In part 1, I talked renal physiology to warm you all up!😉😂

In part 2, we are talking pharmacology and how we combine💊

See 🧵 below

I’m presenting the whole talk at the fabulous #SOA23 ..book now!



#FOAMed #POCUS #FOAMcc #medtwitter eventsforce.net/hm/frontend/re…

https://twitter.com/Wilkinsonjonny/status/1654856279783768065

There are 5 classes of diuretics we can consider.

You don’t have to just use furosemide! Everyone’s favourite loop…

Let’s use our physiology and pharmacology knowledge to combine some of them, to achieve good natriuresis as well as diuresis👍👏🤷‍♂️

Deresuscitation has become more and more ubiquitous within ICU practice. But what tools can we use to do it? Over the next 2 Tweetorials, i’ll explain some pharmacological methods. Focussing on the JICS mix!

My talk from #ACCS2023

#FOAMed #POCUS #FOAMcc #medtwitter The brilliant paper in question is well worth a good read through. For both its novel description of combination diuretic therapy, and its golden descriptions of simple and complex fluid/renal physiology.

Here’s the infamous JICS mix:

journals.sagepub.com/doi/epdf/10.11…

So, remember C3,4,5 keeps you alive?!

Yes, today’s Tweetorial from @icmteaching, @ICUltrasonica and myself is all about the diaphragm!

It’s a pretty vital muscle, and a muscle often forgotten. It’s no wonder why, when it’s weak, your patients won’t liberate from the ventilator! So, does #POCUS have a role in assessing it. Of course it does!🤷‍♂️😂

We use 3 probe positions:

1) Mid axillary/RUQ point - marker 12 O’clock
2) Mid clavicular/Subcostal - marker 12 O’clock
3) Mid clavicular/subcostal - marker 3 O’clock

Today it’s Lung #POCUS for you!

It is:

Easy to perform
Accurate
Sensitive
Repeatable
Negates irradiation or transport elsewhere!

#FOAMed #POCUS #FOAMcc #foamus @icmteaching @ICUltrasonica

Where do we scan then?? Linear/curvilinear or phased probe positions shown👍👇 We don’t tend to use linear for the basal sections, as you need depth for the PLAPS points. To see the pleura clearly, minimise depth and drop gain down, you get a real concept of sliding on the screen.

Here are the normal views for you @GEHealthcare

1/13

Today’s Tweetorial for you!

We look at basic cardiac #POCUS views👍 🫀

First; the Parasternal Long Axis (PLAX)

#FOAMed #FOAMcc #echofirst

Probe position shown with marker to right shoulder, left Parasternal edge; roughly at intercostal spaces 2-3/3-4🤷‍♂️ 2/13

What should you see on ultrasound, and the associated sono anatomy🤔

BTW, this is the only basic position you need for this. Dipping the tail or lifting the tail then get you inflow and outflow views. This is more advanced. #FUSIC

1/7

Here is a quick Tweetorial on Abdominal Aorta #POCUS for you all!

It’s a RULE IN study! Not a rule out ⚠️

Images from a forthcoming book chapter with @LukeFlower1 @icmteaching + @ICUltrasonica !

#FOAMed #FOAMcc #echofirst

#medtwitter

Hopefully we won’t see these?! 2/7

Apply careful firm pressure to displace pesky bowel gas. I start at the umbilicus; you can find the vertebral body easily here. You can then move up or down, tracing the vessel. The aim is to see as much of the vessel as you can. Marker - right (SAX) or to the head (LAX).

So; there are often debates regarding ultrasound probe manoeuvres 🤷‍♂️

Here we go with a graphical Tweetorial, courtesy of myself, @ICUltrasonica and @icmteaching

Hope this helps (you may see these soon in a forthcoming book btw😉

#FOAMed #POCUS #FOAMcc #echofirst 1/7 2/7

SWEEPING

Here we slide the probe along a slug trail of gel, quite crudely, across a wide area of the body. This is often used to ‘window shop’, for structures we can’t see at first. When they snap into view, we can fine-tune movements 👍 Also allows view of larger organs.