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NephroPOCUS

@NephroP

Apr 19

One of my favorite topics in #POCUS - various effusions seen from different sonographic windows.
Here is a thread 🧵with labeled images for those interested.
1. PLAX view - pericardial effusion - anterior to descending aorta ⚫️below LA), wedge shaped
#MedEd #IMPOCUS #Nephpearls

2/ PSAX papillary muscle view
LV is think as many of my patients have #CKD and LVH (as well as mitral annular calcification seen on PLAX view above)
#Nephrology #POCUS

3/ Apical 4-chamber view
Sometimes, effusions may be missed due to inadequate visualization of ventricular free wall/lung interference. Always pay attention to the RA area
#POCUS

Read 22 tweets

NephroPOCUS

@NephroP

Apr 18

@Rajiv_Sinanan

@Rajiv_Sinanan @ThinkingCC 1/ Real reason(s) based on my conversations with people from different backgrounds:
Private practice: "#POCUS sounds interesting but I ain't got time for that. Will consider if I get compensated"
Academia: (not generalizing but most places)
Emphasis is on funded research

@Rajiv_Sinanan

@Rajiv_Sinanan @ThinkingCC 2/ Clinical faculty are hired for clinical duties, outreach dialysis etc., which is fair but the problem is educational endeavors are rarely rewarded/provided with protected time. Faculty who want to be #POCUS champions must first learn it (either from institutional experts or

@Rajiv_Sinanan

@Rajiv_Sinanan @ThinkingCC 3/ external courses), then integrate into curriculum, take care of administrative stuff/image archiving, prepare didactic material etc., which consume a lot of time and effort. Without dedicated protected time, its almost impossible to continue the initial enthusiasm.

Read 8 tweets

NephroPOCUS

@NephroP

Feb 17

Small thread 🧵illustrating #POCUS based hemodynamic assessment. Relatively a classic case of pulmonary HTN and right heart failure but would like to get some insights from the experts.

1/ Parasternal long axis (PSAX) showing D-sign
#VExUS #MedEd #Nephpearls #IMPOCUS

2/ Parasternal long axis (PLAX) view demonstrating RV dilatation.
One of the three musketeers is big. Don't know what I'm talking about? Here is a brief reminder: 🔗nephropocus.com/2021/07/12/the…
(Mobile thing in the RVOT is PA catheter; M-mode quiz from this morning is actually this)

3/ Apical 4-chamber view #POCUS
Note how RV is dilated - bigger than LV and forming the cardiac apex.
Inter-atrial septum is bowing to the left indicating high right atrial pressure (not unexpected).

Read 21 tweets

NephroPOCUS

@NephroP

Jun 29, 2021

#Nephrology #POCUS short story:
1/ Simple case, want to remind some pitfalls in routine practice.
There was a patient with orthostatic hypotension. Likely neurogenic secondary to amyloidosis.
Read the thread 🧵below:
#IMPOCUS #MedEd mini #tweetorial

2/ Physician A orders IV albumin q 6 hours and keeps continuing because:
1. 'Formal' echo from 4 days ago reported a RAP of 3 mmHg = not high
2. 'Documented' weight showed 3 kg drop since admission
Interestingly, documented cumulative fluid balance is +4 L!

3/ Physician B comes in and performs physical examination (#POCUS). Supine BP is relatively low (SBP ~103 mmHg) but nothing different compared to patient-reported figures at home. Pt feels OK, on midodrine.
Here is the IVC👇

Read 9 tweets

NephroPOCUS

@NephroP

May 26, 2021

1/How can #POCUS #echofirst help in the evaluation of #hyponatremia?
#Nephrology consulted for low sodium. Pt received diuretic for shortness of breath (which was possibly due to hiatal hernia as shown on CXR).
2 physicians FELT patient was EUVOLEMIC
Small 🧵below 👇 #MedEd

2/Based on the above labs, it does look like euvolemic hyponatremia (Urine Na is high, Uosm >100 but not too high, BUN not high). BP was 150s systolic.
That's it? Give some salt tablets or UreNa etc.?
No; perform PHYSICAL EXAM (= #POCUS)
IVC was small - doesn't tell much 😬

3/ Next step? Look at the heart, assess stoke volume.
Recent echo LVEF>50%
LV contraction looks good visually
We measured LVOT VTI (couldn't measure LVOT diameter due to chest deformity precluding good PLAX view but its not a problem; VTI is generally enough)
#POCUS

Read 10 tweets

NephroPOCUS

@NephroP

May 19, 2021

Time to discuss some rationale/evidence behind doing #VExUS #POCUS #Nephrology
A short #tweetorial #MedEd 👇
1/ Is fluid overload harmful?
of course yes. Here is a recent meta-analysis.

2/ Does fluid administration affect renal venous flow in asymptomatic but vulnerable patients (#heartfailure)?
#POCUS #VExUS

3/ In fact, elevated CVP is associated with reduced GFR.
This 👇is a study in outpatients undergoing right heart cath (N = 2557). In CVP values >6 mm Hg, a steep decrease in GFR was observed.

Read 18 tweets

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