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Point-of-care ultrasound #POCUS 📖 | by Abhilash Koratala MD @KoraAbhi, Associate Professor #Nephrology @MCW_Nephrology I👨🏻‍✈️ @POCUSIAPN | 🐥≠ medical advice
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Feb 1 5 tweets 4 min read
After yesterday's #POCUS quiz, it's time to reshare these cardiac tamponade infographics.
Courtesy of @ACEP_EUS
Set of 3
See 🧵for the rest
#Nephpearls #MedEd #FOAMcc Pulsus paradoxus #echofirst
Feb 1 4 tweets 3 min read
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 ☝️…
Jan 30 7 tweets 5 min read
Another set of cardiac #POCUS #anatomy illustrations. 🧵
#Nephpearls #FOAMed
1⃣ Parasternal long axis 2⃣ Parasternal short axis aortic valve level
Jan 27 5 tweets 2 min read
#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 Image Apical 4-chamber view showing severe right atrial enlargement and annular dilatation of the tricuspid valve during systole.
Dec 28, 2022 8 tweets 6 min read
#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
Dec 6, 2022 4 tweets 3 min read
#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
Nov 29, 2022 5 tweets 3 min read
#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).
#POCUS #echofirst #MedEd
Nov 18, 2022 10 tweets 5 min read
Basic cardiac #POCUS views image acquisition flash cards.
Courtesy of Philips Healthcare
#MedEd #Nephpearls #echofirst
Nov 15, 2022 6 tweets 4 min read
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.
#MedEd #IMPOCUS Summary of the recommendations
#POCUS #Brain
Sep 2, 2022 6 tweets 5 min read
A short 🧵 on hepatic vein #VExUS and key pathologies

1/ HV Anatomy & Normal Flow Profile, respiratory variation (forward flow [S,D] ⬆️ during inspiration)

Click ‘ALT’ for normal waveform description

#POCUS #MedEd #Nephrology #IMPOCUS #FOAMed The normal flow profile in ... 2/ A. Tricuspid regurgitation: Systolic flow reversal
B. Tricuspid stenosis: prolonged deceleration time of the D-wave + prominent A-wave

Click ‘ALT’ for further description

#POCUS #VExUS (A) Severe tricuspid regurg...
Aug 22, 2022 22 tweets 18 min read
Time to update the #VExUS resources pinned thread 🧵📌
1/ Tweetorial on image acquisition.
2/ The original #VExUS paper… Image
Aug 22, 2022 4 tweets 3 min read
#POCUS quiz for #VExUS enthusiasts.
Image obtained from a patient with heart failure with preserved EF. IVC 1.9 cm with 30% inspiratory collapse.
Here is the intra-renal image. Interpretation of the venous waveform?
POLL in thread 👇
#MedEd #Nephrology Image 👆#POCUS
S = systolic venous wave
D = diastolic venous wave
Aug 20, 2022 4 tweets 2 min read
CVP waveform - a variant of #VExUS #POCUS
Tracings obtained from a 38-year-old female with severe aortic stenosis and mild pulmonary hypertension who underwent aortic valve replacement. What's the difference from pre to post-op?
Se thread for answer and source.
Aug 9, 2022 5 tweets 4 min read
Cardiac tamponade on #POCUS #echofirst
Click on 'ALT' for description
#MedEd #IMPOCUS #Nephrology
From 🔗 Two-dimensional (2D) and M-mode echocardiographic signs of p Mitral inflow Doppler and LVOT VTI in tamponade.
'ALT' for description
#POCUS #echofirst #MedEd Respiratory variations in flow velocities by spectral Dopple
Jun 8, 2022 28 tweets 13 min read
#POCUS #MedTwitter #Nephpearls
Many #VExUS enthusiasts asked for a #tweetorial on image acquisition pearls. Did one b4 but time for an updated one 🧵

#1 Let's start with basics
Color Doppler identifies the flow + tells the direction (blue is away & red towards the probe [BART]) #2 👆BART holds good unless u invert the scale.
👇Pulsed wave Doppler (PWD) depicts blood flow at a certain point (sample volume) - we analyze the pattern of flow + velocity using this mode.
Above-the-baseline = flow towards the probe (like red on color)
Below = away (like blue)
May 27, 2022 12 tweets 7 min read
#POCUS #VExUS consult for #hyponatremia. Elderly pt with h/o mitral valve replacement. On Bumetanide, UNa ~70 mmol/L, Uosm ~250🧵
Trace edema, JVD +, feels OK
Calling hemodynamic friends @khaycock2 @ThinkingCC @ArgaizR @msiuba @IM_Crit_ @MDBeni @siddharth_dugar Educate us!
1/ IVC 2/ 👆Consistent with elevated right atrial pressure.
👇Hepatic vein #VExUS
D-only pattern (rhythm: ventricular paced)
May 25, 2022 4 tweets 3 min read
#POCUS #echofirst quiz:
In this PLAX view, what structure does the arrow indicate? + what's abnormal about it (if any)?
Clinical: 71y pt with fever/cough, initially thought to be pneumonia, later developed chest pain. BP 134/83 Pulse 106
Will post the answer/source tonight
#MedEd Tweet 1/3
Dilated coronary sinus with a mobile echogenicity (vegetation/infective endocarditis in this case)
Full case: 🔗…
From #POCUS standpoint, 2 main causes: persistent left superior vena cava & pulmonary HTN. This pt had the former.
Apr 19, 2022 22 tweets 12 min read
One of my favorite topics in #POCUS - various effusions seen from different sonographic windows.
Here is a thread 🧵with labeled images for those interested.
1. PLAX view - pericardial effusion - anterior to descending aorta ⚫️below LA), wedge shaped
#MedEd #IMPOCUS #Nephpearls 2/ PSAX papillary muscle view
LV is think as many of my patients have #CKD and LVH (as well as mitral annular calcification seen on PLAX view above)
#Nephrology #POCUS
Apr 18, 2022 5 tweets 4 min read
Looks like #POCUS ologists are in a mood to revive old #VExUS posts and tweetorials today.
Let me re-share the VExUS flash card(s) 🧵
1. VExUS grading live card
#MedEd #IMPOCUS Hepatic vein #VExUS #POCUS
Apr 18, 2022 8 tweets 6 min read
@Rajiv_Sinanan @ThinkingCC 1/ Real reason(s) based on my conversations with people from different backgrounds:
Private practice: "#POCUS sounds interesting but I ain't got time for that. Will consider if I get compensated"
Academia: (not generalizing but most places)
Emphasis is on funded research @Rajiv_Sinanan @ThinkingCC 2/ Clinical faculty are hired for clinical duties, outreach dialysis etc., which is fair but the problem is educational endeavors are rarely rewarded/provided with protected time. Faculty who want to be #POCUS champions must first learn it (either from institutional experts or
Feb 17, 2022 21 tweets 11 min read
Small thread 🧵illustrating #POCUS based hemodynamic assessment. Relatively a classic case of pulmonary HTN and right heart failure but would like to get some insights from the experts.

1/ Parasternal long axis (PSAX) showing D-sign
#VExUS #MedEd #Nephpearls #IMPOCUS 2/ Parasternal long axis (PLAX) view demonstrating RV dilatation.
One of the three musketeers is big. Don't know what I'm talking about? Here is a brief reminder: 🔗…
(Mobile thing in the RVOT is PA catheter; M-mode quiz from this morning is actually this)