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POCUS Med Ed

@pocusmeded

Jan 12, 2022 • 11 tweets • 7 min read • Read on X

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Why we #pocus: unexpected complications and daily changes. A thread.

70 year old male presented with hypoxic respiratory failure. Initially diagnosed with bilateral pneumonia and started on zosyn. Very hypoxic requiring 15L. The following morning #pocus revealed:

Large bilateral pleural effusion a with compression atelectasis. Clinically was never pneumonia. Was upgraded to ICU and intubated. R sided thoracentesis drained 1.8L of fluid and was stepped out of ICU

The following morning lung #pocus exam done. Left lung: lung sliding with diffuse lung rockets consistent with pulmonary edema

Left lung M-Mode: Sandy Beach sign consistent with normal lung sliding

R lung anterior: A lines present but NO lung sliding

M- mode of R lung: barcode sign consistent with pneumothorax.

Couldn't find lung point so got CT to confirm:

This was a clear and excellent example of how #pocus helps patients and saves them from complications. This patient had other reasons to be hypoxic so pneumothorax was not on the differential initially. But post thoracentesis this is always a concern.

@Wilkinsonjonny

@Wilkinsonjonny @iceman_ex @NephroP @nickmmark @nilamjsoni @DRsonosRD @TaotePOCUS @POCUS_Society @POCUSAcademy @POCUS_Manifesto

@POCUS_Manifesto

A lot more about lichtenstein and his early pneumothorax studies in our book the @POCUS_Manifesto on Amazon! amazon.com/POCUS-Manifest…

#POCUS #foamed #meded #criticalcare #echofirst

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More from @pocusmeded

POCUS Med Ed

@pocusmeded

Dec 4

This is jugular venous distension (JVD) seen with #POCUS. But how can we quantify it at the bedside?

Using the Istrail Method described in The POCUS Textbook, we can estimate the actual right atrial pressure to within about 3 mmHg.

#foamed #meded #Medtwitter #cardiotwitter
@nephrop @IM_Crit_ @pocuspeek

Once JVD is discovered, the next step is to slide the probe up the neck to find the collapse point. The vertical distance from the base of the neck to the collapse point is measured. This can best be done at the bedside using your outstretched fingers.

Measure and memorize the height of your outstretched fingers, and this can act as your bedside ruler.

This will give you the pressure in centimeters of water of the visible portion of the jugular vein.

Next, we must measure the right atrial depth, the distance from the chest wall down to the center of the right atrium.

@dr_larryi showed that this can be done at the bedside by measuring the depth of the posterior wall of the left ventricular outflow tract.

Read 5 tweets

POCUS Med Ed

@pocusmeded

Mar 1, 2024

Chest x-rays miss up to 60% of lung consolidations. Especially if they are retro-cardiac.

#pocus misses about 5% if you do a full exam.

Here is a good example with a corresponding left lower posterior lobe ultrasound taken with @ButterflyNetInc IQ3

Chest X-ray was clear but pocus shows DENSE left lower lobe consolidation with static air bronchograms!

Here is the same consolidation 3 days later after antibiotics via the @ButterflyNetInc IQ3 again:

It has shrunken considerably! #pocus is far better than chest X-ray for lung pathology. And it allows for daily evaluation to note disease process response to treatment!

For more on #pocus and lung ultrasound are @POCUS_Manifesto

a.co/d/8SXAH07

Read 6 tweets

POCUS Med Ed

@pocusmeded

Mar 9, 2023

Reason # 76587 why lung #pocus is important: it can often give more information than CXR or CT Chest can. Case in point:

Elderly female on methotrexate and prednisone presenting with fever and cough.

Initial CXR:

Read as "Bibasilar atelectasis." She was started on antibiotics. The following morning had abdominal pain and CT chest abdomen and pelvis ordered. CT chest seen here:

Grossly does not look too impressive. Radiologist read it as "no consolidations, scattered linear opacities." That afternoon seen by a physician skilled in lung #pocus. Left lung lateral lung seen here

Read 10 tweets

POCUS Med Ed

@pocusmeded

Dec 17, 2022

Reason # 67543 why #pocus is important: sometimes mild symptoms are a sign of impending disaster.

41 year old thin athletic male presented to the hospital with a few weeks of mild shortness of breath with exertion.

BP 170/70, HR 100. CXR with cardiomegaly, tortuous aorta.

Bedside #pocus exam shown below:

Most glaring is the size of the aorta. It is clearly larger than the left atrium. Also notable is the anterior leaflet of the mitral valve isn’t opening much.

Read 9 tweets