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NephroPOCUS

@NephroP

Aug 9

Cardiac tamponade on #POCUS #echofirst
Click on 'ALT' for description
#MedEd #IMPOCUS #Nephrology
From 🔗pubmed.ncbi.nlm.nih.gov/32572594/

Mitral inflow Doppler and LVOT VTI in tamponade.
'ALT' for description
#POCUS #echofirst #MedEd

Pulsus paradoxus: during inspiration, right heart filling occurs at the expense of the left, so that its transmural pressure transiently improves & then reverts during expiration (Ventricular interdependence). Seen as 👆on #POCUS

Read 5 tweets

NephroPOCUS

@NephroP

Jun 8

#POCUS #MedTwitter #Nephpearls
Many #VExUS enthusiasts asked for a #tweetorial on image acquisition pearls. Did one b4 but time for an updated one 🧵

#1 Let's start with basics
Color Doppler identifies the flow + tells the direction (blue is away & red towards the probe [BART])

#2 👆BART holds good unless u invert the scale.
👇Pulsed wave Doppler (PWD) depicts blood flow at a certain point (sample volume) - we analyze the pattern of flow + velocity using this mode.
Above-the-baseline = flow towards the probe (like red on color)
Below = away (like blue)

#3
While performing any Doppler study, it's important to keep in mind that the angle between US beam & blood flow determines the accuracy of velocity displayed. Parallel = best, perpendicular = worst
As #VExUS does not rely on absolute velocities, its OK not to have perfect angle

Read 28 tweets

NephroPOCUS

@NephroP

May 27

@khaycock2

#POCUS #VExUS consult for #hyponatremia. Elderly pt with h/o mitral valve replacement. On Bumetanide, UNa ~70 mmol/L, Uosm ~250🧵
Trace edema, JVD +, feels OK
Calling hemodynamic friends @khaycock2 @ThinkingCC @ArgaizR @msiuba @IM_Crit_ @MDBeni @siddharth_dugar Educate us!
1/ IVC

2/ 👆Consistent with elevated right atrial pressure.
👇Hepatic vein #VExUS
D-only pattern (rhythm: ventricular paced)

3/ Portal vein #VExUS
Doesn't look bad

Read 12 tweets

NephroPOCUS

@NephroP

May 25

#POCUS #echofirst quiz:
In this PLAX view, what structure does the arrow indicate? + what's abnormal about it (if any)?
Clinical: 71y pt with fever/cough, initially thought to be pneumonia, later developed chest pain. BP 134/83 Pulse 106
Will post the answer/source tonight
#MedEd

Tweet 1/3
Answer:
Dilated coronary sinus with a mobile echogenicity (vegetation/infective endocarditis in this case)
Full case: 🔗ncbi.nlm.nih.gov/pmc/articles/P…
From #POCUS standpoint, 2 main causes: persistent left superior vena cava & pulmonary HTN. This pt had the former.

2/3
Normally on PLAX view, coronary sinus is barely visible. But when dilated, it can be confused with descending aorta (esp. by users who never encountered this scenario)

Read 4 tweets

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

Looks like #POCUS ologists are in a mood to revive old #VExUS posts and tweetorials today.
Let me re-share the VExUS flash card(s) 🧵
1. VExUS grading live card
#MedEd #IMPOCUS