Thread by @IM_Crit_

ICU POCUS snippets: A bit of context: An elderly patient with hx of DM2 / HTN / HLD / peripheral vascular disease / ureteral stent & recurrent UTIs is admitted to the hospitalists’ service w diffuse abdominal pain, nausea & vomiting. Treated for a few days w antibiotics...

...but never really felt any better (weak/abd pain). Eventually, became hypotensive & was transferred to the ICU for “initiation of vasopressors”. Phys exam: diffuse abd tenderness. Formal echo earlier that day: "Normal LV/RV in size and systolic function". ICU POCUS was done...

...to gain more information regarding the cause of the abd pain and the hemodynamic picture. Some of the clips are shown here:

What is this 👆?

This is actually the pulmonary artery bifurcation. Sometimes u can even see a saddle pulmonary embolus sitting there... We usually get this view from the parasternal short axis at the AoV level aiming a bit higher. Here we were lucky to get it from a poor parasternal long axis:

It is not always as clear as in this case but, if it is, you can interrogate w color Doppler and PW/CW separately each one of the PA branches (R - L):

PW Doppler in one side:

Sometimes you can see different PW profiles in the 2 branches... 👇 👇

PW Doppler focusing on the other side:

How is this 👆Doppler profile of the PA artery called? @khaycock2 has a great talk on this

Yes, I know, you are wondering how all these clips changed patient's management. They didn't, mainly because a "goals of care" discussion shifted the focus of our efforts. Next time they will. And, wouldn't it be nice to make our practice less boring?

Thanks for reading!

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