The bedside nurse always gets the final say on if a patient can go out of the unit.

For #POCUS #VExUS aspiring users:

1. VExUS can assess only the dark side of the moon: the venous side. A detailed hemodynamic assessment should look also at the 💙 itself (RV/LV function, pericardial effusion etc) & the lungs (B-lines? effusions?)

2. VexUS does not assess for volume responsiveness

ICU Stories:

Patient with COPD-obstr sleep apnea (5 l/m O2 nasal cannula at baseline) / A. fib / diastolic heart failure / DM2 / vascular dz / HTN / CKD / morbid obesity (BMI 50) etc presents to the ED with dyspnea/cough/weakness x 2 days. Felt warm; did not check temperature. CXR in ED:

HOCM with systolic anterior motion of mitral valve.

Patient presented with vomiting, weakness and syncope. Previously CKDII - labs showing crt 17 and K 9.4

TAPSE (Tricuspid annular plane systolic excursion): Measures systolic function of the
RV. In AP4 view place M-mode gate over the lateral annulus of tricuspid valve. Then measure the distance from the diastolic trough to the systolic peak. Normal TAPSE is > 17mm.
#POCUS

Echo signs of tamponade:
- Moderate-large effusion
- Plethoric IVC
- RA diastolic collapse
- RV diastolic collapse
- Mitral inflow velocity variability > 25%

R common femoral vein DVT.

EF 20%. Moderate MR. Plethoric IVC. Portal vein is pulsatile indicating venous congestion. Diureses ensued.

Severely dilated cardiomyopathy d/t cocaine use disorder. EF 5%.
#POCUS

ICU Stories:

Middle-aged patient w multiple co-morbidities (CAD/DM2/strokes/seizures/peripheral vasc dz/atrial fibrillation/chronic Foley - UTIs etc) was sent from nursing home to the ED for evaluation of fever/ hypotension. Urine was purulent. CT showed hydronephrosis & bladder wall thickening:

The Supraclavicular Block is a mainstay in N. America for its reliable, dense brachial plexus blockade. Fun fact: While preferences vary globally, it accounted for > 50% of upper extremity blocks in PRAN’s seminal 2018 study (Walker et al).

#pedanessky #babyblocks

baby-blocks.com/block-detail...

Acute Decompensated Valvular Disease in the Intensive Care Unit

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