Ernest Fischer, MD @EAFischer X Profile

Ernest Fischer, MD

@EAFischer

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https://t.co/GRX9ojiPZc

Washington, DC

Joined June 2018

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Ernest Fischer, MD

@EAFischer

3 years

Pinned tweet on 3D models, GIFs, #POCUS, physical exam, etc.

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Ernest Fischer, MD

@EAFischer

9 months

Join us for the next MedStar SiTEL @SocietyHospMed approved regional POCUS course in Washington DC, part of the POCUS Certificate of Completion March 17-20, 2024 https://t.co/Pfb098LzJr https://t.co/rmzQ53QVEq

Ernest Fischer, MD

@EAFischer

1 year

Just starting your POCUS journey? Consider joining our @SocietyHospMed approved regional POCUS course in Washington DC October 17-20, 2024 https://t.co/ewgAns3zzT

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NephroPOCUS

@NephroP

10 months

Vascular #POCUS review - @EAFischer and team https://t.co/bgUfdLVNId Lower extremity DVT #anatomy 👇 #FOAMed #Nephpearls

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Ernest Fischer, MD

@EAFischer

1 year

Bad math: 1) Know how a vertical dimension relates to the length up the neck at different angels a. 30 deg ➡️3 cm b. 45 deg ➡️2.1 cm c. 60 deg ➡️1.7 cm

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Ernest Fischer, MD

@EAFischer

1 year

Just starting your POCUS journey? Consider joining our @SocietyHospMed approved regional POCUS course in Washington DC October 17-20, 2024 https://t.co/ewgAns3zzT

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Ernest Fischer, MD

@EAFischer

1 year

2) Know how a 𝘃𝗲𝗿𝘁𝗶𝗰𝗮𝗹 𝗱𝗶𝗺𝗲𝗻𝘀𝗶𝗼𝗻 𝗼𝗳 𝟭.𝟱 𝗰𝗺 relates to the length up the neck at different angles a. 30 deg➡️3 cm b. 45 deg➡️1.5 cm c. 60 deg➡️2.6 cm

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Ernest Fischer, MD

@EAFischer

1 year

PS – What 𝗶𝗳 𝘆𝗼𝘂 𝗱𝗼𝗻’𝘁 𝗰𝗮𝗿𝗿𝘆 𝗮𝗿𝗼𝘂𝗻𝗱 𝗮 𝗿𝘂𝗹𝗲𝗿 or straight edges? Credit to @ria_dancel for this? 1) Know your probe’s dimensions

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Ernest Fischer, MD

@EAFischer

1 year

Why the gray area (uHJR 0.5 to 1)? (I think) Slight probe angulation can lead to a significant height difference e.g. For an IJV 2cm deep, △14 deg change in angle is a △0.5 cm difference!

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Ernest Fischer, MD

@EAFischer

1 year

How one might use uHJR? Useful cutoffs : 𝘂𝗛𝗝𝗥 ≥ 𝟭.𝟱 𝗰𝗺- positive 𝗟𝗥 𝟰.𝟯 𝘵𝘰𝘸𝘢𝘳𝘥𝘴 PCOP ≥ 15 mmHg 𝘂𝗛𝗝𝗥 < 𝟬.𝟱 𝗰𝗺- negative 𝗟𝗥 𝟬.𝟰 𝘢𝘨𝘢𝘪𝘯𝘴𝘵 PCOP ≥ 15 𝘉𝘦𝘵𝘸𝘦𝘦𝘯 𝘶𝘏𝘑𝘙 𝘰𝘧 0.5 𝘵𝘰 1 𝘸𝘢𝘴 𝘢 𝘨𝘳𝘢𝘺 𝘢𝘳𝘦𝘢 https://t.co/n4oLuutLx0

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Ernest Fischer, MD

@EAFischer

1 year

We found (via logistic regression) that while uHJR did not improve on uJVP for predicting RAP (p=0.27) 𝘂𝗛𝗝𝗥 𝗱𝗶𝗱 𝗶𝗺𝗽𝗿𝗼𝘃𝗲 𝗼𝗻 𝘂𝗝𝗩𝗣 𝗳𝗼𝗿 𝗽𝗿𝗲𝗱𝗶𝗰𝘁𝗶𝗻𝗴 𝗣𝗖𝗢𝗣 (p<0.001) and uHJR was a stronger predictor of PCOP (uHJR adjusted OR 2.6 vs. uJVP OR 1.2)

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Ernest Fischer, MD

@EAFischer

1 year

How well does POCUS for HJR perform (𝘂𝗛𝗝𝗥)? To answer this we had 2 students with basic POCUS training perform uHJR (and uJVD) on 99 patients immediately before RHC, results in @amjmed. https://t.co/dCqwiJpOt9

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Ernest Fischer, MD

@EAFischer

1 year

2) How HJR is performed: https://t.co/iupXPwxU2h

Ernest Fischer, MD

@EAFischer

4 years

4/ 𝗔𝗝𝗧 How to • Palpate anywhere mid-abdomen (RUQ not necessary, may be more painful) • Use even pressure (20-35 mmHg) for ≥10 s • Avoid Valsalva / pain – have pt breath calmly with mouth open • 𝗣𝗼𝘀𝗶𝘁𝗶𝘃𝗲 ➪ sustained increase ≥ 𝟰 𝗰𝗺 https://t.co/YOnfi8WS1D

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Ernest Fischer, MD

@EAFischer

1 year

Before we get into HJR with POCUS, primers on 1) POCUS Neck anatomy: https://t.co/m1VhPldFUn

Ernest Fischer, MD

@EAFischer

4 years

1/ 3D Models for introductory #POCUS of the neck This view is in the 𝗣𝗥𝗢𝗖𝗘𝗗𝗨𝗥𝗔𝗟 𝗰𝗼𝗻𝘃𝗲𝗻𝘁𝗶𝗼𝗻 with the probe marker to the 𝗼𝗽𝗲𝗿𝗮𝘁𝗼𝗿’𝘀 𝗹𝗲𝗳𝘁, if standing at the head of the bed

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Ernest Fischer, MD

@EAFischer

1 year

𝘗𝘚 - 2 𝘮𝘰𝘳𝘦 𝘮𝘰𝘥𝘦𝘳𝘯 PE 𝘴𝘵𝘶𝘥𝘪𝘦𝘴 𝘥𝘪𝘥𝘯’𝘵 𝘮𝘢𝘬𝘦 𝘪𝘵 𝘪𝘯𝘵𝘰 𝘔𝘤𝘎𝘦𝘦s 𝘳𝘦𝘴𝘶𝘭𝘵𝘴 𝘛𝘩𝘦 𝘢𝘣𝘯𝘰𝘳𝘮𝘢𝘭 𝘤𝘶𝘵𝘰𝘧𝘧 𝘧𝘰𝘳 𝘗𝘊𝘖𝘗 𝘪𝘯 𝘵𝘩𝘰𝘴𝘦 𝘴𝘵𝘶𝘥𝘪𝘦𝘴 𝘪𝘴 𝘩𝘪𝘨𝘩𝘦𝘳 (>22 𝘮𝘮𝘏𝘎) 𝘸𝘪𝘵𝘩 𝘮𝘪𝘹𝘦𝘥 𝘳𝘦𝘴𝘶𝘭𝘵𝘴

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Ernest Fischer, MD

@EAFischer

1 year

How well does HJR reflect left sided filling pressure? According to S. McGee’s pooled results, HJR has the 𝗯𝗲𝘀𝘁 𝗰𝗼𝗺𝗯𝗶𝗻𝗮𝘁𝗶𝗼𝗻 𝗼𝗳 𝗽𝗼𝘀𝗶𝘁𝗶𝘃𝗲 𝗟𝗥, 𝗻𝗲𝗴𝗮𝘁𝗶𝘃𝗲 𝗟𝗥 𝗮𝗻𝗱 𝗿𝗲𝗽𝗿𝗼𝗱𝘂𝗰𝗶𝗯𝗶𝗹𝗶𝘁𝘆. https://t.co/1FNneJQJj6

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Ernest Fischer, MD

@EAFischer

1 year

That’s the history. Today it is well established that 𝗛𝗝𝗥 𝗿𝗲𝗳𝗹𝗲𝗰𝘁𝘀 𝗹𝗲𝗳𝘁 𝘀𝗶𝗱𝗲𝗱 𝗰𝗼𝗻𝗴𝗲𝘀𝘁𝗶𝗼𝗻 (in patients with heart failure) https://t.co/MWJkcDgaSh

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Ernest Fischer, MD

@EAFischer

1 year

It is not until 1957 (𝘵𝘩𝘢𝘵 𝘐 𝘤𝘰𝘶𝘭𝘥 𝘧𝘪𝘯𝘥) that HJR is described as “present with heart failure of all etiologies”. https://t.co/CMhEsaFXk6

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Ernest Fischer, MD

@EAFischer

1 year

In 1925 Lian (professor) and Blondel (intern… wonder who did most of the work 😂 ) reported that 𝗽𝗿𝗲𝘀𝘀𝘂𝗿𝗲 𝗰𝗼𝘂𝗹𝗱 𝗯𝗲 𝗮𝗽𝗽𝗹𝗶𝗲𝗱 𝗮𝗻𝘆𝘄𝗵𝗲𝗿𝗲 𝗼𝗻 𝘁𝗵𝗲 𝗮𝗯𝗱𝗼𝗺𝗲𝗻, not just the liver, to get the response

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Ernest Fischer, MD

@EAFischer

1 year

Pasteur (not Louis) first described HJR as a sign of TR in 1885 Rondot in 1898 actually coined the phrase HJR and noted that it didn’t just reflect TR

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Ernest Fischer, MD

@EAFischer

1 year

𝗛𝗲𝗽𝗮𝘁𝗼-𝗷𝘂𝗴𝘂𝗹𝗮𝗿 𝗿𝗲𝗳𝗹𝘂𝘅(HJR) History, utility and how well does it perform 𝘄𝗶𝘁𝗵 𝘂𝗹𝘁𝗿𝗮𝘀𝗼𝘂𝗻𝗱 a thread

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NephroPOCUS

@NephroP

1 year

Principle of mass conservation: in the absence of valvular regurgitation/ intracardiac shunts, stroke volume is the same across each valve or orifice. #POCUS #echofirst #MedEd #Nephpearls

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