Thread, 1/n - Male 75. Acute dyspnea since 1 hour, can't talk, wheezy. SPO2 75%. No previous record. "All that wheezes is not asthma". #POCUS leaves no doubt about pulmonary edema, Dx while patient is being attached to monitor.BP 180/110 mmHg.
2/n CPAP 10 mmHg, IV infusion of nitrate being prepared. Pectus excavatum, parasternal long axis impossible from usual 3/4 ICS. But Apical 4 chamber suggests mild LV systolic dysfunction
3/n As I was about to bolus nitrate 500 mcg - BP drops from 180/110 to 120/70 mmHg. Patient improving with CPAP. So I hold the bolus and try to get more cardiac views. Patient upright plus pectus excavatum, thus not the best quality, but aortic valve appears calcific.
4/n CWD across aortic valve - PG 56 mmHg 
5/n Cardiology admit, confirm Dx, plan for CAG and cardiac surgery consult EM #POCUS helped Dx pulmonary edema, and aortic stenosis - avoiding vasodilator Rx which can potentially cause hypotension and cardiovascular collapse in severe aortic stenosis.
6/6 @threadreaderapp unroll please
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