2⃣ Optimize the PLAX for the LVOTd. Sometimes I find that too much "optimization" actually makes it harder. Just know your options and do what works with your patient.
3⃣ Understand Doppler physics. Specifically PWD for this one. Recognize how the angle of insonation AND the angle of flow relative to the probe, affects your measurements.
4⃣ Get that VTI - properly! Angle adjustments are eh. At best they correct for one dimension, and not really for your angle of insonation. Not ideal, but if you must.
5⃣ Finally - mind the pitfalls, in both acquisition & interpretation. Being off angle can only underestimate VTI, but overtracing can overestimate.
Anything else you'd like to see or add? Comments always welcome!
This window is attainable only via a transESOPHAGEAL echo (TEE).
Point-of-care TEE is used widely in SICUs worldwide, and MICUs outside the US. You can expect to see them increasingly in US MICUs over the next decade. (2/8)
By viewing the heart via the esophagus, windows are often much crisper than when fighting with rib shadows, edematous lungs, and often bandages/wounds (esp. in surgical patients) on the chest. (3/8)
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!
🚨 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.