Discover and read the best of Twitter Threads about #pocus
Most recents (24)
Otro casito 🧵. Mujer de 35 años que llega a Ux con Glasgow de 8, estable hemodinamicamente y con acidosis metabólica severa (pH 6.9) al parecer en estado posictal que no recupera, tuvo cscs TCG, (se desconoce duración) , se intuba y me ingresa a uci, con TAC normal, VNO 3.2 …
… realizo 🪟 neurologica, emerge bien, gaso de control en eq ab y extubeichon exitosa, reinterrogando, la px tiene app de hipotiroidismo en tx con levo, ingesta de sglt1 para bajar de peso, Qx: histerectomia por miomatosis en Feb 2023. Resulta y resalta que…
…había tenido en 3 ocasiones lipotimia después de valsalva y esta vez fue síncope posterior defecar, tonces pensé ps este pedo es cardiogénico, vamo a insonarla y oh sorpresa, limpiamos toda la casa, sin dejar caer una sola gota de pintura que no sea quesesooooo 😱 twitter.com/i/web/status/1…
What is #Pre-Hospital #CriticalCare? A short 🧵:
Also referred to as Pre Hospital Emergency Medicine (PHEM), #PHEM is “that area of medical care required for seriously ill or injured patients before they reach hospital (on-scene) or during emergency transfer to hospital” 1/11
Also referred to as Pre Hospital Emergency Medicine (PHEM), #PHEM is “that area of medical care required for seriously ill or injured patients before they reach hospital (on-scene) or during emergency transfer to hospital” 1/11
PHEM in Ireland is practiced by a small number of doctors who respond voluntarily to taskings from @AmbulanceNAS to serious illness or injury.
These doctors are supported by charities like @WicklowRR.
Other groups include: @WestCorkRR @EastCorkRR and @CRITICALcharity 2/11
These doctors are supported by charities like @WicklowRR.
Other groups include: @WestCorkRR @EastCorkRR and @CRITICALcharity 2/11
PHEM doctors complement the work of @PHECC practitioners in @AmbulanceNAS @DubFireBrigade and many other emergency agencies.
PHEM doctors can provide additional interventions, medications and decision-making, or simply be the closest resource to a time critical emergency. 3/11
PHEM doctors can provide additional interventions, medications and decision-making, or simply be the closest resource to a time critical emergency. 3/11
Novel Content No.2 at #SOAPAM2023 virtual #OBAnes highlights Day 2: @DoctorStahl speaks on Obstetric Critical Care #OBCritCare
@DoctorStahl is an intensive care bear, who loves #OBAnes. QR code to references. #OBCritCare #SOAPAM2023
Pregnancy-associated mortality ≈ maternal mortality. #OBAnes 0.2% - doing well (wonder what the denominator is?), so Elmo could ask why are we worried? #SOAPAM2023
#SolShnider track 3 during #SOAPAM2023 virtual #OBAnes highlights Day 2 kicks off with @antonchau1 on DPE vs other LEA options.
Next up for #SolShnider track 3: Dr Clemens Ortner on #POCUS in #OBAnes emergencies. (@KalagaraHari @AnaSjaus)
Dr Mark Zakowski, MD presents on Barriers to optimal staffing in #OBAnes (topical for @OAAinfo, @SOAPHQ & @CAS_OBSection members - indeed the worldwide shortage of #AnyAnes makes this important for @wfsaorg @ASALifeline @ANZCA @docanaesthetic @CASUpdate) #SOAPAM2023. “Adapt or… twitter.com/i/web/status/1…
ICU pictorials: A patient was admitted for "weakness". Unimpressive vitals / phys exam / labs. A few days later because of temp 101 F, a fever w/u was initiated. Due to "SOB", a CT chest angio was done:
👆Massive saddle PE extending in both sides w evidence of R heart strain
Echo findings:
1/n: Thread of interesting ED #POCUS case. F/70+, known epigastric hernia (relapsed post repair years ago). Repeated vomiting since 1 week. Labs and plain x-rays -
2/n Distended stomach noted on #POCUS -
3/n Clinically the hernia appeared to be reducible. However, #POCUS demonstrated obstruction of gastric outflow due to incarcerated portion of gastric antrum.
Otro casito bueno pa la colección, abro 🧵 Mujer 37 años PO miomectomía laparoscópica, sin APP. Refiere anestesio que se le dió AGB, se resecaron los miomas pero aparentemente quedaban restos, se volvió a irrigar con glicina en cavidad uterina para distenderla y posterior a esto
…inicia con bradicardia de 30 lpm, SAT 60% y poliuria, sangró 700, se le transfunde 1 PG, 1 L Hartmann e inicia vasopresor, la hiperventila tratando de mejorar SAT y posterior pasa a UCI. Donde la recibimos con efecto residual de sedación, RASS -4 pupilas isocóricas de 6 mm…
… con PAM 69, FC 40, FR 16 SAT 60%, con nore a 0.2 mcg/k/min, ritmo sinusal por telemetría pero con extrasístoles ventriculares aisladas, llc de 5 segs, VMI, Fio2 al 60%, csps crepitantes, abdomen con hx qx sin datos de dehiscencia o sangrado. Solo con GV en ese momento…
Cardiac #POCUS views - image acquisition pearls from JACC POCUS workbook
#MedTwitter #Nephpearls #FOAMed
Thread🧵below:
1/
#MedTwitter #Nephpearls #FOAMed
Thread🧵below:
1/
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3/
#POCUS enthusiasts, is this IVC normal, abnormal? (asking about possibilities, not definitive conclusions)
#FOAMcc #MedEd #Nephpearls
(Transverse view in thread)
#FOAMcc #MedEd #Nephpearls
(Transverse view in thread)
IVC transverse #POCUS
#POCUS answer:
I deliberately avoided clinical context in the original tweet to gather multiple opinions.
Image obtained from a thin, trained athlete with resting HR in 40s-50s.
A dilated IVC is commonly seen in this setting with no right heart pathology. In addition, particulate… twitter.com/i/web/status/1…
I deliberately avoided clinical context in the original tweet to gather multiple opinions.
Image obtained from a thin, trained athlete with resting HR in 40s-50s.
A dilated IVC is commonly seen in this setting with no right heart pathology. In addition, particulate… twitter.com/i/web/status/1…
Dr Clemens Ortner, MD continues the #Solshnider track, speaking on #POCUS in the #OBAnes emergency - How can we guide care? #SOAPAM2023
Deresuscitation has become more and more ubiquitous within ICU practice. But what tools can we use to do it? Over the next 2 Tweetorials, i’ll explain some pharmacological methods. Focussing on the JICS mix!
My talk from #ACCS2023
#FOAMed #POCUS #FOAMcc #medtwitter
My talk from #ACCS2023
#FOAMed #POCUS #FOAMcc #medtwitter
The brilliant paper in question is well worth a good read through. For both its novel description of combination diuretic therapy, and its golden descriptions of simple and complex fluid/renal physiology.
Here’s the infamous JICS mix:
journals.sagepub.com/doi/epdf/10.11…
Here’s the infamous JICS mix:
journals.sagepub.com/doi/epdf/10.11…
We know, universally, oedema on the ICU is contentious. Early goal directed therapy trials after Shoemaker, all demonstrated worse outcomes. Why?🤔
There were signals towards positive fluid balance and probably states of venous congestion in the treatment arms.
There were signals towards positive fluid balance and probably states of venous congestion in the treatment arms.
A summary thread from the great Emergency Medicine Australasia issue I finally read on the plane; @EMAJournal #foamed
Thom study in EMA: patients with unstable cervical #fractures can sit (29%), walk (63%), lack midline tenderness (27%), and have delayed presentation (20%).
Thom study in EMA: patients with unstable cervical #fractures can sit (29%), walk (63%), lack midline tenderness (27%), and have delayed presentation (20%).
@EMAJournal #emergencymedicine
surf injuries were mostly lower c-spine
NEXUS underperformed compared to Canadian C-spine.
#drowning and cervical CTs are not inextricably linked: don't automatically image unless signs of axial loading/very specific concerns
surf injuries were mostly lower c-spine
NEXUS underperformed compared to Canadian C-spine.
#drowning and cervical CTs are not inextricably linked: don't automatically image unless signs of axial loading/very specific concerns
@EMAJournal [my $0.02 on immobilising (virtually) anyone prehospitally: cervical immobilisation is a myth: collars don't actually immobilise, and 'immobilisation' doesn't actually prevent neurological injury...it *does* however harm (eg aspiration and other harms)]
Some excellent anatomic illustrations for friends who place central lines.
#POCUS #MedTwitter #Nephpearls #FOAMed
Courtesy: pubmed.ncbi.nlm.nih.gov/27521991/
1. Internal jugular vein (A. Transducer placement in short axis, B. long axis)
#POCUS #MedTwitter #Nephpearls #FOAMed
Courtesy: pubmed.ncbi.nlm.nih.gov/27521991/
1. Internal jugular vein (A. Transducer placement in short axis, B. long axis)
M mode in echo is a bliss
Gives a grt temporal resolution
ie.,Relation of structures with respect to time.
At times it's difficult to follow motion of valves in 2D
In this thread let's see about Mitral valve M MODE
A normal mitral valve M mode
#echofirst #pocus @pocus_today
Gives a grt temporal resolution
ie.,Relation of structures with respect to time.
At times it's difficult to follow motion of valves in 2D
In this thread let's see about Mitral valve M MODE
A normal mitral valve M mode
#echofirst #pocus @pocus_today
E &A are two positive waves due to opening of mitral leaflet
E - Early diastole due to LA LV gradient
A - Late diastole due to atrial contraction
C- closure of Mitral valve
D-End systole / Begining of diastole
F-Diastasis
B-Due to Elevated LVEDP in late diastole
E - Early diastole due to LA LV gradient
A - Late diastole due to atrial contraction
C- closure of Mitral valve
D-End systole / Begining of diastole
F-Diastasis
B-Due to Elevated LVEDP in late diastole
Mitral stenosis:
The EF slope is reduced
In earlier times Mitral stenosis severity was assessed with shallowness of the slope. More flatter the slope is , more severe the MS
This semiquantitative method of assessing severity is not used nowadays
A wave is lost in MS with AF
The EF slope is reduced
In earlier times Mitral stenosis severity was assessed with shallowness of the slope. More flatter the slope is , more severe the MS
This semiquantitative method of assessing severity is not used nowadays
A wave is lost in MS with AF
#POCUS quiz
1. What tracing did I obtain here?
2. What are some clinical scenarios where doing this would be helpful?
#IMPOCUS #MedEd #Nephpearls
1. What tracing did I obtain here?
2. What are some clinical scenarios where doing this would be helpful?
#IMPOCUS #MedEd #Nephpearls
#POCUS Answer: Pericardial effusion
Cannot comment on tamponade just from this view
Other views in 🧵below. No obvious chamber collapse.
Cannot comment on tamponade just from this view
Other views in 🧵below. No obvious chamber collapse.
Subcostal #POCUS
Some helpful illustrations of cardiac support devices for trainees and non-intensivist consultants like me rounding in the ICU.
🔗ccjm.org/content/84/4/2…
#Nephpearls #MedEd #MedTwitter
Also, good to be aware while performing #POCUS
🔗ccjm.org/content/84/4/2…
#Nephpearls #MedEd #MedTwitter
Also, good to be aware while performing #POCUS
ECMO illustrations #MedEd
Other relevant illustration: Left ventricular circulatory support devices
🔗 nature.com/articles/s4156…
a, The intra-aortic balloon pump uses counterpulsation to provide circulatory support and is commonly inserted via the femoral or axillary artery. b, Microaxial flow devices… twitter.com/i/web/status/1…
🔗 nature.com/articles/s4156…
a, The intra-aortic balloon pump uses counterpulsation to provide circulatory support and is commonly inserted via the femoral or axillary artery. b, Microaxial flow devices… twitter.com/i/web/status/1…
1/n #POCUS Acute right scrotal pain. Performed awaiting scrotal exploration. "Saddle view" from inferior poles to assess gross difference between echotexture
2/n The normal (Left) testis - shows normal internal septal architecture with pulsatile blood flow on color power doppler, with normal overlying skin thickness.
3/n Right testis is swollen, disturbed architecture with heterogenous echoes due to edema and absent flow on CPD
Reason # 76587 why lung #pocus is important: it can often give more information than CXR or CT Chest can. Case in point:
Elderly female on methotrexate and prednisone presenting with fever and cough.
Initial CXR:
Elderly female on methotrexate and prednisone presenting with fever and cough.
Initial CXR:
Read as "Bibasilar atelectasis." She was started on antibiotics. The following morning had abdominal pain and CT chest abdomen and pelvis ordered. CT chest seen here:
Grossly does not look too impressive. Radiologist read it as "no consolidations, scattered linear opacities." That afternoon seen by a physician skilled in lung #pocus. Left lung lateral lung seen here
ICU stories (a brief one): 60 yo male w lung cancer / CAD / HTN / HLD / status post chemotherapy a month ago presented to the ED w SOB/cough/weakness after failing outpatient tx w azithromycin. CT chest: no PE but positive for bilateral consolidations:
Patient came to the ICU intubated, sedated, on pressors & antibiotics for PNA. Next step: POCUS. PLAX looked "weird", so Doppler and "zoomed" views were recorded:
PSAX & subcostal views:
#POCUS question of the day?
1. What does this image show, and what mode of ultrasound was used to obtain it?
2. What is the E-point?
3. What is the A- point?
4. What is EPSS, and why do we use it?
Scroll down to learn how to interpret the image.
1. What does this image show, and what mode of ultrasound was used to obtain it?
2. What is the E-point?
3. What is the A- point?
4. What is EPSS, and why do we use it?
Scroll down to learn how to interpret the image.
Answer 1: The image above shows the mitral valve in M mode taken during the PLAX view at the MV leaflet tips.
Answer 2: During early diastole, the leaflets separate widely with the maximum early diastolic motion of the anterior leaflet termed the E-point
Answer 2: During early diastole, the leaflets separate widely with the maximum early diastolic motion of the anterior leaflet termed the E-point
Answer 3: During atrial contraction, the leaflets move towards each other in mid-diastole (F-point =diastasis) and then separate again with atrial systole, thus resulting in the late diastolic peak or the A point.
ICU stories (from the trenches): 70 yo pt w hx of A-fib/CAD/ICM w EF 25%/VT ablation s/p BiV ICD/CKD/HTN/HLD/peripheral vasc dz/COPD etc presented to outside 🏥 w SOB/weakness/falls. Labs: wbc 15k/creat 3.5 (baseline 2.0)/INR: 8.5/AST/ALT/Tbil: 180/250/3.0, lactate 3.5
RUQ US was obtained to work-up elevated LFTs:
Diagnosed w bilateral PNA/AKI/liver dysfunction. Treated for sepsis w ivf boluses, broad-spectrum antibiotics, steroids, bicarb. Continue to get worse; due to ⬆️O2 needs, transferred to our 🏥. I saw her the next am: in resp distress while on BiPAP 15/10-100%, abg 7.26/50/70/19.
Guideline summary for #ED docs on early pregnancy loss/miscarriage:
acog.org/clinical/clini…
10% of all #pregnancies end in #miscarriage, though the rate approaches 80% by maternal age 45yrs.
Half of early pregnancy loss (AKA miscarriages) are due to chromosomal abnormalities. 🧵
acog.org/clinical/clini…
10% of all #pregnancies end in #miscarriage, though the rate approaches 80% by maternal age 45yrs.
Half of early pregnancy loss (AKA miscarriages) are due to chromosomal abnormalities. 🧵
Crown-rump length (CRL) 7mm or greater and no heartbeat. Mean sac diameter (MSD) 25mm and no embryo.
Each one is an #ultrasound feature diagnostic of early pregnancy loss.
#POCUS
#medtwitter
Each one is an #ultrasound feature diagnostic of early pregnancy loss.
#POCUS
#medtwitter
80% of patients with early pregnancy loss can be safely managed with an expectant management (watch and wait) approach.
Relatively few miscarriages will require ED care; most of these will involve significant and symptomatic haemorrhage or infection.
Relatively few miscarriages will require ED care; most of these will involve significant and symptomatic haemorrhage or infection.
♂ 50 y. With pulsatile femoral mass. history of femoral puncture 💉.
1/4
#vasculardoppler #ultrasound #MedEd #FOAMed #POCUS #radiology @ButterflyNetInc
1/4
#vasculardoppler #ultrasound #MedEd #FOAMed #POCUS #radiology @ButterflyNetInc
2/4
Dx?
Dx?
3/4 Ying-yang , or pepsi sign described in both true and false aneurysms.
On Doppler ultrasound, the yin-yang sign indicates bidirectional flow due to the swirling of blood within the true or false aneurysm. twitter.com/i/web/status/1…
On Doppler ultrasound, the yin-yang sign indicates bidirectional flow due to the swirling of blood within the true or false aneurysm. twitter.com/i/web/status/1…
