Greatly enjoyed launching our @MGH_PCCM@HarvardPulm didactic critical care echo curriculum with LV Assessment - Beyond the Eyeball!
Assessing LV function isn't as simple as it sounds.
Take home messages for POCUS learners below ⤵️: #POCUS#Echofirst#Medtwitter#PCCMTwitter
👀The oft-invoked 'eyeball' method is a deceptive oversimplification. You can't suddenly accurately assess LV function just because you're told to!
You need to train your eye to look at other quantifiable measures of LF function - even if you won't actually measure them. 🧐
Sure - make your best guesstimate of EF. But also look at:
1⃣myocardial thickening
2⃣myocardial excursion
3⃣annular excursion/MAPSE
4⃣fractional shortening +/- fractional area change
5⃣EPSS
You don't have to actually measure these, but you can't 'see' them if you don't know them!
💡My suggestion: Go ahead and actually learn how to measure these, and do each one 10+ times. You will train/refine your eye to accurately eyeball the next one. The more you do, the more subtle differences you'll be able to pick up. It's surprisingly easy to learn!
Can follow if interested in basic-intermediate POCUS content. Intend to be sharing highlights/takeaways from all our critical care lectures/conferences this year!
Critical care echo* lectures. Important qualifier.
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🚨 A case of bactrim-associated ARDS!
BUT its backstory is one of sadness, selflessness, intrigue, sleuthing, clinical acumen, multidisciplinary collaboration, and most importantly, collaboration with patients and families themselves, led by @JennaMillerKC et al. #Medtwitter
It's a tale and disease perhaps ultimately worthy of discussion in the medical historical annals of @AvrahamCooperMD@tony_breu@AdamRodmanMD.
But more importantly, worthy of widespread dissemination for broad awareness, rapid identification and management, and further research.
This harrowing, bone-chilling, terrifying, powerful account of a present day, ongoing, Holocaust while the United States participates in the Beijing Olympics eerily parallels its participation in Berlin's 1936. We must learn from our recent mistakes and act now.
This piece reads as play-by-play a reenactment of the stories I learned about my grandparents and friend's families in the Holocaust. Acceptance of a progressively more racist and genocidal state. "It's not that bad", "it can't get worse", "our whole life is here".
Conjured optimism about future improvement. Hushed tones about the present. Frequent disappearances. Sleeping in clothing anticipating a nighttime arrest, public humiliation, before being sent to a concentration camp.
Session 1: Systematic Approach to Interpreting CT Chest led by Dr. Suhail Raoof!
FOMO? See: Algorithmic Approach to the Interpretation of Diffuse Lung Disease on Chest CT Imaging in @journal_CHESTjournal.chestnet.org/article/S0012-…
@journal_CHEST ⭐️ The secondary pulmonary lobule is your friend in teasing apart the lung parenchyma and defining where a disease process, anatomically, is taking place
⭐️ Hard to make them out? Start at the periphery
The more you understand, the less you need to memorize. Take this 🫀 example:
Severe AR and MR are both defined by a regurgitant volume of 60mL. YET, another criterion, effective orifice area, must be 0.3cm^2 for AR but 0.4 for MR.
I kept mixing up which is 0.3 and which is 0.4. We can keep trying to memorize this, or ask why? Why is the regurgitant volume the same, but the effective regurgitant orifice area (EROA) different?
Here's the pearl:
It's because AR occurs in diastole, MR occurs in systole, and diastole is longer than systole. Therefore, in diastole, a smaller EROA (0.3) can generally yield the same 60mL of regurgitation as a larger EROA (0.4) can during the shorter systole.
Excited for our upcoming Case of the Year Presentation by Drs. Hilary Zetlen and @tpeck_86, "Under Pressure: Trading One Problem for Another". Will be live-tweeting the case (to the best of my ability) below so you can follow along!
First, to address the elephant and 44% who correctly say this is generally impossible: Normally, you *cannot* increase O2 sats by adding Hg, bc sats refer to the saturation of Hg. Adding Hg doesn’t enable the lungs to saturate the new Hg any more than all the Hg it had before.
But unlike "real"/"native" lungs (let’s assume they are completely non-functional here), which all the blood must pass thru, when a pt is on ECMO (an artificial or “membrane” lung), some blood goes through the ECMO circuit, but some blood doesn’t, and that’s where the fun begins.