Ernest Fischer, MD Profile picture
Apr 16, 2021 โ€ข 9 tweets โ€ข 5 min read โ€ข Read on X
1/ More 3D #POCUS models for educators + beginners! (๐—ฐ๐—ผ๐—ป๐—ฐ๐—ฒ๐—ฝ๐˜๐˜‚๐—ฎ๐—น๐—ถ๐˜‡๐—ฒ > memorize)

๐—”๐Ÿฐ๐—– and ๐—ฆ๐—– views
Major chambers in these 4C views:
โžฃLA
โžฃLV
โžฃRA
โžฃRV
2/ Deconstructing the ๐—”๐Ÿฐ๐—– view:

โ€ข The ๐—ฝ๐—ฟ๐—ผ๐—ฏ๐—ฒ ๐—บ๐—ฎ๐—ฟ๐—ธ๐—ฒ๐—ฟ ๐—ถ๐˜€ ๐—ผ๐—ป ๐˜๐—ต๐—ฒ ๐—ฅ๐—œ๐—š๐—›๐—ง, or oriented toward the LA/LV relative to RA/RVx
โ€ข The top of the screen (๐—”๐—ฝ๐—ฒ๐˜…) ๐—ถ๐˜€ ๐—ฐ๐—น๐—ผ๐˜€๐—ฒ๐˜€๐˜ to the probe and
โ€ข Atria are furthest
3/ With those constraints one can determine general ๐—”๐Ÿฐ๐—– probe location

โ€ข Probe marker ~3 oโ€™clock (๐˜ถ๐˜ด๐˜ถ๐˜ข๐˜ญ๐˜ญ๐˜บ 2:30)
โ€ข ~5rd IC space
โ€ข ~Midclavicular line (๐˜ข๐˜ญ๐˜ต๐˜ฉ๐˜ฐ๐˜ถ๐˜จ๐˜ฉ ๐˜—๐˜”๐˜ ๐˜ข๐˜ฏ๐˜ฅ ๐˜ข๐˜ฑ๐˜ฆ๐˜น ๐˜ข๐˜ณ๐˜ฆ๐˜ฏ'๐˜ต ๐˜ข๐˜ญ๐˜ธ๐˜ข๐˜บ๐˜ด 1:1)
โ€ข Probe tilted to head
4/ Another ๐—”๐Ÿฐ๐—– look

And for those interested the ๐—ถ๐—ป๐—ณ๐—ฒ๐—ฟ๐—ผ๐˜€๐—ฒ๐—ฝ๐˜๐—ฎ๐—น + ๐—ฎ๐—ป๐˜๐—ฒ๐—ฟ๐—ผ๐—น๐—ฎ๐˜๐—ฒ๐—ฟ๐—ฎ๐—น LV walls are seen
5/ ๐—ง๐—˜๐—ฆ๐—ง!

The ๐—ฆ๐—– long axis is also a 4 chamber view

โ€ข The ๐—ฝ๐—ฟ๐—ผ๐—ฏ๐—ฒ ๐—บ๐—ฎ๐—ฟ๐—ธ๐—ฒ๐—ฟ ๐—ถ๐˜€ ๐—ผ๐—ป ๐˜๐—ต๐—ฒ ๐—ฅ๐—œ๐—š๐—›๐—ง, or oriented toward the ventricles and apex
โ€ข The top of the screen (๐—ฅ๐—ฉ>๐—ฅ๐—”) ๐—ถ๐˜€ ๐—ฐ๐—น๐—ผ๐˜€๐—ฒ๐˜€๐˜ to the probe and
โ€ข Left sided chambers are furthest
6/ With those constraints one can determine general ๐—ฆ๐—– probe location

โ€ข Probe marker ~3 oโ€™clock (๐˜ถ๐˜ด๐˜ถ๐˜ข๐˜ญ๐˜ญ๐˜บ 2:45)
โ€ข ~Subxyphoid (๐˜ด๐˜ฉ๐˜ฐ๐˜ฐ๐˜ต ๐™ฉ๐™๐™ง๐™ค๐™ช๐™œ๐™ ๐˜ญ๐˜ช๐˜ท๐˜ฆ๐˜ณ)
โ€ข Probe tilted to head
7/ Another ๐—ฆ๐—– look

(๐˜ต๐˜ฉ๐˜ฆ ๐˜š๐˜Š ๐˜ฅ๐˜ฐ๐˜ฆ๐˜ด ๐™ฃ๐™ค๐™ฉ ๐˜ฉ๐˜ข๐˜ท๐˜ฆ ๐˜ฑ๐˜ณ๐˜ฆ๐˜ฅ๐˜ช๐˜ค๐˜ต๐˜ข๐˜ฃ๐˜ญ๐˜ฆ ๐˜ค๐˜ฐ๐˜ณ๐˜ฐ๐˜ฏ๐˜ข๐˜ณ๐˜บ ๐˜ด๐˜ฆ๐˜จ๐˜ฎ๐˜ฆ๐˜ฏ๐˜ต๐˜ข๐˜ต๐˜ช๐˜ฐ๐˜ฏ)
8/ This and other 3D models and GIFs
goodybedside.com/3Dpocus

ping @DRsonosRD - #FOAMed 3D models your team at @VaveHealth could do interesting things with, I'm sure.
9/ The whole #A4C and #SC run down
#echofirst

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More from @EAFischer

Jul 10
๐—›๐—ฒ๐—ฝ๐—ฎ๐˜๐—ผ-๐—ท๐˜‚๐—ด๐˜‚๐—น๐—ฎ๐—ฟ ๐—ฟ๐—ฒ๐—ณ๐—น๐˜‚๐˜…(HJR)

History, utility and how well does it perform ๐˜„๐—ถ๐˜๐—ต ๐˜‚๐—น๐˜๐—ฟ๐—ฎ๐˜€๐—ผ๐˜‚๐—ป๐—ฑ

a thread
Pasteur (not Louis) first described HJR as a sign of TR in 1885

Rondot in 1898 actually coined the phrase HJR and noted that it didnโ€™t just reflect TR Image
In 1925 Lian (professor) and Blondel (internโ€ฆ wonder who did most of the work ๐Ÿ˜‚ ) reported that ๐—ฝ๐—ฟ๐—ฒ๐˜€๐˜€๐˜‚๐—ฟ๐—ฒ ๐—ฐ๐—ผ๐˜‚๐—น๐—ฑ ๐—ฏ๐—ฒ ๐—ฎ๐—ฝ๐—ฝ๐—น๐—ถ๐—ฒ๐—ฑ ๐—ฎ๐—ป๐˜†๐˜„๐—ต๐—ฒ๐—ฟ๐—ฒ ๐—ผ๐—ป ๐˜๐—ต๐—ฒ ๐—ฎ๐—ฏ๐—ฑ๐—ผ๐—บ๐—ฒ๐—ป, not just the liver, to get the response Image
Read 17 tweets
Jan 17, 2022
1/ More 3D #POCUS models for educators + beginners! (๐—ฐ๐—ผ๐—ป๐—ฐ๐—ฒ๐—ฝ๐˜๐˜‚๐—ฎ๐—น๐—ถ๐˜‡๐—ฒ > memorize)

Parasternal Short axis (PSAx) starts with a good PLAx, then rotation 90ยบ clockwise

2/ PSAx Orientation

Reminder the
โžฃ๐—ฅ๐—ฉ is the most ๐—ฎ๐—ป๐˜๐—ฒ๐—ฟ๐—ถ๐—ผ๐—ฟ structure
โžฃ๐—Ÿ๐—” the most ๐—ฝ๐—ผ๐˜€๐˜๐—ฒ๐—ฟ๐—ถ๐—ผ๐—ฟ
3/ Multiple โ€œviewsโ€ can be obtained with this probe rotation, from the
โžข ๐—ฎ๐—ผ๐—ฟ๐˜๐—ถ๐—ฐ level
โžข through the base (๐—บ๐—ถ๐˜๐—ฟ๐—ฎ๐—น level) of the heart
โžข past the ๐—ฝ๐—ฎ๐—ฝ๐—ถ๐—น๐—น๐—ฎ๐—ฟ๐˜† level
โžข to the ๐—ฎ๐—ฝ๐—ฒ๐˜…
Read 9 tweets
Nov 12, 2021
1/ #tweetorial
โฎžOptic disc edema vs. Papilledema
โฎžOrbital anatomy
โฎžOrbital #POCUS
2/ First what is ๐—ฝ๐—ฎ๐—ฝ๐—ถ๐—น๐—น๐—ฒ๐—ฑ๐—ฒ๐—บ๐—ฎ?

๐˜ ๐˜ธ๐˜ช๐˜ด๐˜ฉ ๐˜ ๐˜ค๐˜ฐ๐˜ถ๐˜ญ๐˜ฅ ๐˜จ๐˜ฆ๐˜ต ๐˜ช๐˜ฎ๐˜ข๐˜จ๐˜ฆ๐˜ด ๐˜ญ๐˜ช๐˜ฌ๐˜ฆ ๐˜ต๐˜ฉ๐˜ฆ๐˜ด๐˜ฆ...
[source bit.ly/3yceeCT]
3/ ๐—ข๐—ฝ๐˜๐—ถ๐—ฐ ๐—ฑ๐—ถ๐˜€๐—ฐ ๐—ฒ๐—ฑ๐—ฒ๐—บ๐—ฎ = optic nerve head edema + anterior bulging of physiologic cup

๐—ฃ๐—ฎ๐—ฝ๐—ถ๐—น๐—น๐—ฒ๐—ฑ๐—ฒ๐—บ๐—ฎ is optic disc edema ๐™™๐™ช๐™š to ๐Ÿกฑintracranial pressure

**๐—ก๐—ผ๐˜ ๐—ฎ๐—น๐—น ๐—ผ๐—ฝ๐˜๐—ถ๐—ฐ ๐—ฑ๐—ถ๐˜€๐—ฐ ๐—ฒ๐—ฑ๐—ฒ๐—บ๐—ฎ ๐—ถ๐˜€ ๐—ฝ๐—ฎ๐—ฝ๐—ถ๐—น๐—น๐—ฒ๐—ฑ๐—ฒ๐—บ๐—ฎ [bit.ly/3wEIUwG]
Read 13 tweets
Jun 23, 2021
1/ Volume Assessmentโ€ฆ โ€ฆ is hard

Physical exam for hypovolemia, a thread
2/ Is the above patient?
3/ What do we mean by โ€œ๐—ฑ๐—ฟ๐˜†โ€? By ๐˜ƒ๐—ผ๐—น๐˜‚๐—บ๐—ฒ ๐˜€๐˜๐—ฎ๐˜๐˜‚๐˜€?

๐——๐—ฒ๐—ต๐˜†๐—ฑ๐—ฟ๐—ฎ๐˜๐—ฒ๐—ฑ is often ~ hypertonicity / intracellular volume contraction

๐—ฉ๐—ผ๐—น๐˜‚๐—บ๐—ฒ ๐—ฑ๐—ฒ๐—ฝ๐—น๐—ฒ๐˜๐—ถ๐—ผ๐—ป is โ†“extracellular volume w/ blood volume contraction
bit.ly/3d1GWhh
Read 14 tweets
Feb 22, 2021
1/ Basic #CadiacUS models (color coded / labeled) for Educators or Beginners

At least 2 options when learning any #IMPOCUS โ€“ memorize or ๐—ฐ๐—ผ๐—ป๐—ฐ๐—ฒ๐—ฝ๐˜๐˜‚๐—ฎ๐—น๐—ถ๐˜‡๐—ฒ.

Both will get you there but IMO the latter allows for taking next step into advanced imagingโ€ฆ
2/ This is especially true in Cardiac POCUS โ€“ 4 basic views, but actually so many more. #ECHOFirst

Firm understanding of anatomy and spatial relationships is key!

โžฃNote axis of the heart
โžฃ๐—ฅ๐—ฉ the most ๐—ฎ๐—ป๐˜๐—ฒ๐—ฟ๐—ถ๐—ผ๐—ฟ structure
โžฃ๐—Ÿ๐—” the most ๐—ฝ๐—ผ๐˜€๐˜๐—ฒ๐—ฟ๐—ถ๐—ผ๐—ฟ
3/ #PLAx is ๐™๐™ƒ๐™€ view to learn, if any

Major chambers in view
โžฃLA
โžฃLV
โžฃAorta
โžฃRV(OT)
Read 9 tweets

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