1/ Wild cardiac arrest with #POCUS playing a major role

An elderly male was sent from the nursing home in cardiac arrest. Per the prehospital report that we got, the patient was in vfib and refractory to 5 defib attempts. The patient got amio as well as several doses of epi. 2/
We had a 10 minute ETA.

I had a brief discussion with the resident on dual sequential defibrillation for refractory shockable rhythms. A few recent clinical trials have shown significant benefit when performed early in refractory shockable rhythm.

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The #POCUS was not what it seemed

A strong 3rd year resident presented me this case.
A 47f p/w with a complaint of 1 month of abdominal distention and bloating. She has a history of alcohol use disorder and fibroids but no other medical history. Her exam showed distention 2/
"I looked with an ultrasound" he said, " Her liver took up the entire abdomen. It was huge."
Seemed to check out from the history. Her labs were unremarkable so he placed a bed request for medicine.

Tamponade tweetorial
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68m with a h/o COPD and lymphoma, presented with SOB unrelieved with home albuterol. Had an O2 sat 88% with EMS which improved with CPAP. BP 87/50 and HR 160 which improved to BP 127/70 and HR 115 after 1 L of LR. Exam had increased WOB and clear lungs 2/
CXR showed cardiomegally which prompted cardiac #POCUS. Any significant SOB patient should have a cardiac and lung #POCUS to quickly assess for emergent pathology

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Resident presents a case of a 56 year old f w/ h/o COPD with 2 weeks of new bilateral leg swelling, high BNP and normal CXR. "I'm going to admit her for new onset CHF" he says. Sounds reasonable, but "new onset CHF" requires a #POCUS, so I go to the bedside.
PSLA view next: 2/ PSLA view shows normal LV systolic function which is the first clue to search for alternate causes. While this could be HFpEF, note that the interventricular septum looks flat...