Hi #Medtwitter: Our 7th Critical Care US Lecture is available!

"Clot or not? US for Lower Extremity DVT Assessment"

Brief 🧵with pearls as usual, video link at the end⤵️ (1/7)

Part of the ongoing @HarvardPulm @MGH_PCCM @PCCSM_BIDMC course! Why do you care?

Bc despite DVT ppx, 10% of ICU pts still get proximal lower extremity DVTs.

US has been the gold standard for DVT diagnosis since 1989, when a simple 2x2 sens/spec table made it to NEJM.

You can accurately perform these yourself with minimal training! (2/7)

Such a privilege to hear @Jose_Diaz_Gomez discuss the forefront of POCUS for RV assessment.
Thank you @MGHanesthesia @JuanGRipoll1 for hosting and inviting @MGH_PCCM @HarvardPulm!
Top 10 key points 🧵⤵️ 1⃣ Be sure to optimize for the RV-focused view when making size assessments
asecho.org/wp-content/upl…

Critical care echo lecture #4 @HarvardPulm @MGH_PCCM @PCCSM_BIDMC:
JUST THE RIGHT PRESSURE (i.e. assessing RVSP😀).
Key slides ⤵️ and brief pearls/takeaways 🧵... (1/8)
#Medtwitter #echofirst #PCCMTwitter 1⃣ Speak to your PH specialists about RVSP role and utility in PH diagnosis and management. That is not its role for the intensivist.

Cardiac Output by VTI!
Summary slides from our next lecture, broken into 5 steps⤵️
@MGH_PCCM @HarvardPulm @MGHHCICU

1⃣ Overview & approach - and why you care. CO adds significant detail and nuance to LV function assessment

#POCUS #Medtwitter #PCCMtwitter #echofirst 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.

It's a PFO! A few words about this powerful echo window: The bicaval view 🧵 (1/8)

#POCUS #Medtwitter #echofirst #PCCMTwitter #ICUtwitter

https://twitter.com/JonahRubinMD/status/1577058889454886912

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)

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. 🧐

🚨 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

https://twitter.com/JonahRubinMD/status/1490720088089104390

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.

https://twitter.com/JeffreyGoldberg/status/1490376990054133770

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".

Thrilled to be at @accpchest Virtual Fellows Course! Will try to share bits and pearls as able on this thread (no guarantees!)

Thank you @meredithturetz @subanichandra @DanckersMD and all who created this! 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_CHEST journal.chestnet.org/article/S0012-…

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.

#Medtwitter #cardiotwitter #POCUS #Echofirst 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:

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!

https://twitter.com/HarvardPulm/status/1369789019190665217

Can blood transfusions increase an O2 sat from 80 to 87%?

YES! When the patient is on ECMO😆! (Or has a shunt…)

Buckle up for a hopefully understandable deep dive into some ECMO (/shunt) physiology with (⚠️warning) math and bad pictures.

🧵

#MedTwitter #MedStudentTwitter

https://twitter.com/JonahRubinMD/status/1319307267389476865

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.