Pulmonary-POCUS

What is the short clip challenge? Check out this clip from our 2024 @IUSMDeptMed Grand Rounds. Are you ready to take the challenge? sign up here-->pulmonarypocus.com/contact-us @NephroP @IUPCCM @OSUPCCM_Fellows @accpchest @POCUSJournal

🫀 Ready to level up your critical care echo skills? The NY-Advanced CCE Fellow’s Course by @HaraldPOCUS is back — June 11–12, 2026 in Valhalla, NY. ✅ Live scanning on real models ✅ Doppler mastery ✅ RV, diastology, valvular disease, shock states ✅ Tiny fellow:faculty ratio Perfect prep for your CCeXAM image portfolio. 🔗 bit.ly/3MWDHNe #CriticalCare #POCUS #MedEd #Cardiology #FellowsOnly

Interface 1 right here! pubmed.ncbi.nlm.nih.gov/40423078/

@YubSedhai @nickmmark Largely self directed as well. Great points all around. We need to be the change we want to see in our profession!

Exactly, Nick, I honestly feel that the professional organizations like CHEST and ATS should form a dedicated network and promote ultrasound education within the critical care community. Also, programs should offer a focused track for fellows who develop an interest in ultrasound.

My learning in critical care echocardiography was largely self-directed. I was the first fellow in my program to take the Critical Care Echo boards. What surprised me during job interviews was the dismissive attitude toward it, from community hospitals to major academic powerhouses.

.@nephrothaniel emphasizes that #POCUS courses are just the starting point, not a substitute for longitudinal deliberate practice. #SWNC2026 #Nephmadness

always assume transcutaneous pacing isn’t reliably capturing until PROVEN otherwise the primary therapeutic mechanism of transcutaneous pacing is to irritate the patient sufficiently that their endogenous catechols keep them alive 🫠

2/2 Key Points Use the subcostal short-axis view to visualize the main pulmonary artery bifurcation. You can identify this as a subcostal view because the liver is used as the acoustic window. From the subcostal window, rotate the probe into a short-axis orientation (transducer indicator at the 12 o’clock position) and angle the probe superiorly toward the patient’s left shoulder. This allows visualization of the main pulmonary artery (MPA) as it exits the right ventricular outflow tract (RVOT) and divides into the right and left pulmonary arteries. In this view:The right pulmonary artery typically runs more horizontally, coursing toward the patient’s right side (toward the liver).The left pulmonary artery usually angles posteriorly and slightly inferior, making it appear deeper on the screen.Thank you for taking the challenge. Stay tuned for your next chance to take the challenge.

1/2 Congratulations to this weeks short clip challenge winner! Megan Mcintire from IUSM Med-Peds Q1:What view is? A2: Sub-costal short axis Q2:What structure us represented by the letter B? A2: Right pulmonary artery

Interesting bubble #echofirst image What does it demonstrate? What is the likely diagnosis? #POCUS #Nephmadness Source: J Cardiothorac Surg. 2024;19(1):175. doi: 10.1186/s13019-024-02709-8.

#JADEL New in CASE @CASEfromASE doi.org/10.1016/j.case… 23M; serial TTEs; D1, D4 & W6. No fever. Culture neg. Newly diagnosed (deadly) large testicular mass: A. Non-bacterial thrombotic endocarditis B. Primary cancer C. Infective endocarditis D. Secondary cancer @ASE360

Check out this weeks trial bites. The alveolar recruitment trial. pulmonarypocus.com/trial-bites-bl…

Interesting pediatric case of SLE from @OungSavly Clot formation/thrombosis in the jugular veins can be also associated with heart failure @HoosierPocus @RJonesSonoEM #echofirst adult in cardiogenic shock, not intubated, undergoing Impella implantation

@alex1708ander These are awesome images

TG RV in-out view (TEE) is horizontally mirrored to the subcostal SAX view (TTE) #echofirst shows how to get the TG RV in-out view in 3 steps TG RV in-out view is appropriate for PV & RVOT functional interrogation with Doppler (color & spectral)

Big congratulations to our current Chief Pulmonary and Critical Care Fellow, Matthew Coughlan MD (@MCTrilaudid)! 🎉 ​We are thrilled to announce that after completing his tenure as Chief Fellow, Matt will be joining the faculty in Pulmonary and Critical Care Medicine starting July 2026. ​In his new role as the ICU Point of Care Ultrasound Liaison at @IUBloomington , he will continue to share his wealth of ultrasound knowledge by teaching POCUS to students, residents, and faculty. ​A well-deserved promotion for an incredible educator and clinician. Congratulations, Matt! ​#POCUS #MedicalEducation #IUBloomington #PulmonaryCriticalCare #Ultrasound #MedEd #NewFaculty

Good morning! ☀️ Welcome to this week's $5 short clip challenge 🎥. Here is question 1 of 2: 🤔 What view is this? Click the link below and select week #94 to take the challenge pulmonarypocus.com/short-clip-cha… @NephroP

@essadii Here is a case we published on this. The more we do resuscitative TEE, the more we see this phenomenon pmc.ncbi.nlm.nih.gov/articles/PMC12…

TEE guided CPR?? Very interesting. CPR apparently causing LVOT obstruction, hand position changed and ROSC achieved.

2/2: Cardiac Shunt: Appearance of bubbles in the left atrium within the first 3 to 5 cardiac cycles after opacification of the right atrium indicates an intracardiac shunt. Extracardiac Shunt: Delayed appearance of bubbles in the left atrium after > 3 to 5 cardiac cycles indicate an extracardiac shunt. Shunt Severity Based on Bubble Count Shunt severity based on bubble count is as follows: Mild: 3 to 10 bubbles in the left atrium Moderate: 11 to 30 bubbles in the left atrium Severe: > 30 bubbles or complete opacification of the left atrium. Right-to-left shunting happens when right atrial pressure exceeds left atrial pressure, something we see with pulmonary hypertension or acute right ventricular strain. When done correctly, an agitated saline bubble study is a quick bedside test that can help explain persistent hypoxemia and immediately clarify whether shunt physiology is contributing to the problem. To learn about how to perform a bubble study take a look at this case by Heather Andrade with the bubble study tutorial by Brooke Jackson See the case & video here: chestcc.org/article/S2949-… Look at Video # 4 for the bubble study tutorial.

1/2: Congratulations to this week’s Short Clip Challenge winner, Divya Minnaganti from IUSM Internal Medicine-Pediatrics! Divya, enjoy a cup of coffee on us. We had 64 total responses Q1: During an agitated saline study, microbubbles appear in the left atrium within 3 cardiac cycles after opacification of the right atrium. This finding is most consistent with: A2: Intracardiac right to left shunt Q2: Which physiologic condition most directly allows deoxygenated blood to cross from the right atrium into the left atrium during a bubble study? ? A2: Right atrial pressure exceeding left atrial pressure @NephroP

@AycanErkan10 @HoosierPocus @NephroP @ross_prager TEE as an adjunct during in-hospital CPR is used to optimize the efficiency, quality and eventually outcome of CPR/ECLS.

@saenger_david @alex1708ander @NephroP @ross_prager Yes, chest compression malpositioned compressing the aorta

@HoosierPocus @alex1708ander @NephroP @ross_prager Is the aorta being squeezed? I haven’t seen tee during CPR much. Looks strange

You're called to a cardiac arrest, which has been going on for 10 minutes, end tidal CO2 is 6. Chest compressions appear to be of good quality. You place the TEE probe in the mid esophageal long axis and get this clip. What would you change? @alex1708ander @NephroP @ross_prager @RJonesSonoEM

@zaidheartsci @NephroP Lol we do it at the same time

@NephroP TEE during arrest? Optimizing compressions would improve that ETCO2 faster than pretty images. Priorities.

Trying to help with all your heart….but unknowingly blocking the way forward. #POCUS