Discover and read the best of Twitter Threads about #PLAx
Most recents (3)
Young pt โก๏ธ ๐ฅ worsening shortness of breath
PMH: ESRD. Only 1 HD session/week. However, residual urine volume has now decreased substantially
On exam: BP 134/94, 2L O2,๐ง โ , elevated JVP, decreased ๐ซ sounds at bases, No murmurs, very mild edema. Functional left BC AVF
1/13
PMH: ESRD. Only 1 HD session/week. However, residual urine volume has now decreased substantially
On exam: BP 134/94, 2L O2,๐ง โ , elevated JVP, decreased ๐ซ sounds at bases, No murmurs, very mild edema. Functional left BC AVF
1/13
Careful examination of neck veins reveals no pulsations, even with pt sitting up ๐ค
What could explain the absence of venous pulse? 2/13
What could explain the absence of venous pulse? 2/13
Answer is all of the above. JVP examination can be complicated in pts with ESRD.
In the absence of pulsations, I find #POCUS much helpful. Let's enhance our physical examination of congestion:
3/13
In the absence of pulsations, I find #POCUS much helpful. Let's enhance our physical examination of congestion:
3/13
1/ Basic #CadiacUS models (color coded / labeled) for Educators or Beginners
At least 2 options when learning any #IMPOCUS โ memorize or ๐ฐ๐ผ๐ป๐ฐ๐ฒ๐ฝ๐๐๐ฎ๐น๐ถ๐๐ฒ.
Both will get you there but IMO the latter allows for taking next step into advanced imagingโฆ
At least 2 options when learning any #IMPOCUS โ memorize or ๐ฐ๐ผ๐ป๐ฐ๐ฒ๐ฝ๐๐๐ฎ๐น๐ถ๐๐ฒ.
Both will get you there but IMO the latter allows for taking next step into advanced imagingโฆ
2/ This is especially true in Cardiac POCUS โ 4 basic views, but actually so many more. #ECHOFirst
Firm understanding of anatomy and spatial relationships is key!
โฃNote axis of the heart
โฃ๐ฅ๐ฉ the most ๐ฎ๐ป๐๐ฒ๐ฟ๐ถ๐ผ๐ฟ structure
โฃ๐๐ the most ๐ฝ๐ผ๐๐๐ฒ๐ฟ๐ถ๐ผ๐ฟ
Firm understanding of anatomy and spatial relationships is key!
โฃNote axis of the heart
โฃ๐ฅ๐ฉ the most ๐ฎ๐ป๐๐ฒ๐ฟ๐ถ๐ผ๐ฟ structure
โฃ๐๐ the most ๐ฝ๐ผ๐๐๐ฒ๐ฟ๐ถ๐ผ๐ฟ
3/ #PLAx is ๐๐๐ view to learn, if any
Major chambers in view
โฃLA
โฃLV
โฃAorta
โฃRV(OT)
Major chambers in view
โฃLA
โฃLV
โฃAorta
โฃRV(OT)
1/Tweetorial on #TMVR for #ASEchoJC 12/11 8 pm
bit.ly/2EiJQ1v
transcatheter mitral valve replacement #TMVR for failed valve & โฌ๏ธ #STS risk
#VHD 2017 update reoperationโก๏ธ reintervention bit.ly/2P9bX4G
๐expandable SAPIEN S3 only @FDA bioprosthesis for implant
bit.ly/2EiJQ1v
transcatheter mitral valve replacement #TMVR for failed valve & โฌ๏ธ #STS risk
#VHD 2017 update reoperationโก๏ธ reintervention bit.ly/2P9bX4G
๐expandable SAPIEN S3 only @FDA bioprosthesis for implant
2/#Transeptal developed @MayoClinicCV 48 pts
After ๐จ๐ฆ initial experience with #transapical 2009
sick patients with โฌ๏ธ EF #transeptal preserves EF better avoids apical purse string suture
Currently #TMVR registry
>50 % are transeptal & in house mortality 7%
After ๐จ๐ฆ initial experience with #transapical 2009
sick patients with โฌ๏ธ EF #transeptal preserves EF better avoids apical purse string suture
Currently #TMVR registry
>50 % are transeptal & in house mortality 7%
