congestion Evaluation using #POCUS

New BLOG POST on the #VExUS Protocol! Step By Step Guide, Downloadable PDF Pocket Guide, & Calculator
👉🔗pocus101.com/vexus

#medtweetorial👇(1/10)

(2/10) It’s not just about the IVC it’s about what is affected beyond the IVC. Don’t forget the Liver, Gut, and Kidneys.

Venous Congestion in these organs can lead to significant comorbidity. Download the PDF: 👉🔗pocus101.com/vexus

(3/10) Step 1: Look at the IVC if < 2cm then Grade 0, If > 2cm proceed to the next steps. 🔗pocus101.com/vexus

(4/10) Step 2: Evaluate Hepatic Venous Doppler:
🔗pocus101.com/vexus

1. Get Image of IVC and hepatic veins.
2. Place color flow Doppler over the hepatic veins. (Should see BLUE-away)
3. Place your Pulse Wave Doppler gate on a hepatic vein
4. Initiate Pulse wave Doppler

(5/10) Interpret Hepatic Venous Doppler Tracing. 🔗pocus101.com/vexus

(6/10) Step 3: Evaluate Portal Venous Doppler:
🔗pocus101.com/vexus

1. Get 2D image of the Right Portal Vein
2. Place color flow Doppler over Portal Vein (Should See RED-toward)
3. Place your pulse wave Doppler gate on the Portal Vein
4. Initiate Pulse wave Doppler

(7/9) Interpret Portal Venous Doppler Tracing. 🔗pocus101.com/vexus

(8/10) Step 2: Evaluate Intrarenal Venous Doppler:
🔗pocus101.com/vexus

1. Get a 2-D image of the Kidney
2. Place color flow Doppler over Kidney.
3. Place your pulse wave Doppler gate on the interlobar vessels
4. Initiate Pulse wave Doppler

Clip👇

(9/10) Interpret Renal Venous Doppler Tracing. 🔗pocus101.com/vexus

(9/10) VExUS Severity Grading:

Download PDF! 👉🔗pocus101.com/vexus

Grade 0: IVC <2cm = NO Congestion
Grade 1: IVC >=2cm with any combo of Normal or Mildly Abnl Patterns
Grade 2: IVC >=2cm and ONE severely Abnl Pattern
Grade 3: IVC >=2cm and >2 Severely Abnl Patterns

Special thanks to my colleague @khaycock2 for reviewing this material for me. And of course the #VExUS Pioneers: @ThinkingCC @khaycock2 @WBeaubien @EMNerd_ And the #VExUS superusers! @ArgaizR @NephroP @Wilkinsonjonny @Thind888 @load_dependent. Learning from all of you! 🙏🙏

Ping @ChuckWurster @RubbleEM @AIUMultrasound @iamritu @zedunow @sonophysio @MprizzleER @EmergencyEcho @POCUS_Society @POCUSJournal