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@Thind888 @FH_Verbrugge @khaycock2 Dear hemodynamic masters, saw a cirrhotic pt with oliguria (relatively preserved Scr) & pulmonary congestion. Based on these findings, suggested norepinephrine (pressors). Agree? any educational input appreciated.
Basically I interpreted as high output cardiac failure with elevated filling pressures leading to pulmonary congestion.
This tracing I believe is right intra-renal 'arterial' with diminished diastolic flow. Correct me if I'm wrong.
Sorry, didn't realize that the scale dropped
Pt update: Made 3.5 L urine after starting Norepinephrine and continued iv diuresis (was on diuretics prior to becoming oliguric as well). Cr mildly increased but expected as Cr lags behind the insult. Hopefully I get to scan next week and with a better technique this time 👍🏽🙏
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NephroPOCUS
@NephroP
1/ #Nephrology #POCUS case study:
Dr. X is rounding on an ESRD pt who initially presented with dyspnea after missing a dialysis (HD) session; underwent dialysis in the hospital. Pt asymptomatic at the time of exam and lung #ultrasound revealed 👇 Further story in thread #MedEd
2/ Based on the 2-zone lung #POCUS, Dr. X orders for another session of HD. Notably, pt says he is at his 'dry weight' and HD nurse says they could only get 1.5L off during first session. Dr. X doesn't change his/her mind.
Info on various lung scan zones👇
3/ Patient becomes hypotensive during HD and only ~500cc fluid could be removed.
Why can't we get more fluid out of a hypervolemic patient? Dr. X is perplexed and decides to more #POCUS Here is the IVC
Read 16 tweets
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NephroPOCUS
@NephroP
#POCUS #echofirst The correct answer is dilated coronary sinus [48% got it right (of 229 votes)]. From #IMPOCUS standpoint, 2 main causes: persistent left superior vena cava and pulmonary HTN. This pt had the former. Normal anatomy of the coronary sinus (Read #thread)👇 #MedEd
More anatomy: 3D CT angio
We need to understand the anatomy first to understand #pocus orientation
Original image shows the typical location of CS in PLAX view. Don't confuse with descending aorta. You can also see CS from the apical window. From apical 4C, tilt the transducer posterior (in the opposite direction as you would for the 5-chamber view) #POCUS
Read 7 tweets
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NephroPOCUS
@NephroP
#POCUS teaching case: #Dialysis patient c/o sob, reports weight gain. BP low to begin with (~100-110 mmHg systolic) & drops further during ultrafiltration. Dr. X performs IVC #ultrasound at the bedside and sees this 👇 - probably volume depleted? See #thread
#MedEd #nephrology
2/ Dr. X orders to stop ultrafiltration. BP stabilized a little bit.
All done?
Wait, something doesn't make sense. Why did the patient gain weight? (usually #dialysis patients know their dry weight well). Why sob?
In the meanwhile, radiology tech performs chest #X-ray 👇
3/ That's not good. Diagnosis is apparent but lets get Dr. Y who does more than just IVC #POCUS
Subcostal view 👇
Significant pericardial effusion
Read 12 tweets

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