Discover and read the best of Twitter Threads about #IVC
Most recents (10)
Tamilian from India may have migrated to Australia Satellite photograph of the rock carved legend reveals.
#Archaeology #Thread
1/4
#Archaeology #Thread
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Other set of ancient symbols discovered along the eastern coastline of Australia and Antarctica are very similar to early #Sumerian and #IVC characters
Src: William James Veall, (Copyright WJV 2017)
2/4
Src: William James Veall, (Copyright WJV 2017)
2/4
Yet another Rock-strewn debris with a pattern of rocks seemingly set in the form of an ancient legend embedded into the seashore. Exposed size 50 meters in length x 25 meters
3/4
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#AKIConsultSeries:👨w T2DM➡️🏥 for fever, dysuria and CVA tenderness. On arrival: ⬇️BP, ⬆️Glucose, ⬆️AGMA. Dx UTI + DKA. Tx: Abx + Insulin Pump + 4 L Crystalloid + NE
After resus, pt still oliguric, Cr 3.2. NE 0.7 ug/kg/min,🧠confused, BP 85/62, HR 123, 2L O2. CRT 4 sec
1/12
After resus, pt still oliguric, Cr 3.2. NE 0.7 ug/kg/min,🧠confused, BP 85/62, HR 123, 2L O2. CRT 4 sec
1/12
Given DKA, giving additional fluids is tempting. But before we do this, its easy to do a quick assessment of fluid tolerance #POCUS
#LUS shows some B-lines (bilat)
#IVC plethoric w no respiratory collapse
#VExUS shows very pulsatile portal vein 🚨🤔
2/12
#LUS shows some B-lines (bilat)
#IVC plethoric w no respiratory collapse
#VExUS shows very pulsatile portal vein 🚨🤔
2/12
Pulse pressure is low (23!): This suggest a low cardiac output state!
Also, there are signs of fluid intolerance!
#EchoFirst: Window is suboptimal, but we see a Hyper-dynamic LV w small cavity and a turbulent flow (green color). There was no systolic RV failure
3/12
Also, there are signs of fluid intolerance!
#EchoFirst: Window is suboptimal, but we see a Hyper-dynamic LV w small cavity and a turbulent flow (green color). There was no systolic RV failure
3/12
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“The Athens of South India” - 'Madurai' c.500 bce
Megasthenese, Strabo 25BC, Pliny 75 AD Ptolemy 130AD mention of Madurai.
#Keeladi an excavation site in this small #Thread
#Archaeology
“The Athens of South India” - 'Madurai' c.500 bce
Megasthenese, Strabo 25BC, Pliny 75 AD Ptolemy 130AD mention of Madurai.
#Keeladi an excavation site in this small #Thread
#Archaeology
2/n
#Keeladi was an industrial area of #madurai dated back around 580 BCE determined from the excavated Artefacts
thehindu.com/news/national/…
#Archaeology
#Keeladi was an industrial area of #madurai dated back around 580 BCE determined from the excavated Artefacts
thehindu.com/news/national/…
#Archaeology
3/n
The Keeladi residents used to burry their deads in North South direction
thehindu.com/news/cities/Ma…
#Keeladi were experts in Structural #Engineering. They had Plumbing System, Draining system, Water storage system
#Archaeology
thehindu.com/news/cities/Ma…
The Keeladi residents used to burry their deads in North South direction
thehindu.com/news/cities/Ma…
#Keeladi were experts in Structural #Engineering. They had Plumbing System, Draining system, Water storage system
#Archaeology
thehindu.com/news/cities/Ma…
#AKIConsultSeries Middle-aged male ➡️🏥 for painful knee and fever. Now in shock 🚨
📂Chart review: PMH EtOH Cirrhosis, right knee arthroplasty.
It is always a good practice review previous PACS images🩻: Nodular liver, colateral vessels and prosthetic right knee
1/11
📂Chart review: PMH EtOH Cirrhosis, right knee arthroplasty.
It is always a good practice review previous PACS images🩻: Nodular liver, colateral vessels and prosthetic right knee
1/11
On exam: BP 72/48, HR 82, O2Sat 95%.
CRT 7 sec, 🧠somnolent, confused. No edema, no obvious ascites.
Warm, swollen and erythematous knee: Tap with obvious purulent fluid🧫
Cr 2.8 mg/dl (baseline 0.5), K 6.7, Urine 🔬: hyaline casts, some urothelial cells
2/11
CRT 7 sec, 🧠somnolent, confused. No edema, no obvious ascites.
Warm, swollen and erythematous knee: Tap with obvious purulent fluid🧫
Cr 2.8 mg/dl (baseline 0.5), K 6.7, Urine 🔬: hyaline casts, some urothelial cells
2/11
Loos like hemodynamic AKI (AKA Pre-renal)
Usual causes in Cirrhosis:
🔷Distributive: Septic, "Hepatorenal physiology" 🔷Hypovolemic: Laxatives, vomiting, large volume paracentesis
🔷Congestive: Porto-pulmonary HTN, Co-existing cardiomyopathy
3/11
Usual causes in Cirrhosis:
🔷Distributive: Septic, "Hepatorenal physiology" 🔷Hypovolemic: Laxatives, vomiting, large volume paracentesis
🔷Congestive: Porto-pulmonary HTN, Co-existing cardiomyopathy
3/11
Read 10 tweets
#POCUS con USPed Latinoamérica🌎
En #SabadosdePOCUS Roberth González Cardiólogo Pediatra de 🇵🇪 nos habló de #Ecocardiografía en el Paciente #Critico en #Pediatria.
¿Quieres saber un poco de qué trato?
Abrimos 🧵 👩⚕️👨⚕️
En #SabadosdePOCUS Roberth González Cardiólogo Pediatra de 🇵🇪 nos habló de #Ecocardiografía en el Paciente #Critico en #Pediatria.
¿Quieres saber un poco de qué trato?
Abrimos 🧵 👩⚕️👨⚕️
Comentarios iniciales #PedsICU:
No vemos internamente la interacción cardiopulmonar. El #POCUS ha cambiado eso.
Dicha interacción regularmente había sido estudiada por separado.
La integración ❤️-🫁Pulmón debe ser siempre en contexto.
🔄🔃
No vemos internamente la interacción cardiopulmonar. El #POCUS ha cambiado eso.
Dicha interacción regularmente había sido estudiada por separado.
La integración ❤️-🫁Pulmón debe ser siempre en contexto.
🔄🔃
Algo que le sirvió mucho al Dr. Roberth: la #Fisiología, su funcionamiento.
Ojo, este dato se ha mencionado mucho en nuestras sesiones. El #POCUS en verdad te ayuda a mejorar tus conocimientos básicos, cuando ves lo que tanto estudiaste.
Ojo, este dato se ha mencionado mucho en nuestras sesiones. El #POCUS en verdad te ayuda a mejorar tus conocimientos básicos, cuando ves lo que tanto estudiaste.
En nuestros #SabadosdePOCUS tuvimos a @ACRP901 con el tema:
"Los Secretos Ecográficos de la Vena Cava Inferior (#VCI/#IVC)"
¿Quieres enterarte de alguna puntos claves?
Abrimos hilo... 🧵 #POCUS
"Los Secretos Ecográficos de la Vena Cava Inferior (#VCI/#IVC)"
¿Quieres enterarte de alguna puntos claves?
Abrimos hilo... 🧵 #POCUS
Un punto clave del Dr. @ACRP901: "Los niños no son adultos pequeños"
La VCI sigue siendo esquiva.
Es #Fundamental conocer la fisiología y anatomía al tocar este tema.
Y recuerda: los secretos se encontrarán en la #Fisiología más que en la ecografía per se.
La VCI sigue siendo esquiva.
Es #Fundamental conocer la fisiología y anatomía al tocar este tema.
Y recuerda: los secretos se encontrarán en la #Fisiología más que en la ecografía per se.
Kicking off multidisciplinary Research Consensus Panel (RCP) to finally investigate the ❓: what is the optimal medical therapy (OMT) following venous recan? Follow #VenousRCP throughout the day to learn more and contribute! #SIRFoundation @SIRRFS @SIR_ECS @JVIRmedia
🔴 Pathophysiology of venous thromboembolism #VTE
🟠Venous recanalization & stenting
🟡The mystery of medical therapy following recanalization
🟢Patency & outcome measures
🔵Economics & cost-effectiveness of treatment
🟣Future directions
#VenousRCP
🟠Venous recanalization & stenting
🟡The mystery of medical therapy following recanalization
🟢Patency & outcome measures
🔵Economics & cost-effectiveness of treatment
🟣Future directions
#VenousRCP
🔴 ✅#VTE affects ~100 of every 100,000 people yearly in the US
✅Incidence of VTE ⬆️⬆️ exponentially with age, especially after 40
✅#Endovascular recan is a common tx; post-tx algorithms vary widely
✅More #epidemiology info @CircAHA bit.ly/37IptZh
@Pertconsortium
✅Incidence of VTE ⬆️⬆️ exponentially with age, especially after 40
✅#Endovascular recan is a common tx; post-tx algorithms vary widely
✅More #epidemiology info @CircAHA bit.ly/37IptZh
@Pertconsortium
🧵 AKI and #COVID19
68 yo ♂️ PMH obesity, HTN, CAD w stent, OSA, T2DM
➡️ ED w SOB + fever 39.9°C. Poor oral intake
RR 40, Sat 94% Room Air, BP 157/74 HR 124. Alert. Bibasilar crackles
Labs: Cr 1.3 (baseline 0.8), WBC 10, K 5.4, HCO3 17, CK 184. UA and CXR👇 (case from @NEJM)
68 yo ♂️ PMH obesity, HTN, CAD w stent, OSA, T2DM
➡️ ED w SOB + fever 39.9°C. Poor oral intake
RR 40, Sat 94% Room Air, BP 157/74 HR 124. Alert. Bibasilar crackles
Labs: Cr 1.3 (baseline 0.8), WBC 10, K 5.4, HCO3 17, CK 184. UA and CXR👇 (case from @NEJM)
How would you manage this AKI initially? What is the likely cause of AKI in patients with #COVID19? (this last question discussed in thread 🧵)
No easy answer except to say that FENa is very unlikely to be useful. It is not unreasonable to try fluids for AKI in the setting of perceived hypovolemia. However, this gets complicated when the potential for worsening ARDS exists. I'll try to tackle the answers one by one 💪
1/11
**Nuances of IVC assessment**
So I was asked by @msiuba and @NephroP to talk about about the various nuances of IVC assessment in mechanically ventilated patients. I thought I'd go over some basic concepts for both spontaneously breathing and vented patients
Thread/
**Nuances of IVC assessment**
So I was asked by @msiuba and @NephroP to talk about about the various nuances of IVC assessment in mechanically ventilated patients. I thought I'd go over some basic concepts for both spontaneously breathing and vented patients
Thread/
2/11
Concept 1:
The core mechanism of respirophasic alterations of IVC diameter is its relationship with (actual, not transmural) CVP.
⬇️CVP -->⬆️venous return -->⬇️pressure within the IVC --> tendency to collapse (& vice versa).
Concept 2:
The IVC pressure-diameter relationship
Concept 1:
The core mechanism of respirophasic alterations of IVC diameter is its relationship with (actual, not transmural) CVP.
⬇️CVP -->⬆️venous return -->⬇️pressure within the IVC --> tendency to collapse (& vice versa).
Concept 2:
The IVC pressure-diameter relationship
3/11
Since ΔIVC pressure is related to changes in CVP (concept 1), a direct relationship between CVP and IVC diameter exists (image)
Note that as the IVC dilates, its compliance reduces (stiffens). Hence, any further increase in IVC pressure doesn't increase its diameter.
Since ΔIVC pressure is related to changes in CVP (concept 1), a direct relationship between CVP and IVC diameter exists (image)
Note that as the IVC dilates, its compliance reduces (stiffens). Hence, any further increase in IVC pressure doesn't increase its diameter.
