Thread, 1/n - Male 75. Acute dyspnea since 1 hour, can't talk, wheezy. SPO2 75%. No previous record. "All that wheezes is not asthma". #POCUS leaves no doubt about pulmonary edema, Dx while patient is being attached to monitor.BP 180/110 mmHg.
2/n CPAP 10 mmHg, IV infusion of nitrate being prepared. Pectus excavatum, parasternal long axis impossible from usual 3/4 ICS. But Apical 4 chamber suggests mild LV systolic dysfunction
3/n As I was about to bolus nitrate 500 mcg - BP drops from 180/110 to 120/70 mmHg. Patient improving with CPAP. So I hold the bolus and try to get more cardiac views. Patient upright plus pectus excavatum, thus not the best quality, but aortic valve appears calcific.
1/n #POCUS as a part of ED evaluation for first episode of atrial fibrillation (this demographic has significant prevalence of rheumatic heart disease) - appears grossly normal - moving on to other views...
2/n Apical 4C also grossly normal....
2/n but as probe swept caudally from A4C .. what’s that in RA?
1/n #POCUS M/68, vomiting since 6 hours, back pain since 1 h. Says no to chest pain /abd pain / dyspnea. Diaphoretic, vomiting, HR 90, RR 24, BP 128/70, SpO2 91% (air). Reduced BS left side, Abd distended, nontender. ECG normal. Is it acute aortic? Tried to get PLAX heart -
2/n - scanning right parasternal area - found the heart - hyperdynamic, but nothing grossly wrong there.
3/n #POCUS Another look at left hemithorax anteriorly (parasaggital plane, mid-clavicular line, 4th. ICS)
Thread 1/4 - #POCUS Case - MPA+bilateral PE. HR 110, BP 94/68, Sats 98% room air. Subjectively, patient feels well, no dyspnea/pain. Warm skin. Shifted to EM Resus. Lytic or not? Young pt, no known co-morbids / provocation.
#POCUS case - F/80. Known mesenteric stenosis (celiac origin, and SMA). Has upper abdominal pain off and on - ? mesenteric angina. Now presents with severe upper abdominal pain. Tender+++ epigastrium, no peritonism. Normal GB ultrasound and lipase. Lactate 0.4. Previous CT:
Epigastric tenderness and normal lactate argue against acute mesenteric occlusion. #POCUS - SMA origin
Thread - (1/n) #POCUS findings in Left Main coronary occlusion.. this is not a STEMI - its WORSE ! M/50, 12 h intermittent chest pain. 2 hours of constant chest pain. Normal BP, no rales... but.. ECG horrible.
Thread - (2/n) #POCUS findings in Left Main coronary occlusion
Thread - (3/n) #POCUS findings in Left Main coronary occlusion: Cardiology fellow seeing patients .. they (and I) can't appreciate any rales.. but this is how lungs appear all over anteriorly
Patient referred for arthrocentesis, suspected septic arthritis. #POCUS shows triceps abscess, NO effusion. Aspiration attempt could have contaminated the joint & CAUSED septic arthritis. Consider scanning before sticking any needles.
#POCUS image (transverse probe orientation in suprapubic region) in a 20 year old lady (language barrier++) with history of lower abdominal pain and recurrent vomiting since 20 days. Pregnancy test negative. Exam - fullness in lower abdomen, tenderness, no peritonism.
#POCUS appearance of pneumoperitoneum (thread) - appreciate how normally abdominal wall, peritoneal line and intraperitoneal structures can be appreciated
Pneumoperitoneum causes peritoneal line to be enhanced, and gas scatter beneath means intraperitoneal structures can't be seen. Instead, reverberation artefacts from peritoneal line - similar to pleural A-lines - can be seen.
#POCUS at borderzone of pneumoperitoneum can show "peritoneal point" (cf. lung point in pneumothorax)
#POCUS in cardiac arrest - keep probe on prior to pulse check pause - avoid delays searching for window - to minimize duration - and record a 3 sec loop which can be analyzed later. (thread)
(continued) this is what image looked like at pulse check - Dilated RV with septum bowing towards LV - should we give fibrinolytic for possible pulmonary embolism?
#POCUS is just a data point - in overall clinical context - additional data - this was a out of hospital VF arrest. With PE - we would expect a PEA arrest. Moreover, no risk factor for PE - and in fact, patient is on long term warfarin for AF - a "negative risk factor" for VTE?
Male/37. Fever 39 with cough and runny nose. Wheezy, HR 124, RR 30, sat 88% on air. Comments? ( the "season" has started! ) #POCUS
"Figure 8: Transverse thin-section CT scan at the level of the bronchus intermedius in a patient with influenza A virus shows ill-defined centrilobular nodules (arrows). Peripheral subpleural consolidation in the apical segment of left lower lobe"
Absence of consolidation (“hepatization” with air bronchograms) with #POCUS showing sub pleural consolidation supports diagnosis of viral pneumonia