Thread by @gretchemaben

First up for tweet-ucation on this final day of live #CHEST2021 is “The Wave of the Future: Beyond the Ultrasound Basics"! 1/

Dr. Orlando Garner (@ogarnerccm) will discuss "Brain Drain: Neuro-Ultrasound for the non-Neurointensivist." #CHEST2021 2/

Transcranial US anatomy and probe positioning. #CHEST2021 3/

You can assess midline shift. #CHEST2021 4/

Increased ICP will be seen as MCA decreased diastolic flow and a sharp upstroke initially, or even diastolic flow reversal in the setting of cerebral arrest. #CHEST2021 5/

Find the MCA anterior to the thalamus in the circle of willis. #CHEST2021 6/

You can estimate the ICP using the pulsatility index. #CHEST2021 7/

You can also use US to evaluate for vasospasm. #CHEST2021 8/

Measure the optic nerve sheath (bilaterally enlarged in increased ICP). Unilateral enlargement should change your differential (things like optic neuritis). #CHEST2021 9/

ONSD pitfalls #CHEST2021 10/

Take home points! #CHEST2021 11/

Dr. Ali Omranian will discuss "From the Neck Down: Upper Airway Ultrasonography and Confirmation of Tube and Line Placement." #CHEST2021 12/
(SLIDE)

You can use US to evaluate a tracheal intubation #CHEST2021 13/

Normal longitudinal view of upper airway #CHEST2021 14/

The linear probe gives the best view of the airway. #CHEST2021 15/

Anterior structures of the neck #CHEST2021 16/

Algorithm for US evaluation after intubation. #CHEST2021 17/

Caveats #CHEST2021 18/

US for intubation confirmation has been studied. #CHEST2021 19/

Philippe Rola (@ThinkingCC) will discuss "Avoiding the Michelin Men: How to Approach Venous Congestion". #CHEST2021 20/

Asking the IVC whether a patient is fluid responsive is a beginner's question. #CHEST2021 21/

This study looked at the VExUS score for grading venous congestion. #CHEST2021 22/

Possible future fluid management philosophies to consider. #CHEST2021 23/

Dr. Alfredo Jardino will discuss "Waves of Breathlessness: POCUS for Ventilator Liberation." #CHEST2021 24/

Non-POCUS vent weaning protocols #CHEST2021 25/

POCUS weaning protocols #CHEST2021 26/

42% of weaning failures are related to the heart with decreased LV function after removed of positive pressure. #CHEST2021 27/

Start with an eyeball test of the LVEF. #CHEST2021 28/

The EPSS is 100% sensitive for predicting severe systolic dysfunction. #CHEST2021 29/

Can estimate filling pressures using E/A and E/e' ratios. #CHEST2021 30/

You can assess your cardiac output . #CHEST2021 31/

Lung POCUS can also be helpful, #CHEST2021 32/

B-lines can help identify pulmonary edema even with a normal CXR. #CHEST2021 33/

Hepatization of the lung can reflect de-recruited lung. #CHEST2021 34/

You can evaluate whether there is a pleural effusion. #CHEST2021 35/

Lung US score #CHEST2021 36/

The diaphragm makes 80% of the inspiratory effort. You can evaluate thickness fraction and diaphragmatic excursion. #CHEST2021 37/

Diaphragmatic thickness fraction can be measured during inspiration and exhalation. #CHEST2021 38/

Diaphragmatic excursion can also be evaluated. #CHEST2021 39/39