NephroPOCUS

Time to update the #VExUS resources pinned thread 🧵📌 1/ Tweetorial on image acquisition. #POCUS #MedEd twitter.com/NephroP/status…

A lesser known pitfall - maintain head in neutral position when doing IJV #POCUS, not to the side. 🔗sciencedirect.com/science/articl…

@MDBeni @AthaydeEco @khaycock2 But I have inverted it to be easier on eyes for transthoracic folks 👀

@NephroP @AthaydeEco @khaycock2 This is the S-Dr-A pattern. This shape appears when hepatic blood flow is measured through the esophagus, as the direction of blood flow is opposite to normal.

It may also be difficult with EKG.

Doppler helps, especially when the vessel is dilated and we are unsure whether the dilation truly reflects elevated right atrial pressure or is simply due to factors like mechanical ventilation, head position, neck rotation, etc. Usually, getting a good waveform is harder when the vessel is small and collapsing because the waveform gets disrupted as the vein collapses. In contrast, when the vessel is dilated, obtaining a waveform is relatively easier. So in this case, even though the IJ vein itself appears dilated, the fact that the S wave is still greater than the D wave is pretty reassuring that the right atrial pressure is probably not significantly elevated.

Doppler analogue of the CVP waveform! Internal jugular vein #eVExUS #VExUS #POCUS

🚨 Impella-induced profound LV unloading may lead to low LA pressure with dynamic LAA inward displacement (invagination) potentially increasing the risk of mobilization of a pre-existing LAA thrombus #echofirst ⚠️

@Mohamme97550332 Venous congestion x.com/NephroP/status…

@NephroP Arterlisation?

Femoral vein Doppler - elevated stasis index diagnosed without pulsed wave Doppler!! #VExUS #ColorVExUs #POCUS

or “echoscope” as they used to call it in the 1960s youtu.be/CadQMbAJsCI?si…

#funfact In the era of #POCUS, 🩺 is also known as “wheeze detector” 👀

@alex1708ander assuming there is no S-D fusion 😆

@NephroP A small excuse for those who don’t use ECG during echo: when you see two ❤️❤️ very close to each other, the first one is usually systole (S)

Normal hepatic vein flow profile in TEE Color-M-Mode, diagnosed without pulsed wave Doppler #echofirst Normal hepatic vein flow components👇 ❤️❤️💙 = S, D, AR - normal ❤️💙❤️💙 = S, V, D, AR - normal Shorthand rule: in normal flow profile = S is ❤️

@NephroP Yes, exactly. Performing echo without ECG is like driving a car without tires 🛞 - that’s how I teach echo ☺️ The only exception I accept is during CPR or immediately beforehand #echofirst

PWD

#POCUS answer: About 40% of poll respondents got this wrong 🤔 The correct answer is that this vessel is part of the portal system, specifically the right portal vein. At the main portal vein bifurcation, the color of each branch simply depends on the direction of blood flow relative to the transducer. As you know, blue means flow away from the probe and red means flow toward the probe. It has nothing to do with the intrinsic nature of the vessel itself - whether it’s portal venous, hepatic venous, or arterial. The key is understanding the anatomy rather than relying colors alone to identify vessels. The image shared here actually represents fairly typical anatomy, although variations can happen depending on probe angle and orientation

Doc 1: I did #POCUS. EF is great. I’m done! Doc 2: Wait… do you want to comment on the LV wall thickness? Could it have implications for fluid therapy? (e.g. associated diastolic dysfunction, SAM depending on the clinical context). What about cardiology referral for further imaging or genetic testing? #Nephpearls #FOAMed

#POCUS Excited to share How #VExUS can be useful in assessing venous congestion in lung transplants! Check Portal Vein Doppler !!! Game changer to improve outcomes in 🫁 TX ‼️ 🔥 👉 mattioli1885journals.com/index.php/theu… @WINFOCUS @pandompatam 🙏 @drprash89 @nathanhwaldron @ISHLT @pmgjones