60 y/o ♂️ w/ ischemic heart disease & severe biventricular dysfunction. Aborted VT/VF 3x ICD shocks. Initial shock & multiorgan failure. Na 124, Cr 1.5, AST 679, ALT 765, Tbili 2.6. Una < 5mmol/L. TTE unchanged from baseline. #POCUS #vexus
What do you think is his central venous pressures based on the the IVC evaluation. Patient spontaneously breathing?
This is a very common mistake, either by tilting the transducer or getting off axis during respiratory effort. The cylinder effect is related to oblique plane insonation.
Both IVC are plethoric despite diuresis of more than 12 liters, resolution of respiratory distress and severe orthopnea. Resolving kidney and liver injury with Cr of 1, Na 133, AST 69. IVC & RAP( direct &surrogates) limitations! 
#VExUS. Clinical resolution of decompensated heart failure and organ injury, IVC remains unchanged. Let’s look at Hepatic veins & portal vein. Hepatic systolic flow reversal resolves. PV normalization to continuous flow. Same with IRV (not shown). Initial L & after R.
You can also see color flow normalization with antegrade (blue) flow restoration during systole.
If you want to understand non-invasive hemodynamics and VExUS in #MedTwitter . Learn from the best @ThinkingCC @ArgaizR
@curromir @khaycock2 @MDBeni @msenussiMD @sohn_jackie @Jose_Diaz_Gomez @vladdieiev
@curromir @khaycock2 @MDBeni @msenussiMD @sohn_jackie @Jose_Diaz_Gomez @vladdieiev
I Forgot @NephroP 😮😮😮
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