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Aug 22 β€’ 22 tweets β€’ 18 min read
Time to update the #VExUS resources pinned thread πŸ§΅πŸ“Œ
1/ Tweetorial on image acquisition.
#POCUS #MedEd
2/ The original #VExUS paper
theultrasoundjournal.springeropen.com/articles/10.11… Image
3/ Review article on #VExUS by @nephrothaniel and me in @KidneyMed
πŸ”—kidneymedicinejournal.org/article/S2590-… Image
4/ Review article by @ArgaizR in ACKD
πŸ”—ackdjournal.org/article/S1548-… Image
5/ #VExUS flash cards (static and live ones in this post)
πŸ”—nephropocus.com/2021/10/05/vex…
6/ Conceptual review of #VExUS by the all-star team of authors @ThinkingCC @WBeaubien @ArgaizR @curromir @khaycock2 and colleagues
πŸ”—ncbi.nlm.nih.gov/pmc/articles/P… Image
7/ Our #VExUS friends discuss the emerging concept of fluid tolerance
πŸ”—sciencedirect.com/science/articl… Image
8/ @katiewiskar and team's excellent review on the role of #POCUS #VExUS in fluid-related decisions
πŸ”—sciencedirect.com/science/articl… Image
9/ Brief overview of #POCUS in AKI that presents an illustrative case of #VExUS guided monitoring of congestion.
πŸ”—karger.com/Article/FullTe… Image
10/ Tweetorial discussing the rationale/evidence behind #VExUS
11/ Some other pertinent reviews from our team
πŸ”—kidney360.asnjournals.org/content/kidney…
πŸ”—wjgnet.com/2220-3141/full… Image
12/ Now some videos
1st one for our Spanish friends
@ArgaizR on #VExUS for @HunPocus
πŸ”— Image
13/ Two more videos in Spanish by @ArgaizR
πŸ”—
πŸ”— Image
14/ The OG @ThinkingCC gives a masterclass on #VExUS for @HunPocus
πŸ”— Image
15/ Two videos by me - one short and the other one ~45 min
πŸ”—
πŸ”—
#VExUS #POCUS Image
16/ Excellent video by @curromir (in English)
πŸ”—vimeo.com/720642428 Image
17/ One of the early #VExUS videos by @katiewiskar
Simple and sweet!
πŸ”— Image
18/ Simple and clear #VExUS video by 'Segs and Jonny'
@iceman_ex @Wilkinsonjonny
πŸ”—
#FUSIC Image
19/ I intend to keep the thread shorter this time by avoiding individual cases but here are a couple of must-know traps
20/ Is it always the hepatic S-wave that reverses?
Read these thought process refining cases from @ArgaizR
πŸ”—
πŸ”—
21/ couple of interesting #VExUS case studies illustrating the dynamic nature of these waveforms
@kosmosplatform webinar
πŸ”— Image
22/ A must-know cause of hepatic D-reversal
*Use simultaneous EKG whenever possible

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More from @NephroP

NephroPOCUS Profile picture
Aug 22
#POCUS quiz for #VExUS enthusiasts.
Image obtained from a patient with heart failure with preserved EF. IVC 1.9 cm with 30% inspiratory collapse.
Here is the intra-renal image. Interpretation of the venous waveform?
POLL in thread πŸ‘‡
#MedEd #Nephrology Image
πŸ‘†#POCUS
S = systolic venous wave
D = diastolic venous wave
@khaycock2 @ArgaizR @msenussiMD You'll like it (I know u know the answer 🀫)
Read 4 tweets
NephroPOCUS Profile picture
Aug 20
CVP waveform - a variant of #VExUS #POCUS
Tracings obtained from a 38-year-old female with severe aortic stenosis and mild pulmonary hypertension who underwent aortic valve replacement. What's the difference from pre to post-op?
Se thread for answer and source.
#MedEd
ncbi.nlm.nih.gov/pmc/articles/P…
Read 4 tweets
NephroPOCUS Profile picture
Aug 9
Cardiac tamponade on #POCUS #echofirst
Click on 'ALT' for description
#MedEd #IMPOCUS #Nephrology
From πŸ”—pubmed.ncbi.nlm.nih.gov/32572594/ Two-dimensional (2D) and M-mode echocardiographic signs of p
Mitral inflow Doppler and LVOT VTI in tamponade.
'ALT' for description
#POCUS #echofirst #MedEd Respiratory variations in flow velocities by spectral Dopple
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 πŸ‘†on #POCUS
Read 5 tweets
NephroPOCUS Profile picture
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 πŸ‘†BART holds good unless u invert the scale.
πŸ‘‡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 Profile picture
May 27
#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/ πŸ‘†Consistent with elevated right atrial pressure.
πŸ‘‡Hepatic vein #VExUS
D-only pattern (rhythm: ventricular paced)
3/ Portal vein #VExUS
Doesn't look bad
Read 12 tweets
NephroPOCUS Profile picture
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: πŸ”—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

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