Tamponade tweetorial
1/
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

3/
PSLA view showed a clear large pericardial effusion. Given the patient's clear lung exam (and normal lung #POCUS), this can certainly be the cause.

1/
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...

3/ moving to the PSSA view confirms suspicion for RV strain. Note the flattened interventricular septum, known as the "D" sign.