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Mohammed Megri. MD Profile picture
@MegriMohammed
Jun 2, 2022 • 13 tweets • 5 min read • Read on X
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Another Pt with HFrEF < 20%, and AKI on GDMT and 40 mg Lasix BID on PE he has Bil LE 2+ edema, no respiratory distress. Would you just increase his Lasix or work on improving his LV contractility, afterload with keeping the same preload control?
@POCUS_Society #POCUS, #CriticalCare @accpchest
Sorry intrarenal Doppler wasn’t good because of multiple renal cysts!

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More from @MegriMohammed

Mohammed Megri. MD Profile picture
Apr 17, 2023
This topic is very important, and controversial. Intermediate high risk PE is tough, as the mortality benefits evidence of CDT compared to AC alone its not strong, Therefore, I believe PERT is very helpful.
A large meta-analysis showed the mortality of Submassive (Intermediate high risk) PE is 2.8% and other study showed the mortality ranges from 1.8-10%.
We are dealing with Pts in the red circle 🔴 (before shock but more than low risk) Image
Evidence showed patients in intermediate high risk PE they might be in normotensive shock 20-40% of these patient can have low cardiac index < 1.8 Image
Read 12 tweets
Mohammed Megri. MD Profile picture
Jan 7, 2023
How do you titrate your PEEP in moderate to severe ARDS Patients?
2004 alveoli trial
DOI: 10.1056/NEJMoa032193
549 Pts.
TV ~ 6 ml/kg
Pplat (24-27)
Low PEEP 8.3±3.2 cmh2o (death 24.9%)
High PEEP 13.2±3.5 cmh2o (death 27.5%)
Result= no significant difference between high or low PEEP Image
2008 ~ LOVS trial
JAMA. 2008;299(6):637-645
983 PTs
TV ~ 6 ml/kg
CG: Pplat<30, low PEEP mortality 40.4%
IG: Pplat <40, high PEEP ~ mortality 36.4%

The high PEEP group had lower rates of refractory hypoxemia (4.6% vs 10.2%) ImageImage
Read 22 tweets
Mohammed Megri. MD Profile picture
Nov 17, 2022
GOLD international COPD conference

The conference was great

What’s new? Image
Definition;

COPD is a Heterogenous lung condition characterized by chronic resp symptoms due to abnormalities in the airway (bronchitis, bronchiolitis, emphysema) that cause persistent airflow obstruction
(2018 def in the pic) Image
This is very important ⬇️⬇️ Image
Read 12 tweets
Mohammed Megri. MD Profile picture
Sep 22, 2022
65 yo/f with PMH of recently diagnosed SCLC s/p chemotherapy last session 1 month before presentation who was presented to the ER due to worsening SOA, Cough and after evaluation found to be tachypnic and tachycardiac
CXR showed mild enlargement of the cardiac shadow, obliteration of the right CP angle and bilateral central reticular pattern suggestive of pulmonary edema. Right mediport. Image
POCUS:
PSLX
Read 14 tweets
Mohammed Megri. MD Profile picture
May 31, 2022
🤯🤯 The plan was written (stop Lasix for 2 days and then re-evaluate) their rational is the patient is clinically dry and his creatinine is up?!!!!!!!!😓 these images was taken while Pt on Debutamin
Read 10 tweets
Mohammed Megri. MD Profile picture
Jul 24, 2021
Thank you for your response. As you can see, it's spread out almost equally.

Heart-lung interaction is critically important to understand;

The heart & lungs occupying the thoracic cavity, therefore, Pr changes inside the thoracic cavity can affect the venous return (Vr)
Transmular pressure is the pressure difference between the inside & the outside of the cavity i.e the RA transmural pressure = RA-Ppl(We are assuming the pericardium is normal)

Then venous return depends on volume, pleural pr (Ppl), RA pr, transmural pr, elasticity & compliance Image
During spontaneous breathing 😮‍💨 Ppl always negative, but during inspiration it is more negative than expiration. Due to the increase in the thoracic cavity size

The Pr changes can affect the Vr and the effect will be more pronounced if the Pt is dry & fluid responsiveness Image
Read 10 tweets

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