The hardcover version of The POCUS Textbook is officially released!!!! Get a copy: https://t.co/aJVN3Nkc27 🏥100+ Figures without abbreviations 💊Dozens of videos accessible by QR code with NO passwords and NO paywalls 🩹Step-by-step tutorials by Dr. Istrail for all experience

Get a copy of The POCUS Textbook and see why it is the #2 in the Pulmonary Medicine category! https://t.co/llKiG1hO7U

To learn how to evaluate a patient using #pocus and acquire cardiac views and RVOT Doppler during a physical exam, get a copy of The POCUS Textbook in Kindle or Hardcover: https://t.co/rUIHxzzWr4

Mid-systolic notching is present, which is highly specific for pre-capillary pulmonary hypertension. After further workup, this patient's syncope was in fact due to newly diagnosed CTEPH, exacerbated by her dehydrated state.

Pulmonary hypertension due to "pre-capillary" causes and high pulmonary vascular resistance usually causes a "mid-systolic notch" to appear, while pulmonary hypertension due to left heart disease does not. Here is the patient's RVOT Doppler:

We can examine the blood flow exiting the right ventricle into the pulmonary artery with pulsed-wave Doppler, which can provide key insights into the potential cause of pulmonary hypertension.

The parasternal short axis view confirms a very enlarged right ventricle and flattening of the interventricular septum, causing the "D sign." This is consistent with pulmonary hypertension but does not provide insight into the cause. Recall that there could be "pre-capillary"

The parasternal long axis view of the heart shows a thickened left ventricle and a right ventricle that appears larger than the left ventricle. This is always an abnormal finding and suggests there is more to the diagnosis than just dehydration.

The right IJ is collapsed, suggestive of low or normal right atrial pressure. This could be consistent with a dehydrated state. Pulsed wave-Doppler of the common carotid artery shows a normal waveform with a peak systolic velocity of nearly 75 cm/s. This is a normal finding

Reason number 78987 why #pocus is important: The admitting diagnosis is not always right. This was a young patient who presented with syncope. She had just overcome a GI illness with diarrhea and vomiting and presented to the emergency department. She was tachycardic and

Learn ins and outs of using #pocus to diagnose pneumonia from @Dr_larryi 's internal medicine grand rounds. https://t.co/GRjSPuuQNl #foamed #meded

@dr_larryi To learn how to calculate jugular venous pressure at the bedside, get a copy of The POCUS Textbook, in Kindle or Hardcover. https://t.co/wvvnQ93Q4S

@dr_larryi This is then added to the vertical distance of the blood column in the jugular vein to estimate the right atrial pressure. https://t.co/b9KM1aFKqv

Without #pocus, there is no way to measure this distance at the bedside. @dr_larryI et al showed that you can measure the right atrial depth using ultrasound and then estimate an actual value of the JVP within 3 mmHg in most patients. As shown in Figure 6 from The POCUS

While 5 centimeters is a reasonable estimate, we now know from CT scans that the distance ranges from about 5 to 15 centimeters depending on smoking status or body habitus. So, using the 5-centimeter assumption in a patient with a depth of 15 centimeters could underestimate their

It originated from this 1946 paper. They wanted to select a reference point that passes “somewhere through the heart itself and at the same time bear a reasonably constant relationship to an external landmark,” such as the top of the sternum. With the patient lying flat on

When evaluating the jugular venous pressure (JVP), we are classically taught to first estimate the height of the blood column in the internal jugular vein, then add this to 5 centimeters, the presumed depth of the right atrium. But, where did this 5-centimeter measurement

To learn more about the history of DVT diagnosis, incidence in different populations, and how to perform a DVT exam at the bedside with #pocus, get a copy of The POCUS Textbook on Kindle or Hardcover: https://t.co/bIyoCDY7Hn

While it is not clear exactly why this is the case, it suggests we should be more suspicious of DVT/PE in the winter months. Here is an example of a #pocus DVT exam. Perpendicular pressure is applied in the thigh. The femoral vein is not compressing as it should, a sign of a

And in a study of Italian patients from Ferrara, Italy, between 1998 and 2002, DVTs peaked in January and February and reached their lowest incidence in July. https://t.co/UXbyIOhgxX

This was also seen in DVTs diagnosed in Sweden between 1987 and 2010. As shown below, June and July had the fewest DVTs, while January and February had the most. https://t.co/OcJuHwJWDh