After a hiatus of one day welcome back to day 25th of #scanuary!

It's a month-long marathon of daily tweetorials about #POCUS & its uses

Today we're going to discuss primary survey in non-traumatic shock and use of shock scanning

x.com/i/status/201...

It has been a long time since I read journal index and thought 'actually I would really like to read almost all of those'.

Ischaemic pain has very different cytokine profile from inflammatory. I had a similar experience with microperforation after stone stuck in neck. I worry that necrotic appx can also present like this.

Well, you have to learn to chat as you scan so that you don't lose time. And you use your words to comfort the patient (no matter what you see) and your movements measured and,soothing never abrupt....Every interaction should be therapeutic. "Ah I can see that his heart has served you well"....

PoCUS does not so much change my plan as create it in the beginning- It is my examination on almost every patient. I think it is vital to avoid early closure. When I have time I like to glance and most systems and ask 'where is redundancy' and 'where have we reached capacity'?

A new study assessed the environmental impact of ultrasound.👇
buff.ly/vZk3peS

#radiology #ultrasound

Is it really true that LUS predicts worsening renal function, while measures of venous congestion and right heart function do not? Unlikely. Rather, this is a good teaching example of P-fracking and unfair competition. Follow for my thoughts 👇 #pocusky #cardiosky #emimcc

Although I love PoCUS to bits, and have danced with IVC for > 20 years, my first question would be 'are you thirsty', and if yes, offer a drink.

Have only just read Prof Argulian's book so pretty shaky on this but would like to try....uncertain without ECG, maybe reversed S wave and very slow rising D suggesting poor/slow relaxation of RV?

Agree wholeheartedly - without accessible image archives, ultrasound is just a more sensitive stethoscope.

PS All scans, even training ones, get a short report in relevent patient chart, including location(ie which machine) indication, quality, findings, patient consent re education, and next action recommended.

Yes most certainly, but I have to be very careful re confidentiality. I note UR/date/indication (but no other identifiers) in notebook, and then download clinically important scans (anonymised) AND then rung them through CLIP DeIdentifier App from Ben Smith. CORE USS.

I can't afford a proper system. I download to personally purchased hard drive every 3 months, and only put the occasional important scanset onto hospital radiology system. Would love to have Viewer (GE) or synchronicity (Sonosite) but no money.

Are you meaning recording images themselves, or the patient details?

The challenges of using ultrasound to measure the trachea: a brief report - Critical Care Background Tracheostomy is a common procedure in intensive care medicine, involving the insertion of an artificial airway through the front of the neck into the trachea. The size of tracheostomy tube ...

The challenges of using ultrasound to measure the trachea: a brief report
#pocus #airway
ccforum.biomedcentral.com/articles/10....

🩸 19 days postpartum with sudden vaginal bleeding.
She had no fever, vitals were stable..but the clots were massive. Target sign on POCUS.

❓What’s the diagnosis?

📖 Want the full story?
doi.org/10.1016/j.an...

#EM #OBGYN #FOAMed #FOAM #MedicalEducation #MedEd #POCUS #Ultrasound #Residency

What's a stethoscope?

I have always liked IV Magnesium as a rescue analgesic adjunct, particularly when there are chronic pain signals.

And there should never be more systematic reviews than original RCTs

BRB, I just need to file a patent real quick for a combination of droperidol plus magnesium (dropnesium) as the ideal drug for everything.

migraine? dropnesium.

nausea/vomiting with low Mg? dropnesium.

agitation with unknown QT? dropnesium.

#EMIMCC

What do you use it for specifically Josh?

Go Segs. Nice to see your face. I just listened to your Bipap talk from H&R...excellent primer and now going to listen again with speed reduced!

“A brilliant first day!”

Consultant Intensivist @drfreeze.bsky.social reflects on Day 1 of #SOA25 and shares what stood out.

🔜 Get ready for Day 2 as we dive deeper into ICU innovation and the future of critical care.

There’s still plenty more to come, so stay tuned! 🥳

Sorry but they are a couple of years out of date now...

First ref is an expensive but complete reference that includes a lot of European experience. Second is free I think.

Sorry Gav, I don't post much on Bluesky, I just stalk. Since the Europeans are so far ahead of us, papers may not be in English. The best references I found were in Matthis' big expensive book. Gorg stated that you could not pick atelectasis from PNA just on colour...

Did you get my references? Wasn't sure whether to post to you or Segs.

The Bernoulli equation (simplified to 4 * V squared) is used in every echo to estimate pressure gradients from velocities. One source of error is widely ignored I belive. #echofirst #pocus #emimcc

Hey Segs - I missed you at H&R - I tried to get into your NIV lecture but room was packed (and running late). Hope you are well.

And that intrarenal doppler is a more useful gauge of the effects of right heart disease, compared with pressure measurements - because doppler factors in the RA compliance and the venular compliance.(did I get that right?)