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NephroPOCUS

30 Sep 20, 4 tweets, 3 min read

Stimulated by the enthusiasm of #MedEd student and #nephrology fellow, did a small experiment to see how well #POCUS -determined blood flow in the continuous renal replacement therapy (CRRT) circuit correlates with the actual no.
1/ First, got a color #Doppler img. of the tube 👇

2/ How do you calculate flow? It is the same principle that we use to determine flow rate in an arteriovenous fistula 👇 #POCUS

3/ 2nd step: measured the diameter of the tube (double-lined structure) - 0.42 cm

4/ Now we get a pulsed wave Doppler tracing of the blood flow and the US machine does rest of the job - calculates the product of time-averaged mean velocity (TA Mean) & the area.
Result = 235.8 ml/min...pretty accurate considering the slippery tube & my hand full of gel! #POCUS

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#Nephrology #POCUS case of the day:
What do you think is this anechoic structure adjacent to liver?
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@ArgaizR

OK #VExUS #POCUS hemodynamicians, welcome back to the case. As promised, here are some follow up images:
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Hepatic v. 👇

Looks D-only but could this be S-wave? (or a delayed D? Pt has Afib and predisposed to having smaller S but wondering if there is some S-D fusion here)

Forgot, here is the IVC. Similar to previous.

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Renal #POCUS in a #dialysis patient: Looks fine at first glance (thin parenchyma as expected) but fanning anteriorly reveals a large cyst, which would have been missed otherwise. Labeled images and notes in thread 👇
#Nephrology #MedEd #IMPOCUS

Labeled first image #POCUS
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Labeled second image #POCUS (obtained with phased array probe)
Note: EKG is not needed 😀

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11 Nov 20

#Nephrology consult for worsening creatinine in the context of diuresis in a patient with #heartfailure
Documented weight 3 kg ⬇️ than the previous day. No accurate urine output. Pt feels OK (has some unrelated issue).
Question: over diuresis?
#POCUS #MedEd #VExUS see thread 👇

So, there is decreased LV systolic function and obviously diastolic dysfunction. Bi atrial enlargement. No significant pericardial effusion (there was trace on PLAX).
Next step in the hemodynamic circuit #POCUS assessment?
btw repeat weight was similar.

Next: IVC #POCUS assessment to assess right atrial pressure.
Here it is 👇
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#POCUS #IMPOCUS
Understanding #VExUS from scratch:
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#POCUS Intra-renal vein Doppler waveform looking exactly like that of hepatic vein!
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