Ernest Fischer Profile picture
#Hospitalist | APD | #POCUS | #CCeEXAM | Proceduralist | Allan J. Goody Bedside Medicine Series | Medstar Georgetown University Hospital Internal Medicine
12 Nov
1/ #tweetorial
⮞Optic disc edema vs. Papilledema
⮞Orbital anatomy
⮞Orbital #POCUS
2/ First what is 𝗽𝗮𝗽𝗶𝗹𝗹𝗲𝗱𝗲𝗺𝗮?

𝘐 𝘸𝘪𝘴𝘩 𝘐 𝘤𝘰𝘶𝘭𝘥 𝘨𝘦𝘵 𝘪𝘮𝘢𝘨𝘦𝘴 𝘭𝘪𝘬𝘦 𝘵𝘩𝘦𝘴𝘦...
[source bit.ly/3yceeCT]
3/ 𝗢𝗽𝘁𝗶𝗰 𝗱𝗶𝘀𝗰 𝗲𝗱𝗲𝗺𝗮 = optic nerve head edema + anterior bulging of physiologic cup

𝗣𝗮𝗽𝗶𝗹𝗹𝗲𝗱𝗲𝗺𝗮 is optic disc edema 𝙙𝙪𝙚 to 🡱intracranial pressure

**𝗡𝗼𝘁 𝗮𝗹𝗹 𝗼𝗽𝘁𝗶𝗰 𝗱𝗶𝘀𝗰 𝗲𝗱𝗲𝗺𝗮 𝗶𝘀 𝗽𝗮𝗽𝗶𝗹𝗹𝗲𝗱𝗲𝗺𝗮 [bit.ly/3wEIUwG]
Read 13 tweets
23 Jun
1/ Volume Assessment… … is hard

Physical exam for hypovolemia, a thread
2/ Is the above patient?
3/ What do we mean by “𝗱𝗿𝘆”? By 𝘃𝗼𝗹𝘂𝗺𝗲 𝘀𝘁𝗮𝘁𝘂𝘀?

𝗗𝗲𝗵𝘆𝗱𝗿𝗮𝘁𝗲𝗱 is often ~ hypertonicity / intracellular volume contraction

𝗩𝗼𝗹𝘂𝗺𝗲 𝗱𝗲𝗽𝗹𝗲𝘁𝗶𝗼𝗻 is ↓extracellular volume w/ blood volume contraction
bit.ly/3d1GWhh
Read 14 tweets
16 Apr
1/ More 3D #POCUS models for educators + beginners! (𝗰𝗼𝗻𝗰𝗲𝗽𝘁𝘂𝗮𝗹𝗶𝘇𝗲 > memorize)

𝗔𝟰𝗖 and 𝗦𝗖 views
Major chambers in these 4C views:
➣LA
➣LV
➣RA
➣RV
2/ Deconstructing the 𝗔𝟰𝗖 view:

• The 𝗽𝗿𝗼𝗯𝗲 𝗺𝗮𝗿𝗸𝗲𝗿 𝗶𝘀 𝗼𝗻 𝘁𝗵𝗲 𝗥𝗜𝗚𝗛𝗧, or oriented toward the LA/LV relative to RA/RVx
• The top of the screen (𝗔𝗽𝗲𝘅) 𝗶𝘀 𝗰𝗹𝗼𝘀𝗲𝘀𝘁 to the probe and
• Atria are furthest
3/ With those constraints one can determine general 𝗔𝟰𝗖 probe location

• Probe marker ~3 o’clock (𝘶𝘴𝘶𝘢𝘭𝘭𝘺 2:30)
• ~5rd IC space
• ~Midclavicular line (𝘢𝘭𝘵𝘩𝘰𝘶𝘨𝘩 𝘗𝘔𝘐 𝘢𝘯𝘥 𝘢𝘱𝘦𝘹 𝘢𝘳𝘦𝘯'𝘵 𝘢𝘭𝘸𝘢𝘺𝘴 1:1)
• Probe tilted to head
Read 9 tweets
22 Feb
1/ Basic #CadiacUS models (color coded / labeled) for Educators or Beginners

At least 2 options when learning any #IMPOCUS – memorize or 𝗰𝗼𝗻𝗰𝗲𝗽𝘁𝘂𝗮𝗹𝗶𝘇𝗲.

Both will get you there but IMO the latter allows for taking next step into advanced imaging…
2/ This is especially true in Cardiac POCUS – 4 basic views, but actually so many more. #ECHOFirst

Firm understanding of anatomy and spatial relationships is key!

➣Note axis of the heart
➣𝗥𝗩 the most 𝗮𝗻𝘁𝗲𝗿𝗶𝗼𝗿 structure
➣𝗟𝗔 the most 𝗽𝗼𝘀𝘁𝗲𝗿𝗶𝗼𝗿
3/ #PLAx is 𝙏𝙃𝙀 view to learn, if any

Major chambers in view
➣LA
➣LV
➣Aorta
➣RV(OT)
Read 9 tweets