👋 Welcome back to #Scanuary – Day 23!

I am C-3POcus, the emergency department ultrasound machine that never sleeps 🤖📟

I’ll keep taking you through my ED shift, rolling from patient to patient as the day unfolds.

Handovers are done.

Night team is in.

Skeletal staffing.

Registrar captaining the ship and prioritising the sick.

@salmannaeem217 @drmohansai He’s called to see a gentleman in his 40s.

🕑 Severe upper abdominal pain x 2 hours
🤮 Associated vomiting
⚡ Now severe pain in the left groin and leg

No past medical history.

Vitals:
HR 110
BP 150/70
SpO₂ 98% RA
Lactate 3.8 (rest of VBG normal)

POCUS so far:

❌ Free fluid
❌ Hydronephrosis
❌ Urinary retention
❌ Gallstones / cholecystitis

So… what next? 👀

👋 Welcome back to #Scanuary – Day 22!

I’m C-3POcus, the emergency department ultrasound machine that never sleeps 🤖📟

I’ll keep taking you through my ED shift today — rolling from patient to patient as the chaos unfolds.

@salmannaeem217 @drmohansai
#POCUS #Scanuary 🚨 The red phone rings — ambulance pre-alert for red flag sepsis!

A gentleman in his 60s: lethargic and breathless.

Vitals from the crew:
• HR 130
• RR 35
• SBP 80
• Cool peripheries

They’re 5 minutes away.

It’s obviously sepsis… right? 🤔

We get ready in ED Resus. My doc loves a systematic approach to shock. He reminds his colleague of HI-MAP (aka RUSH protocol)

👋 Welcome back to #Scanuary – Day 21!

I am C-3POcus, the emergency department ultrasound machine that never sleeps 🤖📟

I’ll continue taking you through my ED shift, rolling from patient to patient as the day unfolds.

Today, we’re diving into something a little different…

🦵 The deep veins.

Compression, clots, and time-critical diagnosis—let’s get scanning. It’s 1pm and the department is busy. Ambulances are pouring in and the triage queue is getting longer by the minute.

In the middle of the chaos, I’m wheeled into another Majors cubicle. A man in his 60s presents with unilateral lower limb swelling. The doc is wondering—could this be a DVT?

There are no formal ultrasound slots today, and with the weekend coming, he may wait days for a diagnosis.

So we take a quick look with POCUS…

🩸 We will come back to discuss the findings shortly.

👋 Welcome back to #Scanuary – Day 20!

I am C-3POcus, the emergency department ultrasound machine that never sleeps 🤖📟

It’s 11am and I’ve been wheeled into another Majors cubicle.

A young woman presents with lower abdominal pain. She reports ongoing vaginal bleeding but says this pain feels different from her usual period pain.

Vitals are stable. Bloods are normalish.

Abdominal exam shows right-sided lower abdominal tenderness.

The ED SHO has discussed the case with surgeons, who want gynaecology to see her first.

Gynae, however, don’t think this is their patient 🤷‍♂️

Looks like I’m about to earn some respect… A quick scan of the right lower quadrant reveals:

• A dilated, blind-ending tubular structure
• Non-compressible, no peristalsis
• Diameter >6 mm
• Surrounding echogenic fat stranding
• Multiple echogenic foci with posterior acoustic shadowing

There is also localised free fluid and free air, highly suggestive of ruptured appendicitis with appendicolith.

The patient is referred back to surgery. A CT scan is ordered and confirms perforated appendicitis. Patient is taken to theatre which confirms appendicitis with pus in RLQ.

🤖📟 Case closed.

Welcome to #Scanuary

A month-long marathon of daily tweetorials on #POCUS and its utility in our clinical practice.

@salmannaeem217 and @drmohansai have done a fantastic job so far, sharing numerous clinical pearls.

For the next few days, I’m going to introduce you to my dear friend C-3POcus 🤖📟 — the emergency department ultrasound who will bring you tales from his long ED shifts. Hi, my name is C-3POcus, your Emergency Department ultrasound machine.

I never sleep, but my day seems to restart around 8am when a new team walks in. I’m usually left at the side of a bed. Sometimes I get dumped in a storeroom with all sorts of weird equipment. Worse still, I’ve been abandoned in the sluice 😳.

Eventually someone comes looking for me—usually when I’m in a terrible state. They give me a quick wipe, clean the blood off my probes, remove old catheter equipment from my tray, and top me up with fresh ultrasound gel. Bliss ✨

It’s usually the same 3–4 doctors and nurses who take care of me. I can tell they love me—they carry me everywhere and introduce me to all their patients.
Let me tell you the story of a typical day for me in the ED… 🩺📟

Day 18: Echo in Shock Part 2 ⚡️ we looked at 2D clues for elevated LV filling pressures. Dive deeper with Diastology!

MV Inflow & Tissue Doppler: Get more data with E/e'
E/e' > 14: Suggests high LV filling pressures & potential for pulmonary congestion.

How to:
- Measure E & A waves with PW Doppler: Place the PW-doppler sample volume at the tips of the mitral valve leaflets and record the early filling (E) and atrial kick (A) diastolic filling velocities. This is looking at LV diastolic filling.
- Assess septal & lateral annular velocity with TDI: Use tissue Doppler imaging to measure the early diastolic myocardial velocity of the septal and lateral annulus. This is looking at LV relaxation.

- Limitations:
Mitral annular calcification
Tachycardia
Arrhythmias
Severe MR/MS & few more..

Learn more: @KiranRikhraj has an amazing video on understanding Diastology! Must watch!
youtu.be/bsAs20xtJAg?si…

#POCUS #Scanuary
@casualtysrus
@davemaca1yahoo1
@Katita1981
@salmannaeem217 We've confirmed our patient is in shock and can tolerate fluids.
But how do we know if they'll actually respond? Let's explore some POCUS tools to predict fluid responsiveness.

1) LV Diastolic Diameter:
A smaller LV might have more room for fluids. "Kissing ventricles"

Caveat: LV size alone isn't enough! Small LV can also be seen in RV failure or pressure overload - these patients don't want more fluids. LV hypertrophy can make the LV cavity small but can have restricted filling and raised LAP. So NOT PERFECT!

#POCUS #Shock #FluidResponsiveness #EmergencyMedicine #Scanuary

Its Day 18 #Scanuary : Ultrasound in Shock Part 1⚡️

Shock isn't just low blood pressure! It's all about tissue oxygen delivery.
Do we need Ultrasound to diagnose Shock? NO! That’s all us!

POCUS helps:
- Confirm your hypothesis for shock.
- Uncover the underlying cause (e.g., heart failure, fluid loss, infection).
- Guide treatment decisions (e.g., fluids, vasopressors, inotropes).
- Monitor for response to see if treatment is working.

Remember, it's not the ultrasound probe, but the person holding it who is always in control! #POCUS #Shock #EmergencyMedicine #Scanuary

@casualtysrus
@davemaca1yahoo1
@Katita1981
@salmannaeem217 When should we pick up the probe? 🤔

- Not if you know what to do! In life-threatening haemorrhage (like an amputated limb), immediate action (pressure, tourniquet) is key. POCUS should not delay critical interventions.
- Uncertain Shock: When the cause isn't clear, POCUS can help pinpoint the problem.
- Two-hit Shocks: POCUS can uncover hidden issues (Eg Septic Cardiomyopathy). Patients can experience two simultaneous shock states (e.g, vasoplegic and cardiogenic).
- Guiding Treatment: Use POCUS to monitor the patient's response to treatment and see if your initial hypothesis and management plans are effective. #POCUS #Shock #EmergencyMedicine #Scanuary

Day 17 #Scanuary: Valvular Assessment 🔍

Valves keep the blood flowing smoothly. 🩸 Patients in the ED might have known valve problems, experience their first symptoms, or even have a sudden, serious event. 🚨

Why does it matter?

Tailor management to their specific needs.
Quickly transfer those who need advanced care. 🏥

Disclaimer: ⚠️

POCUS isn't a complete valve check
Its aim is to:
- Identify significant valvular disease.
- Guide initial management.
- Facilitate timely referral for further evaluation and treatment.

#POCUS #Echofirst #Scanuary Lets talk Aortic!
A normal aortic valve has 3 cusps. They're named after the coronary arteries they relate to: Left Coronary Cusp, Right Coronary Cusp, and Non-Coronary Cusp.

In about 1-2% of the population, you might find bicuspid aortic valves, often caused by the fusion of two cusps.

This patient group is at higher risk of:

- Aortic stenosis
- Aortic regurgitation
- Aortopathies (diseases of the aorta)

Important to watch for these conditions!

#POCUS #Scanuary

Day 16 of #Scanuary! 🫀 Today we dive deep into the pericardium - that sneaky little sac surrounding your heart. Think of it as your heart's snuggly little home, except sometimes it gets a bit too snuggly... #POCUS #Scanuary @casualtysrus @davemaca1yahoo1 @Katita1981 @salmannaeem217 First things first: how to tell a pericardial effusion from an imposter - pleural effusion. 🧐 The deep PLAX view is your friend here. Look for the descending thoracic aorta (DTA) - pericardial effusions remain above it, while pleural effusions tend to hang out below.

Check out this amazing infographic by @NephroP #POCUS #Echofirst #Scanuary

It's Day 15 of #Scanuary Today's topic: The People’s Ventricle!

The LV gets a lot of attention because of its impressive guns 💪, but the RV is the unsung hero of the heart! In the ED, we need to be masters of RV assessment. Why? Because diagnosing RV failure (new, worsening, or at risk) is crucial for guiding management. #FOAMed #POCUS #cardiotwitter

Lets take a poll what's the primary role of the right ventricle (RV)? 🤔 #MedTwitter #Echofirst #Scanuary

@casualtysrus
@davemaca1yahoo1
@Katita1981
@salmannaeem217 Let's dive into a hypothetical case scenario: 🏥

Case : A patient with COPD & T2DM has frequent hospital stays for exacerbations. Now, she presents with SOB, cough, fever, abdominal pain, tachycardia (HR 110), fever (38°C), Blood pressure (110/60), lactate 3, and hypoxia. Classic sepsis isn't it? 🚨

Sepsis 6 initiated: IV fluids, antibiotics, nebs. Bloods reveal deranged LFTs, AKI stage 2, so fluids continued.

Then, things worsen. Worsening acidosis, lactate up to 8, agitation. Time for intubation & ofcourse more Fluids!! 😱

During induction, cardiac arrest! 💔 Thankfully Quick ROSC, and someone grabs that ultrasound!

Let's analyse!

It's Day 14 of #Scanuary! Today's topic: Using Echo for chest pain in the ED. 🏥 Chest pain is common, but can be tricky to manage. Echo can be a game-changer for quick bedside assessment.

@casualtysrus
@davemaca1yahoo1
@Katita1981
@salmannaeem217 Case: Middle-aged man with chest pain... sounds like a routine case, right? 🤔 WRONG! His ECG showed subtle hyperacute T-waves in V3-V5 with poor R wave progression, but no classic STEMI. So declined for emergency PCI!
Echo was key! 🔑 Revealed RWMA in LAD territory with impaired LV function. Was taken to the cath lab, PCI was performed for a critical LAD blockage! 🫀 #POCUS saves lives! #Scanuary #Echofirst

#Scanuary Day 13 Alert!

Ready to take your echo skills to the next level? 🚀 Today, we're diving DEEP into some slightly more advanced techniques than 2D echo in the emergency setting. Think extended views, Colour Doppler mastery, M-mode secrets, and more! #Scanuary #POCUS #Echotips

@casualtysrus @davemaca1yahoo1 @Katita1981 @salmannaeem217 Unlock the power of Colour Doppler! It's like adding a whole new dimension to your echo exam. See blood flow direction, spot turbulence, and assess those tricky valve regurgitations.

Pro Tip: Keep that colour box small and focused for the sharpest image. Don't forget BART! (Blue Away, Red Towards 😉) #POCUS #FOAMed #Cardiotwitter #Scanuary

Thank you, @davemaca1yahoo1 , for incredible insights on PEM POCUS! 🙏  I have learnt so much. Now, get ready to dive headfirst into the world of echocardiography in the emergency department!

For years, minds like Leonardo da Vinci were captivated by the mystery of the Heart. Now, we can witness its intricate dance in real-time with ultrasound! I'll be your guide for the next 6 days.

Let's get started! Day 12 #Scanuary #POCUS #EmergencyMedicine #echocardiography #cardiotwitter Lets start with some basics.

Positioning: Left lateral decubitus is ideal, but adapt as needed (supine for trauma/arrest, sitting up for youe breathless patient).
Probe: Phased array probe is your friend.
Machine: Adjust depth/gain/focus. Important: Ensure the probe marker is on the RIGHT side of the screen on the Cardiac preset! #echotips #cardiotwitter #Scanuary