I like using IJV #POCUS as an alternative to IVC, especially when the IVC is unreliable or inaccessible. But it’s not foolproof.
I’d love to hear from those who use it frequently - what practical pitfalls have you encountered? I’ll start with an article/observation below.
#Nephpearls #FOAMed 🔴Tilting the head to one side can artificially dilate the vessel
amjmed.com/article/S0002-…

#eVExUS (= extended #VExUS) includes evaluation of additional veins when the original 3 veins are unobtainable or unreliable for any reason.
Below👇🧵 is an illustrative case showing abnormal pattern in all these veins.
#POCUS #FOAMed #Nephpearls
1⃣ IVC #ultrasound: dilated 2⃣ Hepatic vein #Doppler
Systolic flow reversal #POCUS #VExUS

Latest post on NephroPOCUS.com 🔗nephropocus.com/2023/11/20/vex…
Selected #VExUS #POCUS teaching cases.
#FOAMed #Nephpearls #CriticalCare
Follow the thread below 🧵👇 1. A classic #VExUS #POCUS example showcasing how diuretic therapy led to the simultaneous improvement of all three waveforms (hepatic, portal, and intrarenal) alongside improvement in serum creatinine and sodium levels.
🔗 karger.com/bpu/article/51…

#echofirst views used to evaluate the right heart.
From ASE comprehensive echocardiography textbook/2010 guidelines
#POCUS #MedEd #CriticalCare #IMPOCUS
(🧵of 5 tweets) #POCUS

Common #echofirst views used in the #POCUS setting, image acquisition pearls and structures visualized.
Thread below🧵
Courtesy, ASE TTE guidelines 2018
#MedEd #FOAMed #FOAMcc
1⃣ Parasternal window 2⃣ Parasternal window continued

Focused question: Is HTN in a #dialysis patient always⬆️ intravascular volume? Remove💧?
Clinical: ESRD due to polycystic kidney disease, BP 160s/~100, IVC not well-visualized.
Next step to assess RAP: #VExUS
Below is hepatic vein Doppler
#POCUS #Nephpearls #FOAMcc
Follow the🧵 https://t.co/xZe23bHvJVtwitter.com/i/web/status/1…
2/ 👆What do you think?

Cardiac #POCUS views - image acquisition pearls from JACC POCUS workbook
#MedTwitter #Nephpearls #FOAMed
Thread🧵below:
1/ 2/

#POCUS enthusiasts, is this IVC normal, abnormal? (asking about possibilities, not definitive conclusions)
#FOAMcc #MedEd #Nephpearls
(Transverse view in thread) IVC transverse #POCUS

Some excellent anatomic illustrations for friends who place central lines.
#POCUS #MedTwitter #Nephpearls #FOAMed
Courtesy: pubmed.ncbi.nlm.nih.gov/27521991/
1. Internal jugular vein (A. Transducer placement in short axis, B. long axis) 2. The supraclavicular approach to the subclavian vein (A. Transducer in short axis to the vessel, B. long axis)
#POCUS #MedEd

#POCUS quiz
1. What tracing did I obtain here?
2. What are some clinical scenarios where doing this would be helpful?
#IMPOCUS #MedEd #Nephpearls onlinejase.com/article/S0894-…
#POCUS #MedEd

Just plethoric IVC or there is some other notable finding?
#POCUS #MedEd #Nephpearls #POCUS Answer: Pericardial effusion
Cannot comment on tamponade just from this view
Other views in 🧵below. No obvious chamber collapse.

Some helpful illustrations of cardiac support devices for trainees and non-intensivist consultants like me rounding in the ICU.
🔗ccjm.org/content/84/4/2…
#Nephpearls #MedEd #MedTwitter
Also, good to be aware while performing #POCUS ECMO illustrations #MedEd

https://twitter.com/NephroP/status/1536861093460680704?s=20

After yesterday's #POCUS quiz, it's time to reshare these cardiac tamponade infographics.
Courtesy of @ACEP_EUS
🔗acep.org/emultrasound/s…
Set of 3
See 🧵for the rest
#Nephpearls #MedEd #FOAMcc Pulsus paradoxus #echofirst

A 58-year-old woman with no known comorbidities presents with progressive fatigue and shortness of breath x several months. Noted to have bilateral pedal edema; BNP 2,473 pg/mL.
#echofirst 👇❓
Answer and 🔗 to source in thread.
#POCUS #MedEd #FOAMcc Left atrial myxoma -> pulmonary hypertension (RVSP 93 mmHg) -> RV dysfunction (Note obvious RV enlargement ☝️
cvcasejournal.com/article/S2468-…

Another set of cardiac #POCUS #anatomy illustrations. 🧵
#Nephpearls #FOAMed
Source: sciencedirect.com/science/articl…
1⃣ Parasternal long axis 2⃣ Parasternal short axis aortic valve level
#POCUS

#MedEd image of the day. What's wrong with the 🫀?
Clinical: A woman in 40s with h/o severe mitral stenosis secondary to rheumatic heart disease & Afib presented with worsening dyspnea, orthopnea, & chest pain x 7 months
See thread for #echofirst images and source/answer.
#POCUS Apical 4-chamber view showing severe right atrial enlargement and annular dilatation of the tricuspid valve during systole.

#POCUS puzzle 🧩of the day. Can you put together the pieces and arrive at an unifying diagnosis? Go through the thread 🧵below.
Context: #dialysis patient, physical examination #FOAMed #Nephrology #MedEd

Image No. 1 👇 Color #POCUS

#POCUS quiz
You are performing physical examination in a patient with suspected fluid overload (plethoric IVC).
Parasternal short axis view demonstrates D-sign. But what's in the RV?
Apical view in thread.
#Nephrology #MedEd #FOAMcc
🔗 to source will be posted in a few hours. Apical #POCUS

#POCUS #tamponade #MedEd
Short axis view and 🔗to source in thread. 👆image shows parasternal long axis view with diastolic collapse of the right ventricle.
👇short axis view at the aortic valve level showing right atrial systolic collapse (arrowhead) and RV diastolic collapse (arrow).
Source: cvcasejournal.com/article/S2468-…
#POCUS #echofirst #MedEd

Basic cardiac #POCUS views image acquisition flash cards.
Courtesy of Philips Healthcare
#MedEd #Nephpearls #echofirst
🧵
1/ #POCUS

Head‑to‑toe #POCUS skills for intensivists in the general and neuro #intensivecareunit population: consensus and expert recommendations of the European Society of Intensive Care Medicine.
🔗pubmed.ncbi.nlm.nih.gov/34787687/
#MedEd #IMPOCUS Summary of the recommendations
#POCUS #Brain