Thread by @katiewiskar

Journal Club in the time of COVID 🤓🩺😷

@ubcimpocus had our inaugural #POCUS journal club with our fellow @teres_sono (welcome to #MedTwitter Terry!!).

The topic was all things #VEXUS and some really great questions came up (1/)

Note COVID modifications:

- small group, all seated 6ft apart
- masks, wipes, hand sanitizer easily accessible
- no shares food; individual drinks (yes, gasp, alcohol - #professionalism)
- Zoom mtg on individual devices to enable distanced screen sharing

Many questions came up, both technical and philosophical:

- When scanning the hepatic vein, does it matter which branch (L/mid/R) you scan? (My answer: I scan whichever gives me the best waveform (3/)

- When looking at intrarenal venous flow, does the waveform have to hit baseline to be considered abnormal; or is obvious cardio-phasic pulsatility enough time call congestion? (My answer: yes to the latter) (4/)

- Can TR cause abnormal intrarenal waveforms, in very severe cases? And in cases w severe TR present and no intrarenal tracings obtainable, do abnormal PV/HV tracings help you clinically? (My answer: I’m not sure; I think can be helpful if you have serial scans to compare) (5/)

- The IVC: is there value in looking not only at size, but collapsibility; and in both long and short axes? This wasn’t done in the #VEXUS paper. (My answer: yes, absolutely) (6/)

Perhaps the most important:

- the use of solid organ Doppler to identify congestion has been studied in limited populations (and #VEXUS even more so). These are primarily HF and cardiac Sx pts. How justified are we using these tools in other pt populations - ie, sepsis? (7/)

Overall it was a fantastic #nerdnight that I hope is soon repeated. This is such a fascinating topic with so much still to be discovered - we hope to share some of our own #VEXUS research down the road 😉

Thanks @shanearish for hosting! Ping @BuddingSprout

Ping my #POCUS friends and #VEXUS experts for their thoughts on the above queries: @ThinkingCC @Thind888 @khaycock2 @EMNerd_ @NephroP @npacker2015 @mwhite_86 @haileyahobbs @arntfield @Buchanan_MD @IM_POCUS @PittIMPOCUS @08JDub88 @msiuba @DRsonosRD @ArgaizR @dan___kim @AlaifanT