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POCUS Med Ed

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

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

Mar 1

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