Its the 26th of January and we are back again with another post of #scanuary

It's a month-long marathon of daily tweetorials about #POCUS & its uses

Today we're going to discuss sonographic secondary survey in non-traumatic shock and use of #PoCUS to assess severity and tailor management of patient in shock

If you find the post useful, please like & retweet Lets discuss each shock one by one

A 35 yr old presents with history of smoking presents with weight loss and shortness of breath

Shock primary survey reveals
HR 135
BP 120/90
SPO2; 94% on air
Temp 37
RR 26/min
CRT 4 secs
Raised JVP
Lactate 5

You are thinking it is probably obstructive shock

You do the SHoC scan and patient has a pericardial tamponade

After a hiatus of one day welcome back to day 25th of #scanuary!

It's a month-long marathon of daily tweetorials about #POCUS & its uses

Today we're going to discuss primary survey in non-traumatic shock and use of shock scanning

If you find the post useful, please like & retweet 🚨The red phone rings and there is pre-alert

65 yr old male
Shortness of breath
HR 135
BP 140/95
RR 28
SPO2 89% on air
Temp : 39.7C

Your registrar sets up the resus room, good debrief with team

📢Patient arrives, a concise handover with added history of productive cough and history of travel to Kenya 2 weeks ago

A: maintaining airway with 15 litre NRB

B: RR 28/min Moderate work of breathing crackles bilaterally, SPO297% on 15 litres NRB

C: HR 135/min. BP 135/92, CRT 4 secs, cold peripheries up to mid-forearm, Heart sounds S1+S2+0

D: GCS 15/15, BM 9 mmol

E: faint mottling of peripheries, looked clammy, Temp 39 C

🧠The registrar thinks that this patient has 'Sepsis' due to pneumonia.

Start 'sepsis 6' so gives 1 litre of fluid, Abx and orders investigations and CXR

You have now made it to the 9th post of #scanuary.

It's a month-long marathon of daily tweetorials about #POCUS & its uses

Today we're going to discuss ocular PoCUS

If you find the post useful, please like & retweet 🌟Let's start with a case as always

53 yr old pt with T2DM has been getting worsening blurring of vision over last 8 months but last night suddenly everything went dark and now she cannot see from her left
No history of trauma or pain in the eye

OE Visual acuity is reduced to fingers

You had learnt about ophthalmoscopy in medical school so you try to examine the posterior chamber of the eye

BUT

There is a cataract which does not allow you to look beyond the lens

You have slit lamp but do not know how to perform post chamber exam with the pris.

Welcome to the 8th post of #scanuary.

It's a month-long marathon of daily tweetorials about #POCUS & its uses

I hope you found yesterday's post about small bowel #POCUS useful

Today we're going to discuss large bowel PoCUS

If you find the post useful, please like & retweet 🌟Let's start with a case again

An 80-yr old nursing home resident has presented with some abdominal pain.
Known to suffer with multi-factorial constipation

PMH of Parkinsons disease, chronic pain

Examination reveals just distended abdomen with generalised tenderness

The differentials are broad however, limiting to large bowel causes only
1. Diverticulitis
2. Ileus due to chronic constipation
3. Faecal impaction
4. Obstruction

This patient may need a CT abdomen to confirm the diagnosis but PoCUS can help give an idea about the underlying disease and expedite the confirmatory test

Welcome to the 7th post of #scanuary.

It's a month-long marathon of daily tweetorials about #POCUS and its uses

I hope you found yesterday's post about #VEXUS useful

Today we're going to discuss bowel PoCUS

If you find the post useful, please like & retweet 🌟Let's start with a case

Its Friday night and ED is heaving with patients

A 60 year old coming with abdominal pain
Hx of previous bowel resection for cancer
Pain started 3 hours ago
Opened their bowels this morning
Examination reveals distended abdomen with generalised tenderness

Welcome to the 5th post of #scanuary.

It's a month-long marathon of daily tweetorials about #POCUS and its uses

I hope you found yesterday's post about bile duct PoCUS useful

Today we're going to discuss renal PoCUS

If you find the post useful, please like & retweet 🌟Let's start with a case

A 75 yr old patient presents with delirium to ED.
PMH
CKD
T2DM
CHF
Dementia
Bloods show AKI & raised inflammatory markers
CXR is nil acute
So, treated as urosepsis and admitted

Welcome to the 3rd post of #scanuary
It's a month-long marathon of daily tweetorials about #POCUS and its uses

I hope you found yesterday's post about gallbladder PoCUS useful

Today we're going to discuss bile duct PoCUS

If you find the post useful, please like & retweet 🌟Ultrasound is the recommended first line investigation for bile duct pathologies

I find it useful in conjunction with rest of liver and GB scanning

Its 3rd of January and welcome to the 3rd post of #scanuary

It's a month-long marathon of daily tweetorials about #POCUS and its uses

Today we're going to discuss gallbladder PoCUS in the 2nd part of RUQ #POCUS

If you find the post useful, please like & retweet 🌟It's one of the most useful modalities of POCUS that I find in my practice

⭐️Let's start with a real case

A 34-year-old female presented to ED the day before with RUQ pain and vomiting
Bloods were normal so was the CT scan & US pelvis
So, she is sent home

2/
⭐️Ultrasound is one the best modalities for RUQ pain.

⭐️Although CT can give us a good visual, but it can miss radiolucent stones which is one of the common causes of RUQ pain

Welcome to 2026 everyone & happy new year

As promised, we are going to kick off #scanuary this year again.
We will be covering lots of topics on #POCUS including
POCUS for abdominal pain, shock scan, eyes, UGRA and also TCD in #scanuary

First up a 🧵 on abdominal PoCUS
1/16 2/16
A 85-year-old pt presents to the ED with new onset delirium and a fever.
They are seen by a doctor and after physical exam, CXR, bloods they're diagnosed to have a UTI
🟩Physical exam unremarkable
🟩CXR= clear
🟩Bloods raised CRP, WBC and AKI

Since we are doing all things PoCUS in #Scanuary.

I wanted to highlight the utility of #POCS and shock scanning in all ages of patients with shock

Here is a 🧵about

▪️Tachyarrythmias in neonates

▪️Shock assessment and management Its tricky to find out the severity of the disease in children

A detailed history including birth Hx is key
Along with
A,B,C,D,E and accessory examination

Do not forget about the weight and plot it on the centile charts

We are 1 week in January & today is our 6th tweetorial for #Scanuary

We are going to do the part 2 of 2 of LUS

Today we're going to discuss
B-profile , consolidation , effusion and their interpretation 🌟B-lines

There is some controversy about how they're formed
But most agree that they are ring-down artefacts due to fluid in the interstitium surrounded by air containing alveoli of the lung

3 more B-lines in one ICS is considered abnormal
pubmed.ncbi.nlm.nih.gov/3882979/

Welcome to the 5th tweetorial of #Scanuary

I know yesterday's post was a bit dry so today we are going to make it more interesting

This is a 2 part post on LUS & interpretation
We're going to discuss
Is it #POCUS or is it Enhanced Examination with Ultrasound?
Lung US for PTx 🌟Is it #POCUS or is it Enhanced Examination with Ultrasound ?

The concept of PoCUS means that one should have a question in mind with simple Yes & No answer and then use PoCUS to confirm it.

This came from its use for FAST scans in early 80s & 90s

Its 4th of January are we going strong with our 4th post of #Scanuary

Today we are going to go back to basics

We are going to lung ultrasound, image creation, pitfalls and scanning for lung US

So brew a cup of coffee and sit back 🌟Why bother

It is easy to perform and fairly easy to see underlying pathologies. Its sensitivity is better than physical exam and CXR reaching that of CT scan for certain pathologies

No radiation so it can be repeated multiple times to monitor the lungs

Its 3rd of January which means its the 3rd post for #Scanuary

I hope yesterday's tweetorial was useful

Today we are going to talk about the infamous & controversial Erector Spinae Plane (ESP) block and what RA means in EM 🌟RA in EM
I recently had a chat with @NavBahal & @Jennythatcanbl1 about this
RA for anaesthetists means complete anaesthesia of surgical field hence they use clever blocks to achieve that

In EM it means regional analgesia to reduce the use of other analgesics as part of MMA

🌟Its the 2nd of January & we are back again for our 2nd tweetorial of #Scanuary

I hope you liked yesterday's tweetorial

I will be talking a bit more about RA for CWI & pain in ED

@casualtysrus @Katita1981 @gokpocus @davemaca1yahoo1

A 🧵 ⭐️CWI limits ventilation, cough & movement due to pain

⭐️This can cause delirium, deconditioning and LRTIs in people with CWI esp elderly

⭐️Apart from surgical fixation only good analgesia can limit such complications

Happy New Year everyone

Its the first day of January and we are going to kick off #Scanuary with something close to my heart

A 🧵about regional anaethesia (RA) and pain management for chest wall injuries in ED 🌟Why

Trauma in elderly is on the rise and second most common are injured is thorax

Systemic analgesics alone are not good enough

We need MMA

Yes, IMO we should be able to do RA in ED as pain management is within our remit as specialty.

I had always struggled supervising juniors doing procedures on patients.

It was a challenge to get the best outcome for patient and supervisee

When to be hands-off & when to be hands-on or when to stop and take over.

Here is a 🧵on my current approach which I think works well Success of a procedure lies in preparation

Enter into a contract between supervisor & supervisee pre-procedure

Set expectations
Define communication plan
Mentally rehearse the procedure & pitfalls
Take consent & reassure patient
Define critical point for a TAP OUT
Debrief

I have recently come across a challenging case where it felt like everything fell into place and we had a good outcome.
In debrief a common theme that came out that the treatment of such an extreme case are not in the guidelines

Hence a 🧵 on ASHICE
51 yr ♀️
Looking pale & short of breath
Suspected MI
Arriving in 5 min

Seen by a clinician on arrival and they were given the ECG below

Seeing the recent tweets about changes in approach to cardiac arrest.

Here is a 🧵on my point of view about current challenges of management of cardiac arrest.

and

My approach to CA
1/11 2/11
🌟Definition:

⭐️Biased towards cardiac causes

⭐️Assumes the heart stops in all cardiac arrests

It was great day spent teaching ultrasound guided peripheral venous access to nurses and doctors

A small🧵about tips & tricks for USG IV access 🌟Preparation is the key

⭐️Prepare the machine
Right probe, preset, gain, depth and focus

⭐️Prepare the equipment
Cannula, tegaderm, wipes, gauze, flush

⭐️Prepare the patient
Let them know what to expect, its going to hurt a little bit and to stay still