Mabusi

Extending my gratitude to @ross_prager @arntfield for letting me come to London and see the great things you’re doing with point of care ultrasound (POCUS). I truly appreciate your KINDNESS, HUMILITY and willingness to share your wisdom and knowledge. #pocus #hemodynamics #vexus

Our VESPER team, led by Dr. @john_basmaji have recruited the first two patients into our RCT of venous congestion guided resuscitation in septic shock!! Our goal is to understand how venous congestion can be used to guide decisions surrounding fluids, inotropes, RV support in septic shock. Focus for VESPER right now is feasibility but we have already recruited two patients in the first week live!

@ross_prager I use POCUS for patients with SSTI, sometimes ruling out an abscess by feeling fluctuation can be challenging. US gives me more confidence.

Admittedly, I am not the biggest fan of using POCUS for cases of suspected necrotizing fasciitis. The sensitivity is poor (e.g. looking for fascial thickening/fluid or gas) BUT in select cases, the specificity for subcutaneous air is great. This case was suspected cellulitis with high lactate. No palpable crepitus. The subcutaneous tissue shows A-lines, which are lung artifacts typically seen in the thorax. When you see them elsewhere i the body, this means air. In the case of suspected necrotizing fasciitis, it means air in the tissue. Will I routinely use POCUS for suspected nec fasc. No. Will I consider it it in select cases where there is significant diagnostic uncertainty, yes. Anyone else have soft tissue POCUS pearls?

Clinicians can enhance patient understanding by using numerical data instead of verbal probabilities, consistent denominators, absolute risk comparisons, and clear context for unfamiliar data types. ja.ma/4aKdivK

(1/3) What's the worst trend in POCUS for 2025? Ultrasound to measure the height of the jugular venous pressure. In fact, this might be the worst trend in POCUS ever👇

Do you have an innovative way to teach or an interest in publishing #MedEd scholarship? 📚🩺 I was honored to join the @ATSMedEd webinar to discuss how to craft and publish "How I Teach" papers for @ATSScholar and other educational journals. Great insights shared with @CardsNYC, Yuri Matusov, and Abi Kumaresan ! Watch the full session here: youtu.be/7JiM-1TggR8 🎥 #MedTwitter #FOAMed #FacultyDevelopment #Scholarship

Patient with fevers, dyspnea, and hemoptysis. You place the echo probe and see this 😰 What's the diagnosis? Here are some tips as an echo-loving ICU doc👇

Comparison of #POCUS -based methods of jugular vein and inferior vena cava for estimating CVP #FOAMed #Nephpearls 🔗pmc.ncbi.nlm.nih.gov/articles/PMC45…

in thyroid storm, treating sinus tach with a beta-blocker will occasionally cause death many patients have reduced LVEF & compensatory tachycardia (borderline cardiogenic shock) beta-blockers push them over the edge what data supports B-bl in thyroid storm? why do this?

A few thoughts on pericardial tamponade: 1. Clinical Diagnosis that is NOT binary - exists on a spectrum of symptomatic effusion to hemodynamic collapse. 2. Hypotension is a LATE finding when compensatory mechanisms overwhelmed - be wary of normotensive shock. 3. Congestive injury is present before forward flow is impaired from the PCE --> we have a great case report that is being reviewed of a PCE with severe venous congestion that is improved by pericardiocentesis, when there are no features of tamponade. 4. Echo features suggestive of tamponade include: - Pericardial effusion (remember, smaller effusions that appear quickly can cause tamponade) - RV diastolic collapse - RA systolic collapse - Dilated IVC - Excessive MV and TV inflow variation - Low LVOT VTI (not a classic one, but hugely valuable as a sign of shock early) - VTI variation (an echo correlate to pulses paradoxus where LVOT VTI is a surrogate for SV which causes the BP variation seen in pulses) 5. Drainage should be done before the patient is in extremis - ultrasound useful to landmark best approach, but most clinicians do not use realtime needle guidance (some do, but most landmark with U/S) 6. Be wary of draining larger chronic effusion to quickly, especially if there is a degree of RV dysfunction. Rapid drainage can decompensate RV failure 7. Regional tamponade (e.g. post cardiac surgery) is a different beast - search chamber by chamber carefully in 2 views (on TEE) to identify chamber collapse. Isolated RA / LA tamponade common and can cause atypical hemodynamic tamponade compared with circumferential PCE See this example of regional tamponade with RA clot here. What other pearls am I missing?

1/🚨NEW #BehindTheScenesInterview: What is “Fluid Tolerance” and how can VExUS help guide us? Don’t forget- strong basic POCUS skills are essential before using VEXUS ‼️ 🎥:m.youtube.com/watch?v=A9obNM… 🎥: youtu.be/jmRXi7lPN-U 🖥️:coreimpodcast.com/2025/11/26/ven…

New Pulm PEEPS Pearls episode out today about the use of methylene blue in septic shock! Listen here: pulmpeeps.com/2025/11/25/111…

2025 has been a tough year for me professionally - here are some of the thing's I've learned🧵 Fail fast Listen to your gut Do Less = More Focus Productivity is not impact If you never give up you never lose Stay on the steep part of the learning curve Automated, Delegate, or Deprecate as much as possible

@jmartinezo93 @accpchest @lincolndepmed Felicidades Papá 🙌🏾

Monday News: 🥳 Honored to receive the Top Rapid-Fire Case Report Award in the Rare and Disseminated Mycobacterial Infections session. Many thanks to @accpchest for the opportunity and recognition.

(1/x) For venous congestion, it turns out that the same Doppler pattern can have different prognostic and therapeutic significance depending on the underlying cause. These have been coined congestive 'endotypes'. Here's how I think about them👇

1/ 🚨 NEW episode on venous congestion & the VExUS score 💧 Venous congestion is a century-old concept, but modern tools now allow clinicians to detect, quantify, and monitor it ‼️ 🖥️: coreimpodcast.com/2025/11/19/ven…

📊 Research Summary: Adults with #AFib who drank at least one cup of caffeinated coffee daily after successful cardioversion had a lower risk of recurrence than those who abstained from coffee and caffeine. #AHA25 ja.ma/3WKyFVq

FOCUS signs associated with Tamponade #useit #POCUS

Congratulations to this week's winner Hilary Kleppel from IUSM Internal Medicine/Pediatrics. Congratulations Hilary enjoy a cup of coffee on use! Here is a recap of this weeks metrics We had 102 responses! Q#1: The TEE shows aortic regurgitation 92% got this correct !!!! Q#2: The arterial line wave form shows Pulsus bisferiens 76% got this correct Pulsus bisferiens is a physical exam and arterial waveform finding characterized by two distinct systolic peaks within a single cardiac cycle. The term "bisferiens" comes from Latin, meaning "twice beating." It is most commonly appreciated in the carotid or peripheral arterial pulse and can be visualized on arterial line waveforms or Doppler studies

ICU community is like: “there are no positive studies, we need to stop focusing on outcomes like mortality”. Andromeda-Shock2 shows reduction in vital support and in a well done RCT that is highly generalizable to most septic patients worldwide. ICU community is like “well where are the KM curves showing mortality reduction…” I guess no winning eh?