NephroPOCUS
@NephroP
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Point-of-care ultrasound #POCUS 📖 | by Abhilash Koratala MD @KoraAbhi , Associate Professor #Nephrology @MCW_Nephrology I👨🏻✈️ @POCUSIAPN | X≠ medical advice
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Pinned Tweet
Time to update the
#VExUS
resources pinned thread 🧵📌
1/ Tweetorial on image acquisition.
#POCUS
#MedEd
#POCUS
#MedTwitter
#Nephpearls
Many
#VExUS
enthusiasts asked for a
#tweetorial
on image acquisition pearls. Did one b4 but time for an updated one 🧵
#1
Let's start with basics
Color Doppler identifies the flow + tells the direction (blue is away & red towards the probe [BART])
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Some excellent anatomic illustrations for friends who place central lines.
#POCUS
#MedTwitter
#Nephpearls
#FOAMed
Courtesy:
1. Internal jugular vein (A. Transducer placement in short axis, B. long axis)
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A young woman recently diagnosed a periosteal femoral mass presented with dyspnea and pleuritic chest pain, and a chest x-ray was done. What is the likely diagnosis?
Answer: 🔗
#MedEd
#radiology
#chestxray
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#xray
obtained from an elderly patient.
What is this interesting finding?
#MedEd
#FOAMed
Image courtesy:
@DrGalenMD
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Basic cardiac
#POCUS
views image acquisition flash cards.
Courtesy of Philips Healthcare
#MedEd
#Nephpearls
#echofirst
🧵
1/
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Venous anatomy of the lower extremity.
Click ‘ALT’ for figure description
🔗
#POCUS
#MedEd
#Nephrology
#FOAMcc
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Excellent
#echofirst
illustration depicting the relationship between cardiac cycle, Doppler parameters and M-mode at the mitral valve level.
#MedTwitter
#POCUS
#Nephrology
Courtesy🔗
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#MedEd
image of the day:
learned a new analogy - 'lung on fire' appearance caused by diffuse calcified pleural plaques secondary to chronic asbestos exposure.
#Medicalstudent
#radiology
Image: radiopedia
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#POCUS
#MedTwitter
#Nephpearls
Many
#VExUS
enthusiasts asked for a
#tweetorial
on image acquisition pearls. Did one b4 but time for an updated one 🧵
#1
Let's start with basics
Color Doppler identifies the flow + tells the direction (blue is away & red towards the probe [BART])
35
498
1K
60+ person presents with shortness of breath. Worked as manual laborer for several years. What does this
#xray
demonstrate?
#MedEd
#radiology
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#POCUS
guided central venous catheter placement (short axis): manipulation of the needle and confirmation of the tip in the vessel.
Click 'ALT' for figure description
Source
#MedEd
#FOAMed
#Nephpearls
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Graphic representation of
#echofirst
parameters in the assessment of right ventricular failure.
Click on 'ALT' for abbreviations
#POCUS
#MedEd
#IMPOCUS
🔗
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Beautiful illustrations of basic cardiac
#ultrasound
views.
#POCUS
#FOAMed
#MedEd
#Nephpearls
By Dr. Veltman/Faris
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Simplified pathophysiologic representation of cardiogenic and non-cardiogenic
#pulmonaryedema
.
🔗
#MedEd
#POCUS
#Nephrology
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A 25-year-old pregnant woman developed severe dyspnea soon after leg and foot massage, and suffered a cardiac arrest. 👇
#POCUS
#echofirst
Likely diagnosis?
See thread for the answer/source
#MedEd
#IMPOCUS
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Another set of cardiac
#POCUS
#anatomy
illustrations. 🧵
#Nephpearls
#FOAMed
Source:
1⃣ Parasternal long axis
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Routine pre-op
#Xray
obtained from a 55-year-old man who worked as a gemstone cutter for more than 20 years. What is it showing?
#MedEd
#radiology
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#echofirst
#POCUS
image of the day:
Accessing superior vena cava though transthoracic windows is difficult but not impossible. Here are 3 must-know windows.
SVC Doppler is helpful when intra-hepatic vessels are unreliable (extended (e-)
#VExUS
).
#FOAMcc
🔗
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Extensive chest wall collaterals in a
#dialysis
patient with chronic superior vena cava syndrome. H/o multiple central venous catheterizations.
(Image from one of my old case reports)
#MedTwitter
#Nephrology
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1/ Thought of doing a quick
#tweetorial
on image acquisition for
#POCUS
friends starting to do
#VExUS
It's kind of "how I do it" guide and not necessarily optimized for research.
1st: Look at the IVC in both long and short axes
If big, do further scans 👇
#MedEd
#FOAMed
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Nice figure illustrating the basic
#echofirst
views and transducer position from our friends at
@ASRA_Society
🔗
#POCUS
#IMPOCUS
#Nephrology
#MedEd
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Classic Chest
#Xray
Signs of Congenital Cardiovascular Abnormalities.
Interesting article 📖👇🏼
🔗
#MedEd
#radiology
#criticalcare
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Comprehensive infographic illustrating standard transthoracic
#echofirst
views.
From:🔗
#POCUS
#MedEd
#IMPOCUS
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#Hyponatremia
algorithm:
If serum Na is low, osmolality should be low. If not, exclude osmotically active substances (e.g. hyperglycemia) and pseudo hyponatremia. After that, most helpful parameter is physical exam (=
#POCUS
#VExUS
).
#MedEd
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What's happening here?
History: Middle-aged patient with a history of anterior myocardial infarction one year ago.
Answer and source will be posted in a few hours.
#echofirst
#POCUS
#MedEd
#IMPOCUS
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Another FAST infographic (focused assessment with sonography in trauma)
From 🔗
#POCUS
#MedEd
#anesthesia
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Graphic representation of
#echofirst
parameters in the assessment of RV failure.
DTI, Doppler tissue imaging; ET, ejection time; FAC, fractional area change; IVCT, isovolumic contraction time; IVRT, isovolumic relaxation time
#MedEd
#POCUS
#IMPOCUS
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#POCUS
basics:
#Hydronephrosis
appears as branching, interconnected anechoic area in the renal collecting system.
Qualitative grading👇
Image courtesy: Sheehan KN, et al. Open Journal of Internal Medicine, 2022, 12, 1-12
#IMPOCUS
#Nephrology
#MedEd
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#echofirst
#POCUS
image of the day:
Long axis and short axis views of the left ventricle demonstrating coronary artery territories as well as 17 myocardial segments (to identify regional wall motion abnormalities).
From 🔗.
#MedEd
#IMPOCUS
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LVOT VTI-based algorithm in hemodynamic
#shock
#POCUS
#FOAMed
#Nephpearls
Click ‘ALT’ for abbreviations
Courtesy 🔗
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Beautiful drawings of the basic
#echofirst
views by Drs. Veltman & Faris (4 slides).
#POCUS
#FOAMed
#FOAMcc
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#POCUS
#IMPOCUS
#Nephrology
image of the day:
Back to basics of lung
#ultrasound
: A-lines and B-lines
See 🧵for brief explanation.
#MedEd
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Normal
#anatomy
of the heart and major thoracic vessels with correct positioning of various lines.
(IABP = intra-aortic balloon pump)
Courtesy:
#MedEd
#xray
#radiology
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Simplistic representation of Pathophysiology of
#cardiorenal
disease.
Do not ignore the venous congestion component. Use
#VExUS
#POCUS
to gather objective data.
#MedEd
#Nephrology
🔗
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Principal pathogenic mechanisms of
#AKI
in the context of sepsis or major surgery.
Use
#POCUS
to identify & monitor hemodynamic AKI
#Nephrology
#MedEd
From: 🔗
DAMPs = damage-associated molecular patterns
PAMPs = pathogen-associated molecular patterns
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Systemic consequences of pulmonary hypertension and right-sided
#HeartFailure
🔗.
#MedEd
#POCUS
#FOAMed
CVP = central venous pressure; GI = gastrointestinal; LMCS = left main compression syndrome; PA = pulmonary artery, RAP = right atrial pressure
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Now that we have several
#VExUS
#POCUS
resources from different educators, I'm going to put them together as a thread and pin to my profile
#IMPOCUS
#FOAMed
1/ Recent case showing improvement in Doppler indices (helped guiding decongestive therapy in a pt. with minimal symptoms)
Time to follow up on
#VExUS
#POCUS
Today's images will demonstrate the improvement in congestion with IV diuretic therapy.
#tweetorial
1/ Portal vein - note the pulsatility is ~55% (<30% taken as normal) & the whole waveform is above the baseline now = improvement!!
#IMPOCUS
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#echofirst
windows and views
Very nice illustration if you have patience to go through it!
#POCUS
#Nephpearls
#FOAMed
#MedEd
Source: Bulwer BE, Thoracic Key
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#POCUS
illustration of the day:
Parasternal short axis, slicing through various levels.
#MedEd
#echofirst
#FOAMcc
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